We have followed up for a period of seven to nine years 100 consecutive arthroplasties of the hip in which an entirely HA-coated implant had been used. The clinical results were excellent and bony incorporation was extensive in all components. No stem became loose or subsided but five cups were revised because of loosening after 3.8 to 5.5 years, having functioned painlessly and shown radiological ingrowth. Revision procedures because of excessive polyethylene wear have been performed on 18 hips and are planned for six more. Two eroded metal backings with worn-through polyethylene were exchanged; six hips showed metallosis without polyethylene wear-through. There were two cases of granulomatous cysts in the groin and 66 hips had osteolysis located periarticularly, in the greater trochanter or in the acetabulum.
We compared radiographically the femurs for 5 years after cemented (Landos Titane) and uncemented (Zweymüller/Endler) hip arthroplasty (THA) for coxarthrosis in 120 patients. The bone changes followed a characteristic time-course with rapid initial remodeling and almost no further changes after 3-4 years. No association between bone changes and clinical results was found. The groups did not differ in bone atrophy and ectopic bone formation, whereas the incidence of distal cortical hypertrophy and proximal radio-opaque double line was higher around uncemented stems. The age and body weight of the patients and the stem size did not affect the bone changes, but women with uncemented stems developed more bone atrophy than did men.
We report a series of 32 free flap reconstructions following acute hand and forearm trauma. The series consists of two dorsalis pedis flaps, four scapular flaps and 26 lateral arm flaps. One flap became infected and failed completely, and a partial necrosis occurred in another flap. The transfers covered large skin defects, exposed tendons, tendon grafts, bone, bone grafts, joints, nerves and nerve grafts. The donor site morbidity was negligible. Our study shows that free microvascular flaps are a safe and convenient alternative to conventional flaps in hand surgery. The lateral arm flap seems very suitable for small and medium size defects.
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