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Up to now, sporting activity after total hip arthroplasty has been limited or terminated completely because of the risk of failure. In the case of younger patients, it is desirable to know whether this attitude is justified. Consequently, an analysis has been made of 110 patients (all male, average age at the time of the operation 55 years, 42 bilateral). Sport was practised in 78 and 56% of the cases prior to an after the operation respectively. The patients with intense sporting activity were examined and the findings compared with those who did not participate in a sporting activity after the operation. The incidence of replacement due to loosening is surprisingly higher among the group of patients with no sporting activity (14.3% to 1.6%). In the light of these findings, there is no need to prohibit sport in these cases. To allow for a gradual resumption of sport, guidelines have been elaborated on the basis of present-day knowledge of quantitative and qualitative hip strain. The short load peaks appearing as the heel touches the ground on walking or running will be attenuated by means of a viscoelastic heel pad.

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Between 1978 and 1986, 59 patients received a GSB III elbow prosthesis, six of them in both elbows. Rheumatoid arthritis (RA) was the underlying cause in 51 of the patients and post-traumatic osteoarthritis (PTOA) in eight. Of these, 24 patients (28 prostheses) have since died; two, both operated on bilaterally, had had their implants for more than ten years and had already been assessed for inclusion in the long-term follow-up. Two patients, each with one elbow prosthesis, have been lost to follow-up and three males who are still living (two with PTOA, one with juvenile RA) had their prosthesis removed before ten years had elapsed.The remaining 32 patients (28 RA, 4 PTOA) with 36 GSB III elbows were examined clinically and radiologically after a mean period of 13.5 years. Pain was considerably reduced in 91.6%. Mobility was increased by 37° in those with RA and by 67° in those with PTOA.There were three cases of aseptic loosening and three of deep infection. The main complication was disassembly of the prosthetic component in nine elbows (13.8%). This last group included two patients with postoperative fractures unrelated to the operative technique and one with neuropathic arthritis. Ulnar neuritis occurred in two patients.Since 87.7% of all the GSB III prostheses implanted in this period remained in situ, our results are comparable with those for hip and knee arthroplasty. The outcome of every artificial joint replacement is evaluated for pain relief and functional improvement and also for the duration of this success. The last factor is critical since more young patients undergo joint replacement and revision surgery, particularly with the exchange of a prosthesis, has many technical problems with a reduced prospect of success.Replacement arthroplasty of the elbow is not a common operation. The number has increased in the last ten years, and the results are improving, but the percentage of complications and revisions reported in the literature is higher than for the hip, knee and shoulder. An analysis of the most relevant literature on elbow arthroplasty published between 1987 and 1997 1-35 shows a mean period of follow-up of 4.9 years (0.25 to 17) and few of these studies had uninterrupted and complete series.Our aim was to analyse the long-term results of a consecutive series of patients with the GSB III elbow prostheses implanted for more than ten years. Patients and MethodsThe requirements of a good elbow prosthesis are: 1) optimum adaptation of the implant to the physiological requirements; 2) unobstructed flexion and extension; 3) lateral stability; 4) construction from biomechanically accepted materials; and 5) minimum bone resection to enable greater choice if revision is needed.Our experience with the GSB I elbow prosthesis began in 1971. At that time all rigid hinge joints showed a high rate of loosening. As a result of an analysis of their mode of failure 36 (Figs 1a to 1c) the GSB III elbow prosthesis was developed (Allo Pro AG, Baar, Switzerland). It has essentially remained unchanged and has bee...

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The osteopenia associated with experimental inflammatory arthritis was studied by a histomorphometric method that exphasized net changes in bone composition. Juxtaarticular trabecular bone volume and turnover were studied in the carrageenan injection model of inflammatory arthritis of the mature rabbit knee. Trabecular bone volume was studied by histomorphometry of the femoral condyles and confirmed by photodensitometry on standard macroradiographs. Osteogenesis was studied by imaging of calcein fluorochrome-labeled newly formed bone in undecalcified histological sections. A significant net loss of cancellous bone (approximately 20%) occurred over 49 days in both the medial and the lateral femoral condyle in the arthritis group compared with normal controls. Total osteogenesis was increased fourfold and it was calculated that an even greater increase in total bone resorption was responsible for the negative bone balance. There is evidence that the periarticular bone loss of human rheumatoid arthritis is also associated with increased bone turnover. Quantitative studies of the kinetics of bone remodeling in inflammatory arthritis will provide the basis for therapeutic attempts to prevent or reverse arthritis-induced bone loss. Fracture risk in inflammatory arthritis may be increased not only by osteopenia, but additionally by the presence of a large proportion of newly formed (and presumably less mineralized) bone.