The effect of retention of the femoral neck and of cement upon the stability of a proximal femoral prosthesis.

Radiological measurements of downward femoral component migration are reported for 203 hips in the first 2 years following total hip arthroplasty. The femora differed with respect to the retention of the femoral neck--in 167 it was retained and in 36 it was damaged--and to the use of cement--142 hips were press-fits and 61 were cemented. Multivariate analysis demonstrated that both retention of the neck and the use of cement retarded migration (ie, increased stability) of the femoral component (P = .0003 and .0037, respectively).

[A peculiar tumor. Adamantinoma of the long bones. Apropos of 7 consecutive cases followed up after resection]. / Une tumeur singulière. L'adamantinome des os longs. A propos de sept cas consécutifs suivis après résection.

Seven cases of tibial adamantinoma have been reviewed. All were treated by en bloc resection and followed for one to twenty years after operation. Of five patients followed for more than three years, three have had a good result after 3, 12 and 20 years of follow-up. One patient suffered a recurrence in the soft tissues seven years after resection and remained well after thirteen years follow-up. One patient required amputation two years after resection and died from a mediastinal tumour of undetermined nature sixteen years after amputation. The two failures occurred in patients seen secondarily following recurrence after initial curettage. The tibial shaft was reconstructed in three cases by massive allografts. One of these failed because of infection but was reconstructed using autografts; one had a late fracture which united spontaneously. The third, after sound union, had to be amputated for recurrence. Two smaller resections were treated successfully by tibial and iliac autografts. Two cases were treated by free vascularised fibular transplants which united, though one suffered a late fracture which united spontaneously. Curettage, which is almost always followed by recurrence, should be rejected in favour of extensive resection. Resection is successful when done primarily but poses severe problems in reconstruction and requires a prolonged period of treatment. The small numbers in this series do not allow a judgement to be made as to the superiority of one technique over another.