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We carried out total hip replacement and femoral head bone-grafting in 21 hips with congenital dysplasia or dislocation, obtaining as much support of the cup by the host bone as was possible. A Charnley small or extra small cup was implanted in 20 cases and a miniature femoral component in 15. The results of 20 hips were reviewed prospectively at an average of 10 years. Nineteen patients had no pain. Three cups showed radiological signs of loosening, one was causing other symptoms. All the stems, except one, were radiologically stable and were symptomless. The graft had fused without resorption in 18 cases. Two grafts showed severe resorption with loosening of the cup. Satisfactory long term results of total hip replacement and femoral head bone-grafting can be achieved using special surgical techniques and the appropriate components. Medialisation of the hip and the use of small cups are important in allowing sufficient support of the prosthesis by bone so that the distribution of load on the graft is minimised. The grafted femoral head provides suitable bone stock for reconstruction of the acetabulum.

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Of the first 127 consecutive patients who had had a Charnley total hip replacement at the First Orthopaedic Clinic, University of Florence, between 1970 and 1977, 74 (76 hips) were re-evaluated eleven to eighteen years post-operatively by clinical examination and roentgenograms. In this group we identified 8 failures (3 mechanical loosening and 5 septic loosening). All failed cases were revised. At 13 years average follow-up, the incidence of radiological aseptic loosening was 19.1% for the acetabular component and 17.6% for the femoral component; nevertheless in most of these cases, the clinical status was excellent or good. Acetabular component wear was found to be a significant problem.