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Hip resurfacing arthroplasty was introduced as an alternative to the conventional total hip arthroplasty which had shown suboptimal results in younger patients. Application of the resurfacing technique in younger patients has increased over the last few years. To date, no randomized controlled trials with a minimum follow-up span of 10 years comparing hip resurfacing to conventional hip replacement have been conducted in patients under 55 years of age. Australian and English hip registries demonstrate high revision rates after 5 years for some brands of resurfacing implants. In addition to these disappointing revision rates, the complication of aseptic lymphocytic vasculitis caused by metal particles evoking a local tissue reaction has been increasingly reported. The resurfacing procedure recently received some negative media attention in the Netherlands, leading to confusion among patients. In order to ease patient doubts, it is important to correctly inform them as to the type of implant used, for example, by means of the website or an information card.

Objective: To determine the long-term results of primary cemented total hip arthroplasty in patients under the age of 40. In cases of acetabular defects, initial reconstruction with bone impaction grafting was performed., Design: Cohort analysis., Methods: Details of patients under the age of 40 who underwent primary cemented total hip arthroplasty between 1 January 1988 and 30 June 2004 were analysed. The primary goal of this study was to determine the time until revision surgery. Kaplan Meier analysis was used to calculate prosthesis survival., Results: A total of 175 total hip arthroplasties in 130 patients were included in the study. Acetabular reconstruction using bone impaction grafting was performed on 84 hips (48%). The average age at surgery was 31 years. Six patients (8 hips) died during follow-up; none of these had undergone revision surgery. Average follow-up was 8.1 years (range: 2.0-18.5). In total, 24 hips (14%) were revised. Reasons for revision were: septic loosening (n = 8), recurrent dislocations (n = 4), traumatic loosening (n = 1) and aseptic loosening (n = 11). The 10-year prosthesis survival was 83% (95% CI: 76-90) with the endpoint 'revision for any reason' and 92% (95% CI: 86-98) with the endpoint 'revision for aseptic loosening'. Aseptic survival of the cups with and without bone impaction grafting was 95% (95% CI: 89-100) and 90% (95% CI: 81-99) (p = 0.73), respectively., Conclusion: Hip replacement with cemented total hip arthroplasty in patients under the age of 40 produced good long-term results. Acetabular deficiencies reconstructed with bone impaction grafting also produced good results in this group of patients.

Objective: Determination of long-term results of hip replacements in patients who, at the time of operation, were under the age of 50. Procedures whereby an existing acetabulum defect was filled with bone chips that were impacted into a strong layer, after which a cemented total hip prosthesis was implanted., Design: Descriptive., Method: Prospectively collected data from patients who were under the age of 50, and had undergone a hip replacement operation at our hospital between 1 July 1979 and 31 December 1987 were analysed. Data were collected up to 31 December 2002. The main outcome was time to revision. Survival was calculated by the Kaplan-Meier method., Results: The study group consisted of 25 patients, 17 women and 8 men with 29 prosthetic hips. The average age at operation was 37.6 years (range: 20-49). Follow-up time was 15-23 years (median: 18.7 years). 1 patient (1 hip) was lost to follow-up. 3 patients (4 hips) died within 15 years after the operation; none of them had undergone revision. 4 revisions had been performed: I septic loosening (14 years p.o.) and 3 aseptic loosenings (6, 15, 20 years p.o.). The cumulative survival with the end-point 'revision for any reason' was 96% (95% CI: 88-100) at to years and 88% (95% CI: 74-100) at 20 years; after exclusion of the septic loosening the survival at 20 years was 92% (95% CI: 80-100)., Conclusion: Hip replacement including a reconstruction technique for an acetabulum defect in patients under the age of 50 was regarded as successful if after 10 years, at least 90% of the prostheses were still in situ.

There is no agreement about the most ideal type of hip prosthesis to be used in patients younger than 50 years. The most commonly used hip prostheses in patients younger than 50 years are uncemented or resurfacing prostheses and to a lesser extent cemented prostheses. A good result of a hip prosthesis can be defined as follows: 10 years after surgery more than 90% of the prostheses should be still in situ during endpoint revision for any reason. No trials are available comparing cemented, uncemented or resurfacing hip prostheses. Studies are available of cemented hip prostheses in patients younger than 50 years that prove that more than 90% of the hips are still in situ after 50 years. There are no studies available of uncemented or resurfacing hip prostheses in younger patients that prove that after to years of follow-up 90% or more of the prostheses are still in situ. The Scandinavian hip registers show that the highest rate of prostheses still in situ after 10 years is achieved by cemented hip prostheses.

