Ten-year results of a press-fit, porous-coated acetabular component.

We retrospectively reviewed, ten years after surgery, 100 consecutive total hip replacements in which the Duraloc 300 cup had been used. Post-operative radiographs were analysed for placement of the cup and interface gaps and follow-up radiographs for lucent lines, osteolysis, wear and migration. All the components were found to be stable with no evidence of loosening. The mean rate of wear was 0.12 mm/year. Three hips developed acetabular osteolysis at the level of the apex hole. Two have successfully undergone bone grafting without removal of the implants and one patient is awaiting surgery. The Duraloc 300 cup has a survival of 100% at ten years with no aseptic loosening and a low incidence of pelvic osteolysis.

Unpredictable progression of osteolysis following cementless hip arthroplasty. 24 femoral components followed for 6-10 years.

We reviewed 24 hips that developed femoral osteolytic lesions following cementless total hip replacement with a Porous-Coated Anatomic prosthesis after a mean of 8 (6-10) years. 15 of the hips showed hardly any radiographic deterioration in the osteolysis. 2 became much worse with dramatic loss of bone stock. Both of these hips required revision of the acetabular component as well as bone grafting of the otherwise well-fixed femoral component. The remaining 7 hips showed mild-to-moderate enlargement of the lesions. All 24 hips were asymptomatic. Blood tests and bone scintigraphy were of no predictive value in assessing the probable progression of the lesions. Serial radiography remains the cornerstone of the monitoring of osteolysis, following cementless hip replacement, the extent of bone loss being usually far greater than indicated by radiographic examination.

Unusual cause of ulnar nerve palsy.

An ulnar nerve palsy occurring as the result of an elbow dislocation is well recognized. An unusual case of an elbow dislocation with concomitant radial head fracture and ulnar nerve palsy caused by the radial head lying in the medial epicondylar groove is presented.

Loss of bone stock with cementless hip arthroplasty.

One hundred four porous-coated anatomic cementless hip arthroplasties followed from 2 to 6.5 years (mean, 50 months) were studied. Ninety-four percent had excellent clinical results. Thigh pain occurred in 23% of patients, but was severe in only two. "Cancelization" and rounding off of the calcar were noted in 83% of hips, whereas localized osteolysis occurred in 24 femurs and one acetabulum. Ten of these measured more than 10 mm, and all of those in the femur were located proximally. None of these patients were symptomatic and none have come to revision. Ultrahigh-molecular-weight polyethylene wear and plastic debris were implicated as the cause of osteolysis. Lytic lesions were seen only after 3 years and occurred only in patients with 32-mm femoral heads in whom the outer diameter of the acetabular component was 52 mm or less. Use of excessively thin ultrahigh-molecular-weight polyethylene in these patients may have predisposed them to accelerated wear. Section modulus mismatch resulting in stress protection is considered as an alternate mechanism of proximal bone resorption.

Inserting the distal screws in a locked femoral nail.

We describe a simple method of inserting the distal screws in a locked femoral nail. The method requires no aiming device and no assistant. The only equipment needed is a 3 mm Kirschner wire and an air drill.

Auger ankle arthrodesis.

In 1986, O'Hara and Pearson described a method of ankle arthrodesis using an auger. They reported eight cases, all of which fused successfully. The same method was used in this comparative study of eight cases. Successful arthrodesis was obtained in only three cases, while two developed a painless fibrous ankylosis. The remaining three cases were considered failures.