The essentially satisfactory results from the ICLH implant as used until 1975 were marred by examples ofloosening and sinking ofthe tibia] implant, by patellar pain ofvarying severity, by wear of the tibial implant caused by fragments ofcement and by failure consistently to control the alignment ofthe leg. This report describes the methods now being used to overcome these complications and gives an account of the success so far achieved. Work on the design of an implant-which replaced only the surfaces of the affected bones and lacked, as do the natural articular surfaces, any direct mechanical link between the components-began at Imperial College in

We report on two 16.5-year-old ski-jumpers who sustained unusual glenohumeral joint injuries. The first fell on landing, the other while running out. Neither could give any indications as to the pathomechanics of the injuries, thus illustrating the high speed nature of the trauma.

The results of this study confirm the positive short and medium-term results with the CLS stem in a long-term process. The formerly described phenomenon of the residual thigh pain with cementless stems was clearly minimized.

We performed a prospective randomized study to determine blood loss differences between supine or lateral patient position, during surgery in elective total hip replacement. Between January and October 1996, 64 consecutive cases of total hip replacements were randomly scheduled for a procedure either in the supine or in the lateral position. Of the 56 cases evaluated, 29 were operated in the supine position (SP) and 27 in the lateral position (LP). The standardized implantations were performed without cement and the blood loss was measured. The calculated loss of Hb on the day of operation was 235 g Hb +/- 17 (mean +/- s.e.) in the SP group and 177 g Hb +/- 14 in the LP group, respectively, (unpaired t-test p = 0.01). The calculated loss of Hb after five postoperative days was 227 g Hb +/- 24 (mean +/- s.e.) in the SP group and 179 g Hb +/- 24 in the LP group, respectively, p < 0.2. The net loss of Hb after five postoperative days was calculated by subtracting all perioperative blood substitutions (Cellsaver, autologous and homologous blood) resulting in 340 g Hb +/- 21 (mean +/- s.e.) in the SP group and 272 g Hb +/- 21 in the LP group, respectively, p = 0.02. The blood loss in primary cementless total hip replacement surgery can be significantly reduced by performing the procedure in the lateral position compared to that in the supine position. The blood loss is limited to the day of operation, as indicated by the stable Hb-levels thereafter.

T he radiolucent lines and the stability of the components of 66 knee arthroplasties were assessed by six orthopaedic surgeons on conventional anteroposterior and lateral radiographs and on fluoroscopic views which had been taken on the same day. The examiners were blinded as to the patients and clinical results. The interpretation of the radiographs was repeated after five months.On fluoroscopically-assisted radiographs four of the six examiners identified significantly more radiolucent lines for the femoral component (p < 0.05) and one significantly more for the tibial implant. Five examiners rated more femoral components as radiologically loose on fluoroscopically-assisted radiographs (p = 0.0008 to 0.0154), but none did so for the tibial components. The mean intra-and interobserver kappa values were higher for fluoroscopically-assisted radiographs for both components.We have shown that fluoroscopically-assisted radiographs allow more reproducible, and therefore reliable, detection of radiolucent lines in total knee arthroplasty. Assessment of the stability of the components is significantly influenced by the radiological technique used. Conventional radiographs are not adequate for evaluation of the stability of total knee arthroplasty and should be replaced by fluoroscopically-assisted films.J Bone Joint Surg [Br] 1999;81-B:24-6. Received 18 June 1998; Accepted after revision 17 August 1998 Conventional radiographs remain in standard clinical use although cadaver studies have shown that they are not reliable in identifying interfaces reliably 1 and in the assessment of radiological stability in knee arthroplasty. This is because a tilt of the beam of only 2.3° to the plane of a 50 mm wide tibial component will obliterate a radiolucent line 2 mm thick (Fig. 1). We have compared the use of conventional and fluoroscopically-assisted radiographs of knee prostheses to determine whether such standardised radiographs would allow better reproducibility of their interpretation and lead to a different appraisal of the frequency of total joint loosening. Patients and MethodsWe assessed 66 Freeman-Samuelson-Modular knee prostheses (Protek, Baar, Switzerland) which had been implanted between 1989 and 1994. Thirteen patients had bilateral replacements. Fifteen patients were male and 38 were female. The mean age at implantation was 74 years (55 to 90) and the mean follow-up was 41 months (12 to 78). We took conventional, routine anteroposterior and lateral radiographs, followed immediately by fluoroscopicallyassisted anteroposterior and lateral views, on a standard fluoroscopic screening table with a moveable tube and an image intensifer. The knee and the tube were moved until the surfaces of the prostheses were parallel to the X-ray beam. All the radiographs were evaluated by six orthopaedic surgeons who were blinded as to the patients and the results. Conventional and fluoroscopically-assisted radiographs were assessed randomly by different panels for the appearance of radiolucent lines in different parts of the pro...