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Purpose of the Study: From an initial group of 206 hips in 190 patients we carried out a retrospective clinical and radiological control of 74 hips in 72 patients covering a period of 20 years., Material and Method: Indications in 74 operated hips evidenced 48x(64.9%) primary and 26x(35.1%) secondary coxarthrosis. The average age at the time of operation was 53 years (37 years-68 years). All 72 patients with 74 hips received cement-free self- cutting Alloclassic screw cups of pure Titanium together with a cement-free square Alloclassic stem consisting of Titan- Aluminium-Niob alloy according to Zweymüller. Regarding the technique of operation we used the approach after Watson-Jones in the supine position. As prophylaxis against thrombosis 40% of the patients received derivates of heparine and 60% had anticoagulant therapy with cumarine. Prophylaxis against heterotopic ossifications were not carried out at this juncture in our department., Results: After an average post-operational examination lapse of 20 years we were able to examine 72 patients (37.9%) with 74 hips (35.9%) clinically and radiologically. Further classification of the 72 patients records 47 females and 25 males. The average age at the time of operation was 53 years and at the time of post-operational check-up to 74 years. For the clinical post-operational check-up (n=74) we used the Harris Hip Score. Further evaluation shows 12x(16.2%) excellent results, 26x(35.1%) good and 29x(39.2%) fair results. In 7 patients (9.5%) we had to observe poor results because of multimorbidity, although also in these cases stability of TEP had been achieved. The radiological post-operational check-up of the 74 stable hips (35.9%) shows an average excentric position of the head of 1.4 mm (0 mm up until 4 mm) compared with 1 mm after 10 years. Over an average of about 20 years we carried out an exchange of the inlay and the head because of excentric position of the head, which correlates to a rate of reoperation of 6.8%., Discussion: In 2000 and 2001 we published our 10 year results with cement-free Alloclassic screw cup and cement-free stem in 133 hips in 123 patients and compared our findings with those of other authors. After 10 years we saw only 3 % complications with cups and an overall re-operation rate of 6.7%. The 20-year-results show in all cases stable components of both cups and stems. 5 patients (6.8%) had to undergo re-operation with an exchange of inlay and head, whereby the components of the prosthesis themselves turned out to be stable. An average polyethylene abrasion of 1 mm after 10 years compares with a value of abrasion of 1,4 mm after 20 years. The 6.8% rate of re-operation after 20 years indicates the excellent results of the use of cement-free Alloclassic total endoprosthesis system of the hip according to Zweymüller., Conclusions: The biocompatible qualities of modern prosthesis material lead to a quicker and optimal bony incorporation of the pros- thesis components. The excellent 20-year-results show a broad indicative spectrum, component stability of the prosthesis in all patients and therefore encourage the further use of cement-free hip implants in the future.

Purpose of the Study: It is the aim of our study to present the results of our way of treatment of the periprosthetic fractures, with the cemented as well as the cement-free stems., Material: From 1.1.1988 until 31.3.2005 we operated 42 periprosthetic fractures of the hip in 41 patients. 31 of our patients were females, 10 of them males. In 22 cases we operated the right side, 18 times the left side and once we had to operate both sides, but at different times. We used the Vancouver classification scale for the grading of the fractures. In our study we excluded type A fractures; we registered 41 type B fractures and one only type C fracture. The reason for periprosthetic fracture in all these 42 cases was definitely a trauma. In 6 cases we found pre-existing loosening of the stem. We have grouped our patients under two headings: 1. Primary cemented stems (n=13) 2. Primary cement-free stems (n=29) The average age at the time of primary operation was 63.6 years in the group of cemented stems and 67.2 years with the cement-free implants., Methods: The principle of this operation lies in a stable technique of osteosynthesis. If one operates on a stable stem one uses a one and only technique of osteosynthesis. Patients who also suffer from a loosening of the stem, are treated by replacement of the stem combined with a particular form of osteosynthesis. We generally use a transgluteal access with an L-shaped detachment of the Musc. vastus lateralis. In the group of cemented stems (n=13) we carried out a replacement of the stem 6 times and in the group of cement-free stems (n=29) we had to replace the implant on 7 occasions. Analysing the osteosynthesis technique we find the use of titanium cerclages and titanium elements on 35 occasions, in both groups taken together. As implant for the stem we preferred the modulated revision stem according to Zweymüller. Clinical post-operational examination of our patients was carried out according to the Merle d'Aubigne score and two x-rays at different levels., Results: After an average post-operational check-up time of 3 years and 2 months, we were able to examine 8 patients with cemented stems (61.5%), 4 of whom had replacement of the stem by a cement-free implant. In the cement-free group we evaluated 24 patients after an average time of 4 years and 11 months. In this group we had 5x a replacement of the stem, 3x of these we could operate cement-free. The post-operational radiological check showed an excellent building-up of bone structure without any dislocation of the implant in all 32 cases., Discussion: The average age of our patients shows 77 years with those with cemented stems and 74.5 years in the ones with cementfree implants. Analysis of the cemented stems shows a loosening rate of more than 50%, which coincides with the findings of many other authors. After a couple of years using cups of polyethylene we were confronted with the problem of the so-called Polyethylene disease. These alterations may finally lead to a loss of bone quality, to mechanical loosening of the implant and an increase in danger of fracture. When we discuss the group of patients with cement-free stems and compare them to those with cemented ones, we find a number of quite different characteristics. B2 fractures appear in a quite higher number of patients with cemented and loosened stems. In this regard, our own study is congruent with the studies of other authors. In the cement-free group we had 75% B1 fractures with a stable stem. The explanation for these figures is, that the cement-free implants were well incorporated in the bone structure., Conclusions: The choice of operative procedure when treating periprosthetic hip fractures depends on the type of fracture and the stability of the prosthesis. Our own very positive experiences and the then emerging results lead to a certain strategy in procedure. That means, for us, the use of a cement-free modulated revision stem according to Zweymüller combined with a particular technique of osteosynthesis, using titanium cerclages and titanium elements.

