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Thirty-three Girdlestone's arthroplasties used to salvage infected total hip replacements were followed for a mean of 6.2 years to assess the efficacy of this procedure. Subjective and objective assessment was obtained at the time of review. Gram-negative organisms, retained cement, bony sequestra and secondary healing were common features of the five patients (15%) whose wounds discharged for more than four weeks after operation. Girdlestone's arthroplasty provided satisfactory pain relief in 91% of patients, and control of infection in 97%. Although leg-length discrepancy (mean 4 cm) and a Trendelenburg gait made walking difficult and tiring , 42% were satisfied with their functional ability; 85% needed walking aids, and 3 patients could not walk at all and were confined to bed or a chair. Overall, 79% were satisfied. Objectively, the mean Harris hip rating was 60; however, if patients with multiple joint problems were excluded, this score increased to 77. Girdlestone's arthroplasty seems a reasonable salvage procedure in the management of an infected total hip replacement and the results seem to improve with time.

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More than 1,000 industrial amputees at the Ontario Workers' Compensation Board were reviewed. The study investigated the current employment status of amputees and the factors that influenced successful return to work post-amputation. The data obtained from a mailed questionnaire was analysed by the Statistical Analysis System. The results revealed that 89% of amputees returned to work after an amputation. The average follow-up post-amputation was 14 years with a range of one to 64 years. At the time of review the current employment status of amputees was as follows: 51% full time employed, 5% part-time employed, 25% retired and 8% unemployed. The remainder were engaged in a vocational activity, still recovering or were not seeking work. The data revealed that amputees typically changed jobs when returning to the work force. Amputees returned to jobs that were less physically demanding, but required greater intellectual skills in occupations such as clerical and service industries. Factors including prosthetic use, vocational services, and a younger age at the time of amputation were identified as being positively associated wth a return to work. Those factors that were negatively related to successful employment included stump and phantom limb pain and multiple limb amputations. The study concluded that the majority of the amputees reviewed were successful in returning to work. The authors suggest that amputees benefit from treatment programmes that include medical, prosthetic and vocational services.

This contribution describes the microstructural development of a predominantly zirconia scale resulting from thermal oxidation of a Zr–2.65 wt% Nb alloy that is used to provide a superior resilient bearing surface on the femoral condylar component in a novel total knee prosthesis. The oxide scale exhibits superior tribological properties articulating against a polyethylene tibial component, resulting in substantially reduced wear debris and attendant inflammatory response. Critical attributes of this scale are biological compatibility, hardness, maintenance of surface smoothness during articulation, and adhesion to the substrate. Thermogravimetry, transmission electron microscopy, and in situ hot‐stage X‐ray diffraction analyses of the oxide scale and underlying alloy substrate were employed to reveal the microstructural origins for the efficacy and integrity of this oxidation surface treatment. The wrought alloy in the condylar component exhibits a two‐phase microstructure comprising elongated hexagonal α‐Zr grains (<1 wt% Nb) discontinuously surrounded by cubic β‐Zr (∼18 wt% Nb) sheath grains. During oxidation for times up to 8 h in air at temperatures above and below the eutectoid at 620°C, interface control of oxidation kinetics occurs at an alloy/scale interface that advances into the alloy by inward oxygen diffusion. The oxide scale predominantly comprises columnar grains of monoclinic ZrO2, ∼40 nm wide × 200 nm long, with [001]m and [111]m fiber textures and arranged in a brickwork pattern that is highly resistant to lateral fracture and surface grain pull‐out that would compromise scale integrity and function. The scale forms under substantial compression, up to nearly −2 GPa in the surface plane throughout the oxidation, and maintains its compressive state when cooling down to room temperature. At the scale/alloy interface, unoxidized Nb stringers in oxidizing β‐Zr second‐phase grains extend from the alloy into the oxide scale and appear to anchor the scale to the alloy, accounting for the excellent scale adhesion observed. Further oxidation of the β‐Zr second phase farther into the scale is associated with isolated outcrops of equiaxed oxide enhanced in segregated Nb content. Nearer the scale/air interface, lathlike separation into Zr‐rich and Nb‐rich oxides and lamellar intergrowths of a mixed‐oxide phase (probably 6ZrO2·Nb2O5) occur but do not appear deleterious to the integrity or functionality of the scale, especially as the outermost portion of the scale is removed in establishing the final bearing surface of the commercial prosthesis.

Three hundred and fourteen adult upper limb amputees were reviewed retrospectively at the Ontario Workers' Compensation Board. A questionnaire was used to evaluate the use of body and electrically powered prostheses. Follow-up ranged from 1 to 49 years with a mean of 15 years. Results indicated that complete or useful acceptance of an electrically powered prosthesis was reported by 69 of 83 amputees (83%); 199 of 291 amputees (68%) used the cable operated hook, 57 of 291 (20%) used the cable operated hand and 40 of 83 (48%) used the cosmetic prosthesis. The majority of amputees used more than one prosthesis for their functional needs and should be fitted with more than one type of prosthesis. Acceptance of an upper limb prosthesis by 89% (196/220) of below-elbow, 76% (56/74) of above-elbow and 60% (12/20) of high level amputees indicates that for most upper limb amputees, their prostheses are well used and essential to their personal and employment activities.