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Mid Thigh Pain (MTP), i.e. a continuous dull pain in the thigh present after prolonged weight-bearing, is a common experience in hip arthroplasties. Since its origin is not clear, the Authors try to explain its etiology and pathogenesis through an analysis of a selection of their cases and of the literature. MTP seems to be a signal of bone overloading at the interface with the prosthesis; the overloading causes biochemical changes in the fibrous tissue surrounding the femoral component, which, in turn, provokes a bone resorption enhancing movements and overloading. If not treated with unloading, MTP may result in stem loosening.

35 cases of arthroplasty revision are reviewed with mean follow-up time of 56 m. (range 24 to 107), by clinical and radiographic study. The results were satisfactory, having only one case of secondary failure (2.8%), also in comparison with other studies. The reason of this probably lies in the adaptability of our technique: in fact we use without preconcepts both cement and cementless fixations with many types of stems and cotyles; this allows us to obtain a stable fixation also taking in consideration the bone characteristics of each case.

The Authors present 85 cases of multiple reimplantation of total hip arthroplasty (THA), analyzing the complex problems connected to this type of intervention, and putting in evidence primary objectives related technical procedures.

It has been a matter of debate as to when a hip prosthesis can be said to have failed. Pain, limp and functional impairment are considered clinical signs of failure while radiolucent lines, subside, bone reabsorption and gross mobilitation are considered radiological sing. But many times, the patients without signs, free of pain and well functioning, show radiological signs of failure and the patients without radiological signs show clinical signs of failure. In the revision of 613 hip arthroplasties performed since 1983, the authors have pointed out 19 failures of their patients and 36 failures of the implants done in other hospitals. Moreover, they have observed on 15 cases radiological signs of failure without clinical sings.

The Authors have re-evaluated 84 cementless total hip arthroprostheses out of 700 hip arthroplasties carried out in their department from January 1982 to December 1992. The aim was to find a correlation between the radio-lucent line and the clinical signs of prosthetic loosening. On the basis of the results of this study and reports in the literature, the Authors conclude that a very poor correlation exists.