Aims

The aim of this study was to determine both the incidence of, and the reoperation rate for, postoperative periprosthetic femoral fracture (POPFF) after total hip arthroplasty (THA) with either a collared cementless (CC) femoral component or a cemented polished taper-slip (PTS) femoral component.

Growth at the proximal tibial epiphyseal plate of the rat has been measured following three different growth-stimulating procedures. These were proximal periosteal release, distal periosteal release and full periosteal stripping of the diaphysis. A new radiographic method using a photographic technique has made it possible to take accurate measurements of the rate of long-bone growth in small experimental animals. From the results of this animal series we conclude that proximal tibial periosteal division is likely to be the most effective of the three procedures when used to correct leg-length discrepancy in the growing child.

A retrospective review of 1542 Charnley low-friction arthroplasties was carried out to compare the incidence of deep infection arising after plain and gentamicin-containing acrylic cement. There was no significant difference between the two series in primary operations, the infection rate being 1.72% and 1.65% respectively. However, in secondary operations (conversions and revisions) the gentamicin-containing cement gave significantly better results--a 0.81% infection rate as compared with 3.46%. All operations were performed in a clean air enclosure using total-body exhaust suits. Radiological diagnosis of deep infection was possible within one year of operation in all cases. Late haematogenous infection occurred in one case and was related to a skin lesion.

We examined 59 cemented high density polyethylene sockets removed at revision hip arthroplasty. Of these 19 showed areas of wear between the outside of the socket and the acetabular bone. This was associated with lack of acrylic cement in those areas and was also related to the depth of the wear on the articulating surface of the socket. It is suggested that, in some cases, changes at the bone-cement junction are secondary to socket loosening and abrasion against the bone of the acetabulum, rather than to particles migrating from the metal-polyethylene interface. It is therefore important that impingement of the neck of the femoral stem on the edge of the cup be avoided and that, when the socket is inserted, it is not in direct contact with the bone.

Therapeutic injection of facet joints is now widely practised, but British experience has been infrequently reported. We studied the results of injecting facet joints with a corticosteroid preparation in 50 patients suffering from the "facet syndrome". Our series included a number of extra-articular injections and these "failed injections" provide a useful control group. Results indicate that only intra-articular injections are effective; certainty of joint penetration can be ensured only by the routine use of joint arthrography.