Background: Benign and low-grade malignant bone tumours are generally treated with intralesional curettage. At microscopic level tumour cells are left behind and may be responsible for a recurrence. Therefore adjuvant local treatment is necessary., Method: By spraying liquid nitrogen into the remaining cavity, tumour cells are frozen very rapidly. Ice crystals formed in the (tumour) cell will mechanically damage the cell resulting in cell necrosis. This combined treatment of surgery and freezing is called cryosurgery., Results: In 120 patients with a follow-up of at least 1 year the treatment results were good. The tumours were: aneurysmatic bone cyst (n = 32), simple bone cyst (n = 13), chondroid tumour (n = 43), giant-cell tumour (n = 13), eosinophilic granuloma (n = 7) and monostotic fibrous dysplasia (n = 12). There were 10 recurring tumours, some of them very small; 6 recurrences were treated successfully by cryosurgery again; in 2 recurrences marginal resection was carried out; 2 recurrences remained (as yet) untreated., Conclusion: Cryosurgery as a therapy of benign and low-grade malignant bone tumours yields results nearly as good as marginal resection, and has the advantage that segmental bone resections, which need extensive reconstructions are avoided.

In the fifties, patients with a malignant bone tumour were treated with radiotherapy, sometimes supplemented by resection, as recommended by the Bone Tumour Committee established in 1953. In the seventies, improvement of imaging techniques and chemotherapy made limb-saving surgery possible. Currently, 70% of patients with a malignant tumour of the locomotor apparatus are treated by limb saving, oncologically justified surgery. The surgical defects can be repaired with the aid of an endoprosthesis, or bone homografting or autografting. Children are often treated with an operation involving 180% rotation of the ankle to function as the knee, combined with a prosthesis. Adults are sometimes treated with this technique, but also with internal ('standard') prostheses and donor bone. The future will have to make clear which technique is to be preferred in which situation. Probably, typing and prognosis of various tumours may improve, leading to better insight into the treatment. Centralization of the treatment of rare tumours may also contribute to improvement of the treatment and its scientific research.

In a 9-year-old girl chronic recurrent multifocal osteomyelitis was diagnosed, a rare disease mostly affecting children of which the aetiology remains obscure. It is usually diagnosed around the age of II years. The patient suffers from exacerbations and remissions for an average of 2.9 years. Awareness and recognition of the disease is of importance to avoid unnecessary diagnostic procedures and treatment. The prognosis is good.

Objective: Evaluation of the treatment of unstable pertrochanteric femoral fractures with a femoral head prosthesis in older patients., Design: Descriptive., Setting: University Hospital Nijmegen, the Netherlands., Method: From January 1988 through December 1992, 15 patients with 15 unstable pertrochanteric femoral fractures were treated with a femoral head prosthesis and additional wiring of the trochanter. The group consisted of 11 women and 4 men with a mean age of 86 years. Two operations were secondary treatments after broken angled-plate fixation. The other 13 were primary treatments., Results: A stable fixation allowing weight-bearing was achieved in all cases. The operations were accompanied by high morbidity and mortality rates: 4 patients died within 3 months after surgery. One dislocation of the prosthesis occurred. Twelve fractures consolidated, pseudarthrosis of the greater trochanter occurred twice. Five patients regained their preoperative walking ability., Conclusion: Femoral head prosthesis with additional wiring is an alternative with few mechanical complications in the treatment of unstable pertrochanteric femoral fractures.

A follow-up study, based on clinical, radiological and pathological information was performed of 20 patients who had suffered from an osteoid osteoma and of three patients who had been treated for an osteoblastoma in the period 1978-1988. 50% of the patients mentioned both pain at night and a good reaction to salicylates. In 87% of the cases a correct diagnosis was made with the aid of conventional radiography, tomography and bone scanning. Primary treatment consisted of intracapsular (mostly piecemeal) excision in all cases. A local recurrence was observed in one patient with osteoid osteoma and in two with osteoblastoma. At the time of this follow-up study none of the 23 patients had complaints. Histopathological examination did not reveal any difference between the two types of bone tumour.