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In a retrospective study, 22 patients treated surgically for solitary or multiple myeloma between 1980 and 1993 were analysed. The main complaint was pain. A fracture was observed in 7 cases and motor-sensory impaired neurology due to spinal compression in 3. Apart from incisional biopsies, tumour resections, reductions (with and without stabilization by osteosynthesis) and endoprotheses were performed either at the extremities or on the spine. In addition, radiation and chemotherapy were included in the therapeutical concept. Early mobilization was achieved in all cases, and the 5-year survival rate (Kaplan-Meier method) was 48%. The results presented in this study demonstrate that a variety of surgical interventions can be of importance in the treatment of myeloma of the bone, ranging from biopsy or even curative resections in selected cases to endoprosthetic replacement. Thus, good functional results can be achieved and maintained over often long survival times.

The cruciate ligaments were resected with their bony insertions during total knee arthroplasty carried out in 12 patients with severe rheumatoid or osteoarthritis. The ligaments were examined histologically and biomechanically, using ten specimens from healthy adults as a control. A significant difference was found in the tensile stiffness and viscoelastic properties of the ligaments between the arthritic and the control group. The ligaments in the rheumatoid knees had a distinctly inferior tensile strength compared with the osteoarthritic knees. Total knee replacement, which also replaces ligament function, should therefore be considered in severely damaged rheumatoid knees.

Osteomyelitis after trauma or after operations and amputations at the midfoot or tarsus leads to a disadvantage in terms of motion and of weightbearing on the foot. Once local fistula, exophytic bone growth, skin defects and instability of the metatarsus have arisen, hygiene and recovery of joint function are difficult. Four patients were treated by reamputation at the midfoot and bone autografts. The osteomyelitic part was excised and the tarsal and metatarsal bones stabilized. The result at follow up showed painfree stumps without recurrence of infection within 3 years. Little support is needed in the way of orthopedic appliances, and all four patients can walk easily with no pain. This operation is recommended for the primary surgical procedure.