The lastest biomechanical studies have shown that the load in the proximal femur is transferred not only medially but also laterally. Following these new philosophies, an original ultra-short stem with extensive proximal load transfer was developed. The main features of this implant are: an almost complete absence of the diaphyseal portion of the stem; a well defined lateral flare with load transfer also on the lateral column of the femur; and a high femoral neck cut which allows the preservation of most of the anterior, posterior and medial wall of the femoral neck (giving a complete proximal circumferencial bone in-growth). The implant, which we began to use in 1995 as a custom made prosthesis based on pre-operative CT data (140 cases), and later as a standard prosthesis (Proxima Hip 347 cases) was, in the first years, recommended only for young and active patients before being extended with very large indications also to elderly ones. Purpose of this paper is to present clinical and radiological results of 487 implants with an 7 yrs average follow-up. (14 yrs to 3 months). Harris Hip Score (HHS) formed the basis of the clinical assessment. Serial post-operative AP and lateral radiographs were taken for all patients.

Excellent results were reported: patients were followed-up for up to 14 years in all the series there were no revisions for aseptic loosening and only one case was revised for a deep infection. The mean HHS increased from 44.8 pre-operatively to 98.6 post-operatively at the latest follow-up. Tight pain was recorded only in one case. Other complications included 3 dislocations and 2 superficial wound infections. Radiographically good periprosthetic bone remodelling with increase of the bone stock around the implant. No radiolucent lines, subsidence or loosening have been observed.

In conclusion after a 14 year experience we can assert that neck preservation combined with a proximal lateral flare support guarantees a more natural loading of the femur and large indications. The absence of the stem makes this implant ideal not only for conventional surgical approach but also for MIS.

Asepting loosening by polyethylen wears is on of the main problems in total knee replacement. In the last years, the major improvement is about matherials. The polyethylene remains the major problems for long term results of total knee replacement despite new types of polyethylenes like cross linked or high reticulation. From to 2 years a new matherial (Oxinium) for femoral component has been avaluated; Oxinium is an high temperature and oxidation procedure to trasform the articular surface like a ceramic. In this paper early results with this total knee replacement are reported and the advantages of this new matherial are discussed.

110 primary Oxinium-Profix were evaluated. Mean follow up is 18 months ( min2 max 26). Mean age is 67 years (53 yrs– 74yrs). Both components were cemented. In all cases PCL was retained. Never patella was replaced. Lateral release with out-in technique was performed in all cases. The Knee Society scoring system was used to assess patients both clinically and radiografically.

Clinical and radiographic results are promising despite the short follow-up. Oxiunium seems to be a safe matherial, especially for young patients because of low rate of wear. However, only a long term follow up could confirm the intial promising results

Aims: Bone stock preservation is crucial when performing THR in young patients. Previous experiments have confirmed that a physiologic load transfer to the proximal femur has several advantages. First, there is experimental evidence (Fetto et al) that loading the medial and lateral flare effectively preserves in time metaphyseal bone stock. Second, biomechanical tests (Walker et al) have confirmed that with this kind of stress distribution it is possible to remove the diaphyseal portion of the stem.

Following this philosophy, an original ultra-short stem with extensive proximal load transfer was developed. Purpose of this paper is to present clinical and radiological results at 4 yrs average follow up.

Methods: Since June 1995, we implanted 118 stems in 101 patients. Average age at the time of surgery was 51 yrs (30-63) All operations were performed by the senior Author (FFS). Particular care was taken in preserving all the femoral neck and the trochanteric muscles. All implants were customised based on pre-operative CT data. Harris Hip Score (HHS) formed the basis of the clinical assessment. Serial post-operative AP and lateral radiographs were taken for all patients.

Result: Patients were followed-up for up to 9 years (mean follow-up 45 months) and results showed no stem related revisions or infections. The mean HHS increased from 44.8 pre-operatively to 98.6 post-operatively at the latest follow-up. Tight pain was recorded only in one case. Other complications included 2 dislocations, one trapped drain and 2 superficial wound infections. All stems appeared radiografically stable with a well maintained proximal bone stock. No radiolucent lines have appeared around the stem.

Conclusions: Results obtained in this group of relatively young patients have been encouraging. Clinical and radiographic results validate the assumption that torsional loads can be controlled even without the diaphy-seal portion of the stem. Neck preservation combined with lateral flare support guarantees a more natural loading of the femur. The absence of the stem makes this implant ideal for less invasive surgery.

Aims: Most diaphyseal humeral fractures must be treated conservatively. Surgery is indicated for transverse displaced fractures, pathological or impending fractures, non unions, fractures with radial nerve palsy and oblique fractures after conservative treatment failure. Methods: Between March 1998 and July 2001 we operated on 80 patients with a diaphyseal humeral fracture. The cannulated retrograde EXP nail (LIMA LTO) was always employed. Proximal locking is obtained through the nail by causing angled protrusion of a wire from the proximal end of it and into the spongious (cancellous) bone of the humeral head. Distally the EXP nail has two little wings shaped to sit on the medial and lateral columns of the olecranic fossa and to thus provide a very effective rotational and traction control. In 51 cases it was a traumatic fracture; transverse, oblique unstable or polytrauma. In 10 cases a pathological fractures, in 7 an impending fracture, in 12 a nonunion. Nonunion cases had had a previous average of 2.5 operations. 10 patients were obese. Results: Average surgical time was 40 minutes. Average radiation exposure was 1 minute and 40 seconds. Union was obtained in all the 51 primary fractures and stability was secured for all the impending and pathological cases. All but 1 of the non-unions healed after an average of 2.6 months. The one failure was in an obese 65 yrs old lady with an oblique unstable non-union. No patients suffered shoulder pain. In 4 cases a reduction of less than 10 degrees of elbow extension was detected. Conclusions: The EXP humeral nail provides satisfactory stability, it is cannulated and requires minimal radiation exposure.

