Over a 16-year period, 135 custom-made distal femoral prostheses, based on a fully constrained Stanmore-type knee replacement, were used in the treatment of primary malignant or aggressive benign tumours. Survivorship analysis showed a cumulative success rate of 72% at five years and 64% at seven years. Intact prostheses in 91% of the surviving patients gave good or excellent functional results. Deep infection was the major complication, occurring in 6.8% of cases; clinical aseptic loosening occurred in 6.0%. Revision surgery was carried out for loosening and infection, and the early results are encouraging. We conclude that prosthetic replacement of the distal femur can meet the objectives of limb salvage surgery.

Between 1969 and 1985 26 patients with destructive lesions of the distal humerus were treated by endoprosthetic replacement; each implant was custom-made and incorporated part of the distal humerus or the entire bone as well as a hinged total elbow replacement. Recurrence occurred in three of the patients with tumours, and three prostheses were removed because of deep infection in patients with previously compound injuries of the elbow. Another three loosened without infection, but none needed revision or removal and no amputations resulted. Other complications included nerve palsies, but the only deaths were from metastases. A useful range of elbow movement, with a stable arm and good hand function, was achieved in every patient.

Endoprosthetic replacement of the proximal humerus has been performed in our unit on 25 occasions between 1950 and 1982. The indication for surgery was destruction of the proximal half of the humerus so extensive that the only alternatives were reconstruction or amputation. Of the patients with tumours two died from metastases, and three from unrelated causes; local recurrence necessitated amputation in two patients. Minor complications were frequent, but there were no deep infections and, after 1964, no prosthesis became loose. Active shoulder movement after operation was considerably limited, but passive movement was good and function of the elbow and hand were preserved.

We report the long-term clinical follow-up and survivorship analysis of 40 distal femoral replacements performed between 1964 and 1980 for traumatic, locally aggressive and malignant conditions. Custom-made prostheses with fully-constrained knee joints were used to replace a mean of 42% of the length of the femur. Survivorship analysis showed a cumulative success rate of 80% at eight years, with no subsequent deterioration at 18 years. Clinical assessment revealed 78% excellent or good results. Failure was due to infection in three cases, and in two to fracture of a now-outmoded femoral stem.

We report a patient with a peri-acetabular chondrosarcoma which was treated by resection of part of the pelvis and the femoral head. This was followed by replacement with a custom-made titanium alloy pelvic portion and a conventional total hip prosthesis. The operation was carried out in two stages, and yielded a good functional and cosmetic result.

Between 1969 and 1971 20 prototypes of the Stanmore total knee prosthesis were used to replace severely arthritic knees in 18 patients. Seven patients died before the final follow-up and one had to have her leg amputated because of deep infection; in none of these patients had the prosthesis become loose. Ten patients (11 knees) were reviewed at least 10 years after operation. There was no significant clinical deterioration in 7 of these 11 surviving knees when the results at one year were compared with those at 10 years.

We review 210 Stanmore knee replacements in 163 patients to assess the survival of the prostheses and the long-term results. The annual rate of failure reached a maximum of 4.6% in the fourth year after operation; thereafter it declined to reach zero by the eighth year. Between two and eight years after operation, 66.3% of the surviving knees were completely free of pain and 30.2% had mild retropatellar pain. Fixed flexion deformities present before operation were completely corrected in 73% of the knees, and varus or valgus deformities were invariably corrected. Stability was always restored to unstable knees and 80.8% of knees flexed to 90 degrees or more after replacement. Aseptic loosening (8.1%), prosthetic infection (4.3%) and femoral fracture (2.9%) led to 8.5% of the prostheses being revised or removed over eight years. Modifications in prosthetic design and operative techniques have been introduced to minimise such complications in the future.

A series of 81 patients has been reviewed to determine the value of endoprosthetic replacement of the proximal femur and hip in the treatment of bone tumours. Standard statistical methods were used to evaluate the survival of the replacements and the patients. Taking removal of the prosthesis, irrespective of the cause, as the criterion for failure the survival of the replacements was found to be 63 per cent after 10 years. If deaths are regarded as failures, then the survival value falls to 48 per cent. The survival of patients with chondrosarcoma and osteoclastoma treated by endoprosthetic replacement compares favourably with survival after amputation or excision of the tumour.

The Stanmore hinged total knee replacement was introduced in 1969 for severe destructive arthropathy of the knee, and the results of one hundred consecutive operations are presented after an average interval of two and a half years. Insertion of the prosthesis relieved pain in 94 per cent, improved the range of movement in 67 per cent, invariably restored stability and corrected valgus or varus deformity. Gross flexion contractures were improved but not always fully corrected. Serious complications were few, though of three cases of deep infection two came to amputation and one to fibrous ankylosis. There were no mechanical failures of components of the prosthesis.