Loosening and bone resorption in exeter hip arthroplasties. Review at a minimum of five years.

We reviewed at a minimum elapsed time of five years a consecutive series of 143 primary Exeter hip replacements in which matt-surfaced femoral stems had been used. Twenty-five patients had died and six stems and two sockets had been revised before follow-up. The remaining 110 hips were all examined clinically and radiographically. In 15 hips there were radiographic signs of definite loosening of the stem and in eight suspected loosening. The acetabulum was loose in four hips. In another eight hips localised bone resorption was present without signs of loosening. Half the patients with loosening or localised bone resorption had mild pain or no pain at all. The late complication rate with the matt-surfaced Exeter femoral stem is unacceptably high.

The lumbar epidural space in patients examined with epiduroscopy.

Percutaneous epiduroscopy was performed in 10 patients with the aim of comparing the lumbar epidural space of the patients with the findings made earlier in autopsy subjects. The patients were scheduled for partial laminectomy for a herniated lumbar disc. A complete examination was possible in eight subjects. The extent of view was very limited. The epidural space opened up only temporarily as air was injected. The dura mater lay very close to the dorsal aspect of the epidural space and was attached to the flaval ligaments by a dorsomedian connective tissue band. The band was identified in all eight subjects and was found to cause a dorsal fold in the dura mater. An epidural catheter was introduced 2-5 cm into the space by midline puncture in four patients and by the paramedian approach in the other four. The catheter was visualized in two patients only when the paramedian approach was used. None of the midline catheters could be seen in the space. In 2 of the 10 subjects a moderate bleeding impaired the view and made complete examination impossible. Smaller bleeding occurred in three other subjects. The partial laminectomy performed one to two interspaces caudad to the level of endoscopy did not reveal any evidence of epidural bleeding in any subject. The postoperative course of all patients was uneventful.

Loosening and femoral neck resorption 5 years after CAD hip replacement.

In a radiographic study of 86 primary CAD hip replacements with a minimum of 5 years' observation time, implant loosening was found in 11 and femoral neck resorption with the collar of the femoral prosthesis unsupported by bone in 61 other hips.

Total hip replacement with a straight stem prosthesis. A 2-year follow-up of 126 CAD operations.

The clinical and radiographic results in 126 primary CAD total hip replacements were assessed after 2 years in a prospective study. The clinical overall results were satisfactory, with 89 per cent of the hips being free from significant pain. Femoral component loosening was radiographically evident in 6 per cent. The walking speed was increased by 83 per cent in patients with unilateral hip disease. This increase was partly achieved during the second postoperative year.

Clinical and radiological long-term results after Charnley-Müller total hip replacement. A 5 to 10 year follow-up study with special reference to aseptic loosening.

Ninety-nine per cent of the arthroplasties available for follow-up after a minimum of 5 years were assessed clinically and radiologically. Of the original 151 hips, 14 had been reoperated on with exchange of the femoral components because of aseptic loosening. Thirty-one of the 115 re-examined hips showed radiological evidence of femoral component loosening and in 15 hips loosening was suspected. One acetabular component was loose. No deep infection was detected. In 10 of the 31 hips with femoral stem loosening, no complication was suspected after clinical examination only. Varus position of the prosthesis and insufficient cement support at the proximal and distal parts of the stem were associated with increased loosening rates. In patients with a body-weight over 80 kg and in patients younger than 60 years at the operation, loosening had occurred in over 50 per cent of the hips. The clinical overall results were satisfactory, with 79 per cent of the hips being free from significant pain.

Total hip replacement by the Müller-Charnley prosthesis. A follow-up study of 238 operations after 2 to 7 years.

A prospective study of 238 total hip replacements, with the Müller prosthesis, is presented. The complications in the total material and the results in 216 hips with follow-up times from 2 to 7 years are described. Eighty-four per cent of the hips were free from significant pain and 64 per cent had a total range of motion exceeding 160 degrees. Aseptic loosening of the femoral component, entailing reimplantation, has occurred in 6.7 per cent and, in addition, 9.2 per cent show radiological evidence of deterioration of the fixation of the femoral component. No deep infection has been encountered. None of the hips has ended as an excision arthroplasty.

Intertrochanteric osteotomy for osteoarthritis of the hip. A radiological assessment of non-compressive and compressive methods.

A radiological review of two groups of intertrochanteric osteotomies of the femur for primary osteoarthritis of the hip has been made. Each group oroginally consisted of forty-one hips. In one group a Wainwright straight V-spline without compression had been used for fixation, and in the other group an AO angled plate with compression. The time for bony union was equal in the two groups but the incidence of non-union was lower in the AO group. Regression of cysts and of bone sclerosis was more frequent in the Wainwright group, possible as a consequence of the greater medial displacement and varus angulation.