Aim of Study: The aim of our study is to show the long-term results using the Zweymüller cementless Alloclassic stem., Method: In our retrospective study 133 from 206 cases (64.4%) were examined after 10.6 years. The examination was done clinically (Scheme after Merie d'Aubigné) and radiologically. The average age was 72 years (48-92 years) at the time of examination., Results: Intraoperative complications occurred in 3 cases (1.5%), 2 were temporary sciatic-nerve paresis and 1 was a stem fissure. Nine cases had been revised (6.7%). In four of these cases the inlay and the head had to be changed, in two cases mechanical loosening of the cup was found; furthermore, there were one removal of heterotopical ossification and one early infection. Stem problems appeared in only one case with deep infection and had been revised twice. There was neither stem sinking nor mechanical loosening in our series. The average polyethylene wear using a ceramic head with 32 mm diameter was 1 mm after 10.6 years. Clinically excellent results were found in 90% of the cases., Conclusion: The long-term results using the cementless Zweymüller stem with a rectangular transversal section and easy operation technique over 20 years are excellent Because of the cortical anchorage and the biocompatible titanium alloy the Zweymüller stem can be used in all femur forms and in different age groups.

The authors evaluate the problem of heterotopic ossifications as a complication of total endoprostheses of the hip joint. The classification into stages as elaborated by Arcque was used and compared with the clinical correlate. The authors compared the year 1989 when the total number of prostheses was 150 without prophylaxis of ossifications, with the year 1992 when the total number of endoprostheses was 200 with prophylaxis. In 94% of the patients starting on the second day after surgery to the 21st postoperative day 2 x 50 mg Indomethacin (2 x 1 capsule Indocin forte) were administered. As a gastroprotective drug the patients were given Ranitidine, 2 x 150 mg (2 x film tablets Zantac 150). Complications such as gastrointestinal complaints and skin exanthemas were observed only in 6 patients. Prophylaxis of thromboembolic disease was used in 1992 in 65% of the patients by anticoagulants and in 35% of the patients by administration of low-molecular heparin. This procedure proved a very simple, effective and safe method for prevention of para-articular ossifications: [table: see text]

High-molecular polyethylene is used in many technical spheres and in orthopaedics it is used in particular as a sliding component. In orthopaedic endoprosthetics it serves as a material for the manufacture of sockets, whereby polyethylene sockets can be anchored with our without cement. Morphological research corroborates the suspicion of inadequate static firmness of the polyethylene used and this may lead to abrasion and thus mechanical loosening of Endler's screw socket and subsequently also of the metal shank. At the orthopaedic department of the General hospital in Zwettel (Austria) between 1984 and 1987 113 Endler sockets were implanted in 101 patients. So far 41 reoperations were made in 39 patients. In 71% of the patients replacement by a non-cemented socket according to Zweymüller followed, in 17% by a cemented socket according to Müller. In 4 joints at the same time also the femoral component had to be replaced, in 13 shanks bone rarefaction in the area of the calcar femoris was detected. In shanks with removable heads the head was always replaced. Clinical evaluation of the operated patients was done according to the procedure of Merle d'Aubigné.