Aims: Stemmed cup is the evolution of Ring cup. The iliac stem is positioned in direction of sacro-iliac sin-condrosis, in axis with weight-bearing lines. It allows an optimal stability in the iliac bone avoiding the dameged acetabular region. The stemmed cup is indicated:

Ð in CDH primary implant

Ð in revision surgery (grade 2–4 according to Paproskyñs classiþcation). In severe bone loss cases (grade 3–4) we preferred to use auto or homologous bone grafts impacted to þll the bone defect. Methods:We report about 168 stemmed cup implants in 159 patients (9 bilateral cases). 37 CDH was treated as a primary implant (6 bilateral patients). The average age is 69 years (range 38–87). The mean follow up is 36 months (range 6 months Ð 6 years). 21 cases were lost at follow up. We evaluated all patients by X-rays at 1,3,6 months and every year and CT in some cases to check the iliac stem position. Results: 13 patients died because of non-related surgery. Superþcial infections 5 cases; deep infections 6 cases (two-stages revision); proximal migration < 1 cm. In 9 cases without loosening; malpositioning of the stem 7 cases; sciatic nerve palsy 5 cases (1 permanent case); DVT 3 cases.

Radiolucency around stem < 2 mm. 19 cases, radiolucency around the cup in 11 cases; bone grafts resorption 10 out of 57 cases. Mean preoperative Harris Hip Score was 60; mean postoperative HHS 85. Conclusions: The good mid-term results reported conþrm that stemmed cup is a valid solution in revision surgery with mid and severe bone loss but also in CDH when conventional cup are not indicated.

Aims: Avascular necrosis of the femoral head (AVN) evolves in destruction of the hip joint. Treatment of this disease is controversial. Early stages are treated with core decompression whilst in later stages þbular grafting, rotational osteotomy or THR are recommended. Purpose of this study is the evaluation of a new combined approach. Methods: We present a series of 147 AVN in 108 patients treated with the combination of core decompression, bone grafting and electrical stimulation. All surgery were performed with a minimal invasive technique and a dedicated set of instruments which allow for accurate and complete removal of the necrotic bone.

In 30 cases the disease was in Steinberg stage I, 58 stage II, 42 stage III and 17 stage IV. All patients were kept non weight bearing for 6 weeks and partial weight bearing for further 6 to 8 weeks. PEMF were used for 8 ours daily for 3 months. Average follow-up was 37 months (min 12 months, max 108). Both clinical and radiological results were evaluated. Results: We had a good radiographic result in 96% of cases in stage I, 85% stage II, 45% stage III and 27% stage IV. Clinically, we obtained good results in 87% stage I, in 81% stage II, in 65% stage III and in 48% stage IV. Clinical failure was deþned as the performance of a subsequent operation. None of the patients in stage I or II required further surgical treatment. Nine cases in stage III and 5 in stage IV required THR after an average of 19 months. Conclusions: Core decompression with bone grafting and electrical stimulation is a safe and effective procedure in Stage I and Stage II AVN. Promising results were obtained also in stage III and Stage IV.

Aims: Bone stock preservation is thought to be essential when performing THR in young patients. For this purpose we developed a new CAD-CAM titanium cementless femoral stem to be implanted with minimal femoral resection. This implant is constructed to þll completely the proximal metaphysis transferring loads on both the lateral ßare and the calcar. This allows the elimination of the diaphyseal portion of the stem which is prolonged only till approximately 1 centimetre below the lesser tro-canter. Methods: Since 1995, we implanted 76 stems in 71 patients. Average age was 51 yrs (30–63), 34 females and 37 males. Mean follow-up is 45 months (min.12, max 84 months). In all cases we employed an hemispherical pressþt cup. Metal to polyethylene interface was used in the þrst 30 implants whilst metal to metal coupling was chosen for the latter 46 hips. Clinically patients were evaluated with Harris Hip Score. All patients ware evaluated by X-ray 1, 3, 6 and every year postoperative. Results: Average preoperative value of HHS was 42,4, postoperative 98. Tight pain was never recorded. All the stems appear stable radiograþcally, we had no subsidence, no radiolucent lines, no stress shielding, no osteolisis. In 26,4% of cases we had mild proximal calcar resorption. Conclusions: Clinical and radiographic results conþrm that axial and torsional loads can be properly controlled even without the distal portion of the stem. We believe that maximal bone stock preservation in young patients undergoing THR is mandatory in view of the high possibility for these patients to require multiple revisions in the future.