Failure of a non-porous-coated acetabular component inserted without cement in primary total hip arthroplasty.

Thirty-four patients (thirty-eight hips) had a primary total hip arthroplasty with insertion of a non-porous-coated titanium-alloy acetabular component without cement. This component is initially stabilized with use of a central acetabular polyethylene peg, which is inserted into the pelvis, as well as supplementary cortical-bone screws inserted into the ilium. The original diagnosis was degenerative joint disease in thirty-four hips and avascular necrosis in four hips. Twenty-five femoral components were inserted with cement, and thirteen non-porous-coated femoral implants were inserted without cement. The acetabulum was prepared with so-called line-to-line reaming. Thirty-five hips in thirty-one patients were available for clinical and radiographic follow-up at a mean of 4.5 years (range, two to seven years). Serial measurements of the position of the acetabular component revealed that eighteen cups (51 per cent) had migrated. Of these, eleven had been revised. Radiolucent lines of at least one millimeter in thickness at the bone-prosthesis interface were noted adjacent to all but six of the acetabular components. Although this series was small, it demonstrates an unacceptably high rate of failure of non-porous-coated acetabular components after a relatively short duration. We question the efficacy of this acetabular component, inserted without cement, as part of a primary total hip arthroplasty.

The Shrugged-Off Shoulder: A Comparison of Patients With Recurrent Shoulder Subluxations and Dislocations.

In brief: Patients with recurrent anterior shoulder subluxations and dislocations are compared in terms of recurrences, delays in diagnoses, and treatments. Based on these criteria, the subluxers experienced substantially more disability than the dislocators. Since shoulder instability is such a frequent problem in athletes (sports caused the initial episode in nearly 70% of the patients), professionals who deal with athletic injuries must be aware of the shoulder subluxation syndrome, recognize It early, and quickly initiate appropriate treatments.

Acute, complete acromioclavicular separation.

Twenty-three patients with acute, complete acromioclavicular separation were studied prospectively. Twelve patients were treated non-operatively and eleven were treated operatively. A twelve-month minimum follow-up, using a point system to evaluate clinical results, demonstrated comparable results with and without surgery. Roentgenographic findings did not correlate with the clinical results. Minimum immobilization and early rehabilitation of the shoulder was the recommended treatment of choice.