Twenty-year survival of a cementless revision hip arthroplasty using a press-fit bulk acetabular allograft for pelvic discontinuity: a case report.

Acetabular revision in a total hip arthroplasty (THA) with pelvic discontinuity is uncommon and challenging. Optimal management remains controversial, particularly with graft and implant selection. Interpretation of outcomes is confounded by the heterogeneity of patterns of bone loss and the lack of long-term results in great numbers for any given choice of treatment. We report a revision THA using a press-fit bulk acetabular allograft and an uncemented porous-coated anatomic prosthesis for the management of pelvic discontinuity. After 20 years, the patient still had an excellent functional outcome with radiographic evidence of graft incorporation and no signs of loosening.

Using 'cling film' to protect lower limb plaster casts in babies with club foot.

Clubfoot or congenital talipes equinovarus is a common condition affecting babies and non-surgical treatment involves serial manipulation and plaster casting for many weeks. The casts are susceptible to soiling during this time, which makes management and child care even more challenging. The authors report initial experience in a typical district general hospital clubfoot clinic where the parents of a baby used conventional cling film to cover the casts and provide a low-cost, effective and well-tolerated method of protection. Informal reports received from these parents were very positive and encouraging throughout the duration of treatment. The authors believe parents with babies undergoing such treatment for clubfoot could be advised of the benefits of using cling film to protect plaster casts. More formal analysis of feedback from parents and collaborative experience with other hospitals is required before widespread use is recommended. There may also be scope for using cling film to protect lower limb casts used in managing developmental dysplasia of the hip or fractures in children and potentially adults.

Intravenous polymethyl methacrylate after cemented hemiarthroplasty of the hip.

Current cementing techniques used during hip arthroplasty aim to maximize the bond at the bone-cement interface in an effort to increase the longevity of the prosthesis. To accomplish this, one must generate high intramedullary pressures, which are known to be associated with complications such as cement implantation syndrome. We record a rare complication following cement pressurization of a hip hemiarthroplasty that resulted in intravenous polymethyl methacrylate (PMMA). This complication however, is not associated with a significant morbidity or mortality, but it is important to identify and distinguish from a femoral cortical defect, which can be created during surgery.

Intimal hyperplasia within biliary Wallstents: failure of recanalisation by insertion of a second endoprosthesis.

We report two patients with benign biliary strictures in whom we attempted recanalisation of metallic biliary endoprostheses, occluded by intimal hyperplasia, by the insertion of further endoprostheses within the occluded stents. Initial technical success was achieved in deploying the stents and restoring patency with elimination of mural filling defects. However, we found the intimal hyperplasia to be restrained for less than 48 h. From our initial results it appears that biliary metallic stent occlusion by intimal hyperplasia is not effectively treated by insertion of a second endoprosthesis.