Ten-year survivorship of rough-surfaced femoral stem with geometry similar to Charnley femoral stem.

The aim of this study is to review the 10-year results of 269 cemented total hip arthroplasties performed using the Harvard femoral stem with matte surface finish and Charnley stem-like geometry. This is a retrospective cross-sectional survivorship study. We retrospectively reviewed the results of 269 cemented total hip arthroplasties performed using the Harvard femoral stem in 257 patients (men/women 93:164, mean age 71.2 years) between 1990 and 1994. The median duration of follow-up for the surviving implants was 118 (range 60-129) months. Radiographs were reviewed to evaluate the type of osteoarthritis, cement mantle thickness, alignment of the components, presence of aseptic loosening, and radiolucent lines. Kaplan-Meier survival analysis and Cox proportional hazards analysis were performed to evaluate 10-year survival and the impact of various radiological parameters on the prosthesis survival respectively. Of the 248 eligible patients (260 hips), 6 patients (7 hips) were lost to follow-up, and 67 patients had died at the time of the study; 36 hips (35 patients) underwent revision surgery for aseptic failure (median duration 60 months, range 12-125 months), and 11 hips were revised for septic failure (median duration 24 months, range 10-53 months from the index procedure). The femoral component was revised in all patients, whereas the acetabular component was revised in 27 patients. Ten-year survival for the femoral and acetabular components using aseptic loosening (with and without revision surgery) as an end point was 77.5% (71.5%-83.5%) and 91.1% (87.2%-95%), respectively. Cox regression analysis did not reveal a statistically significant (P > 0.05) effect of various radiological parameters on survival rate. Our results demonstrate that the matte surface finish femoral component (with geometry similar to Charnley femoral component) has less satisfactory long-term survival rate.

Fatal haemorrhage following a low-energy fracture of the pubic ramus.

We report a case of fatal haemorrhage following a low-energy fracture of the pubic ramus in an 85-year-old woman.

Carbon fibre composite bone plates. Development, evaluation and early clinical experience.

We compared the mechanical properties of carbon fibre composite bone plates with those of stainless steel and titanium. The composite plates have less stiffness with good fatigue properties. Tissue culture and small animal implantation confirmed the biocompatibility of the material. We also present a preliminary report on the use of the carbon fibre composite plates in 40 forearm fractures. All fractures united, 67% of them showing radiological remodelling within six months. There were no refractures or mechanical failures, but five fractures showed an unexpected reaction; this is discussed.

The shelf operation in the management of late presentation of congenital hip dysplasia.

Shelf operations performed on 24 patients (27 hips) for late presentation of congenital hip dysplasia were evaluated. The mean age at operation was 14 years 9 months and the mean follow-up 16 years 8 months. Two-thirds of the hips had good clinical results at follow-up. Patients operated on under the age of 20 years and with little or no radiological evidence of degenerative joint changes had the highest likelihood of success. The shelf operation was found to provide good cover of the femoral head and, should failure occur, also provides adequate superior support for the seating of an acetabular prosthesis.