AIM OF THE STUDY: Long-term results of unicompartmental arthroplasty (UCA) in medial osteoarthritis are analyzed and the influencing covariates were explored. METHODS: 261 UCA in 229 patients were evaluated mainly by use of a structured questionnaire, 98.5% of the UCA were analyzed after 10 (5-20) years. RESULTS: In the Knee Sec. Score, the items pain and function were improved significantly. Patients were very content with the UCA. Failures (total 30) were especially caused by destruction of the non-replaced compartment (n = 11) and loosening of the tibial component (n = 5). Survival with aseptic failures as the endpoint was 84.9% after 10 and 74.4% after 20 years. Gender, age at operation, design (St. Georg, Tönnis, Endo, Wessinghage) and height of tibial component could not be proved as determining covariates with sufficient statistical significance. CONCLUSION: Cemented unicompartmental knee arthroplasties show good long-term results in medial osteoarthritis, when the criteria for the indication are strictly respected.

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[Radiolunate arthrodesis in rheumatoid wrist--the modified Chamay technique with broadening of indications].

AIM: Radiolunate arthrodesis (RLA) has become an established surgical technique for stabilising wrists destroyed by RA. Our modified surgical technique with special osteosynthesis material has enabled the spectrum of indications to be expanded to include stage IV a--sagittal instability. METHOD: 44 radiolunate arthrodeses were carried out from 10.96 to 6.98. 19 (43.2%) satisfied the criteria for correction RLA with correction of sagittal instability. All (100%) of the 19 radiolunate arthrodeses were included in a follow-up examination, and all were examined clinically and radiologically at specified intervals. The mean follow-up is 22.8 months. RESULTS: Correction of the lunate drift in the sagittal plane was successful. The radiolunate angle was reduced from a mean 23.7 degrees before surgery to 9.3 degrees afterwards. The lunate drift in the frontal plane, which is shown by the ulnar translation index (UTI) was corrected from an average of 0.35 before surgery to 0.30 afterwards. Restoration of the carpal height by bone grafting from a mean preoperative CHI of 0.47 to 0.50 after surgery was achieved. We discovered one failure, thus the consolidation rate dropped to 94.7%. CONCLUSION: Since the capitate is the centre of rotation and movement at the wrist, a stable central pivot is essential, and correction of sagittal instability is particularly important. This demand can also be met by our modified radiolunate arthrodesis.

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[Stabilization of the proximal femur in hip joint replacement using M.E. Müller's acetabular roof socket].

Extreme changes of the hip joint often require individual technical supplements in addition to the endoprosthesis. But the base of success are procedures using a model of prosthesis and a technique that are matured. This is available e.g. with the old M. E. Müller curved stem hip joint prosthesis. In special cases of extreme changes or damage of the proximal femur we perform in artificial joint-replacement of the hip or changing of prostheses a special kind of operative treatment. This is a combination of the Original-M. E. Müller curved stem endoprosthesis, long or short version of the femoral part, in addition fixated by bone-cement and M. E. Müller's special metal socket--primary indicated for stabilization of the acetabular roof. The indications for this method can be changes of proximal femur and hip-joint, especially dysplasias of pelvis or hip joint, extensive fractures especially in old patients, destructions in polyarthritis, dysplasia of pelvis and coxitis caused by juvenile chronic arthritis and long time therapy with corticosteroids, destructions, loosenings and fractures in changing operations of hip-endoprostheses. Until today we treated 15 different cases by this method--one case was operated 13 years ago--with good results, prooved by Merle d'Aubigné's score.

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[Acetabular convexity--a specific addition to total endoprosthetic hip replacement].

Between 1. 1. 1977 and 30. 6. 1988, 1470 total hip prostheses were implanted at the 1st Orthopedic Clinic in Bad Abbach/Regensburg. In 101 cases (82 patients, average age 54.8 years) the acetabular convexity was built up at the same time. This is considered indicated if the acetabulum is too shallow and thus provides insufficient lateral or dorsolateral countersupport. The main area of indication is dysplasia-coxarthrosis and congenital dislocation of the hip, destructive coxitis in chronic polyarthritis or juvenile chronic arthritis, and loosened prostheses. The material used for building up the convexity is a block of corticocancellous bone, which is fixed ventrolaterally to dorsolaterally to the ilium by osteosynthesis. Autologous material was used in 88 cases and homologous material in 13. Sixty-one patients with a total of 77 built-up convexities were followed up. In 92.2% a bony bridge between the corticocancellous block and the rising branch of the ilium was fund. The method described is a valuable addition to replacements in case of extreme hip joint changes and replacement operations. In the authors' opinion it has considerable advantages over supporting shells and similar materials.

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[Themistocles Gluck. 100 years artificial joint replacement].

One hundred years ago Themistocles Gluck reported for the first time about artificial joint replacements and the fixation by cement in a most important publication. Extirpation even of internal organs and differentiated possibilities of their replacement were standing in the center of the scientific work of this genius but first of all controversial discussed German doctor.

Bone Cements↗