Retrospective analysis of 25 consecutive metal on metal proximal femoral replacements performed at our unit between 1965 and 1979.

Methods. Patients were: clinically evaluated using the Modified Harris Hip and Enneking Scoring Systems and radiologically using the ISOLOS scoring system.

The concentration of Cr, Co, Ti, Al, V, Mo & Ni in whole blood and urine was also measured by High-Resolution Inductively Coupled Mass Spectrometry and compared with controls and patients with other implants.

Retrieved prostheses (in situ for in excess of 25 years) were analysed for roughness and wear using a Mitutoya form tracer and an electron microscope.

Results. Thirteen patients have since died; nine from metastatic disease and four from other causes. Of the remainder, eleven (44%) are still alive, five still retaining metal on metal articulations and one has been lost to follow up. They have been in situ for an average of 32 years. The average modified Harris Hip score is 76 (53–93) and the average Enneking Score is 74 (63–90).

In the retrieved prostheses the contact zones were found to be smoother (Ra 0.05?m), have fewer and smaller carbides together with evidence of ‘self-healing’ when compared to the original surface (Ra 0.32?m).

Blood & urine levels of Co & Cr were significantly elevated. Co levels were exceptionally elevated in loose prostheses but levels quickly fell following revision.

Conclusion. We have shown the potential longevity of metal on metal arthroplasty. The wear seen in retrieved specimens is low and we might expect to improve the fixation by reducing the torque with apical bearing and encouraging extra-cortical bone bridging with hydroxy-apatite coated collars. Elevated serum and urine Co levels may well predict a loose prosthesis and may be useful as a screening tool.

Purpose: The purpose of this study was to evaluate the results of custom-made endoprosthetic reconstruction for both tumourous and non-tumourous conditions around the elbow joint.

Methods and Results: 28 consecutive cases of endoprosthetic elbow reconstruction, performed between 1989 and 2003, were identified using the unit database. There were 12 males and 16 females, with a mean age of 48.9 years, (range 14–84). There were 16 cases of malignant tumour (10 primary, 6 secondary), 3 cases of benign tumour (one each of giant cell tumour, osteoblastoma and pigmented villonodular synovitis) and 10 non-oncological cases, (5 cases of fracture, 3 failed total elbow replacements and 1 infected synostosis). A distal humeral prosthesis was used in 16 patients, distal humeral and proximal ulna in 10 patients, proximal ulna with a humeral component in one patient and proximal radial replacement in one patient. Clinical and radiographic review of all available patients, including a functional assessment with The Toronto Extremity Salvage (TES) score was undertaken. The average follow-up was 54.9 months (range 5–144). 5 patients with malignancy died of their disease. One patient required amputation for local recurrence at 5 months. There were two revisions at 4 and 7 years for aseptic loosening of the humeral component. Six patients developed deep prosthetic infection at an average of 21 months (range 6–31), necessitating two-stage revision, of which one patient required subsequent excision arthroplasty. There were no cases of permanent nerve palsy. 18 patients (64.3%) were available for functional follow-up. Average flexion deformity was 33 degrees (7–80) and average flexion was 85 degrees (30–133). The mean TES score was 67.8 (range 36.6–96.6). The mean TES score following two-stage revision for infection, (available in 4/5 patients) was 73.9 (range 54.8–91.6).

Conclusion: Custom-made endoprosthetic reconstruction around the elbow joint is effective in a wide range of pathologies, allowing in most cases a reasonable level of function, even following two-stage revision for infection.