[Non-cemented acetabular cup in hip arthroplasty. Prosthesis survival and clinical results after 1-8 years]. / Ucementeret acetabulaer cup ved total hoftealloplastik. Proteseoverlevelse og klinisk resultat efter 1-8 år.

This is a retrospective clinical evaluation of 1028 primary hip arthroplasties performed with the non-cemented Harris-Galante I acetabulaer cup. Hospital records regarding all hips operated from July 1985 through March 1992 were evaluated after a median of 48 (12-93) months. Furthermore, questionnaires were sent out to all patients still alive in order to establish the actual function of the hips. At time of evaluation, 43 of the 1028 primary acetabular cups (4.2%) had been or were due to be revised. (20 because of one or more episodes of dislocation or displacement of the cup, 10 due to deep infection, eight following aseptic loosening of the cup, two because of implant failure and three due to other reasons). Four hundred and twenty-six hips were without pain, 274 had only mild or slight pain, whereas 84 experienced moderate or worse pain. We conclude, that the results after non-cemented hemispheric acetabular arthroplasties in this study are satisfying with a low rate of aseptic loosening.

[Femoral head necrosis treated with total hip alloplasty]. / Nekrose af caput femoris behandlet med total hoftealloplastik.

One hundred and three patients with non-traumatic osteonecrosis of the femoral head had 144 primary total hip replacements performed. Average age was 47 (22-73) years. In 85 cases a cemented prosthesis, and in 45 cases an uncemented prosthesis was used, while 14 cases had a cemented femoral stem and an uncemented cup. At follow up, 25 patients had died, 13 patients had had a revision of the prosthesis, and two patients were lost to follow-up, leaving 63 patients (92 hips) for clinical and radiological evaluation. Kaplan-Meier plots for survival of the prosthesis were constructed, showing a total risk of failure of 8% at five years, increasing to 16% at seven years. In 89% of the patients without concomitant diseases, the clinical result was excellent or good. There was no difference in the clinical or radiological result in patients with cemented and uncemented prostheses. It is concluded, that the result after total hip replacement due to non-traumatic osteonecrosis of the femoral head is comparable to that of total hip replacement due to osteoarthrosis, and that an uncemented prosthesis can be expected to yield a result comparable to a cemented prosthesis.

[Unsatisfactory results after repeated revision of hip alloplasties]. / Utilfredsstillende resultater efter gentagen revision af hoftealloplastik.

Sixty one cemented second revision total hip arthroplasties and 18 cemented third revision total hip arthroplasties were studied with emphasis on cause of failure, complications, risk of further revision, and clinical and radiographic outcome of surviving, not further revised patients. Aseptic loosening was the major reason for both second and third revisions followed by recurrent dislocations. Twenty one second revisions failed again. Postoperative dislocation was the major complication, entered in 10/61 second revisions and in 4/18 third revisions. Ten second revisions were reoperated on without exchange of components, but for reasons related to the implant. Clinical and radiographic outcome was favorable, but must be seen in the light of the high rate of further revisions. In 33/53 second revisions and in 5/13 third revisions left for evaluation, the overall outcome was considered unsatisfactory. Reoperations for failed arthroplasties should be the prerogative of highly experienced centers.

Acute spontaneous streptococcal myositis. Case report.

Streptococcal myositis of the acute spontaneous type is extremely rare. To the best of our knowledge, this report describes the first case in which a patient has survived, and reviews the differential diagnosis. The treatment is primarily surgical.