The aim of this study was to assess the clinical and radiological outcome of the cementless-system (CLS) femoral component designed by Spotorno with a taper design. Ninety-four patients (107 hips) were operated on from January 1987 to December 1988. The female/male ratio was 2/1, the mean age was 51 years (range 20-77 years). Clinical follow-up was obtained in 89 hips (83%). Five patients (7 hips, 6.5%) could not be traced. Nine patients (11 hips, 10%) had died before the minimum time of follow-up required for this study (10 years). All these hips still had their stem in place at the time of the last intermediate inquiry. The mean follow-up was 10.3 +/- 0.3 years. No stem required revision. According to the Harris score, 84% of hips were rated good or excellent, 14% fair, and 2% poor. The average Harris hip score was 88 at the time of the last follow-up. Fifteen patients (17%) reported occasional thigh pain. All patients reported complete relief of pain within the first 6 months after the operation. Radiologically, 95% of stems showed stable fixation by bony ingrowth, 5% by fibrous ingrowth. Seven (9%) uncemented acetabular components showed progressive migration. Three of those cups had been replaced in the meantime. Fifty-one (65%) of the CLS stems induced either no change in femoral bone density or only patchy loss of bone density localized to zone 1 or 7 according to Gruen, while 27 (35%) of the hips showed some reduction of bone density in the proximal diaphysis of the femur (zone 2 or 6). Severe progressive osteolysis of the femoral cortex underneath the lesser trochanter was found in 4 hips (5%) with coexistent loosening of the cup. In all of these hips, the Mecron cup had been used. At a mean follow-up of 10 years, the results of the CLS femoral component are comparable with those of modern techniques of cementing in primary total hip arthroplasty and with the long-term outcomes of other uncemented stems with tapered design. The long-term fixation of the cup remains an unsolved problem.

The CLS((R)) Spotorno stem allows excellent long-term results in cementless hip arthroplasty, leaving only minimal options for substantial improvements. Our findings on progressive stress shielding point towards a more diaphyseal load transfer of the CLS stem.

Perfusion of enlarged lymph nodes by colour-coded sonography was studied prospectively in 105 benign and 115 malignant lymph nodes. The diagnosis was confirmed histologically in 158 and clinically in 62. Spectral analysis in the benign lymph nodes provided normal values for pulsatility and resistance indices. A pulsatility index greater than = 1.8, or a resistance greater than = 0.9 indicate lymph node metastases with positive prediction of 93% and specificity of 97%. In addition, subjective, semiquantitative classification of lymph node perfusion in relation to the surrounding fat or connective tissue improves the diagnosis of lymph node metastases and of malignant lymphomas.

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