Joint Replacement In Patients Research Articles

Recreational sport activity after total replacement of the first metatarsophalangeal joint: a prospective study

First metatarsophalangeal joint replacement is an alternative surgical procedure to arthrodesis in the treatment of moderate-to-severe hallux rigidus. However, few studies have been published about functional outcome after joint reconstructive procedures for hallux rigidus. The purpose of this study was to assess clinical, radiological and functional outcome, with special regard to recreational and sports activity, after first metatarsophalangeal joint replacement in patients affected by hallux rigidus grade III. Twenty-three patients who had undergone total joint replacement of the first metatarsophalangeal joint were examined preoperatively and three, six, 12 and 18 months postoperatively. All patients (mean age of 57.0 ± 3.7 years) received a non-cemented TOEFIT-PLUS™ implant by one surgeon. Clinical scores (AOFAS score and VAS), radiological examination, patient satisfaction and sport participation were used to evaluate treatment outcome and radiolucent lines. The mean AOFAS score showed a significant improvement from 44.6 ± 7.2 points preoperatively to an average of 82.5 ± 14.4 points at last follow-up (p < 0.001). The mean total ROM of the first MTP joint increased from 28.1 ± 4.9 degrees preoperatively to 52.7 ± 15.7 degrees postoperatively (p < 0.001). After surgery, 91.3% of the patients were able to resume at least one recreational activity. Total arthroplasty for the treatment of hallux rigidus in an active patient population revealed good clinical and functional results. However, postoperative recreational sport activity showed a decrease in comparison to the pre-arthritic state. Further follow-up is necessary to quantify loosening risk in active patients after total hallux arthroplasty.

Bone-Plastic Reconstruction of Proximal Femur in Patients with Femoral Neck Fractures and Pseudarthroses

Rehabilitation potential of medializing valgus osteotomy with formation of bone lock by Konforti-Ivanov and reconstructive bone-plastic operation by Luck was studied in 122 patients with femoral neck fractures and pseudarthroses. The guarantee of surgical intervention efficacy is differentiated approach to the choice of treatment technique with due regard for the peculiarities of proximal femur injuries, stable functional osteosynthesis in combination with dynamic compression of bone fragments by tightening bows with shape memory effect. Good treatment results with long lasting functional effect achieved in 104 (89.7%) patients allowed to recommend using organ saving reconstructive plastic operations as an alternative to joint replacement in patients without presence of coxarthrosis and pathologic femoral head transformation.

An analysis of joint replacement in patients with systemic lupus erythematosus

A small but important group of patients in our lupus cohort has needed total joint replacement (TJR). Arthritis was identified in 94% of our lupus patients. We have determined how many of our patients needed TJR, explored the risk factors for this procedure in patients with SLE and reviewed the outcome for these patients. Records of the cohort of patients with SLE who have attended our lupus clinic at University College of London Hospital/Middlesex from 1978 to 2008 were reviewed and patients who underwent TJR were identified. We recorded demographic data, other major systemic manifestations of SLE, autoantibody profile, previous use of steroids, other major systemic illnesses, smoking and alcohol habits. Nineteen patients with SLE from our cohort of 500 were found to have at least one TJR. Avascular necrosis (AVN) or concomitant rheumatoid arthritis (RA) was present in the majority of these patients. In contrast, age at disease onset, the presence of anti-cardiolipin antibodies, Raynaud's phenomenon and smoking habits were not found to be contributing factors for the need to replace joints. Four of our 19 patients (21.1%) had complications of the joint replacement: two of them had infections of the replaced joint, one had a large haematoma immediately after the surgery requiring surgical evacuation and the other had a deep vein thrombosis. None of the patients so far has required joint re-replacement. In conclusion, 4% of SLE patients in our cohort have one or more joints replaced, the majority because of AVN or RA.

The association between C-reactive protein and the likelihood of progression to joint replacement in people with rheumatoid arthritis: a retrospective observational study

BackgroundThis study sought to evaluate the association between systemic inflammation as measured by C-reactive protein and total joint replacement and the association between change in CRP status (low, ≤ 10 mg/L and high, >10 mg/L) measured over one year and total joint replacement in patients diagnosed with rheumatoid arthritis.MethodsA cohort of patients was selected from The Health Improvement Network (THIN) dataset of anonymised patient-level data from UK general practice with a confirmed chronic rheumatic diagnosis. Surgery-free survival was evaluated using Cox proportional hazards regression models (CPHM).Results2,421 cases had at least one CRP measurement of which 125 cases (5.2%) had at least one major joint replacement. In CPHM, each additional unit increase in log mean CRP (range 1 to 6) was associated with a hazard ratio (HR) for major orthopaedic surgery of 1.36 (95% CI 1.10 to 1.67; p = 0.004), after controlling for age at first rheumatoid presentation and average body mass index over the same observation period. Repeated CRP observations around one year apart were recorded in 1,314 subjects. After controlling for confounding factors, in cases whose CRP remained high (>10 mg/L), the HR for joint replacement increased more than two-fold (p = 0.040) relative to cases whose CRP remained low. In patients whose CRP increased from low to high, the HR was 1.86 compared to those who remained in a low state (p = 0.217). By comparison, among those subjects whose CRP was reduced from a high to low state, the hazard ratio was more than halved (1.46) from to those who remained high (p = 0.441). Although underpowered, the trend evident from CRP change corroborates the association of TJR progression with mean CRP.ConclusionCRP level predicts progression to major joint replacement after standardisation for relevant risk factors as did change in CRP status between low and high states observed over one year.

Orthopaedic surgery in patients with rheumatoid arthritis over 20 years: prevalence and predictive factors of large joint replacement

Objective:To study the prevalence of orthopaedic surgery and to evaluate possible predictive factors for large joint replacements in patients with early rheumatoid arthritis (RA).Patients and methods:A cohort of 183 patients...

Assessing Osteolysis with Use of High-Throughput Protein Chips

Previous studies of bone resorption around failed joint replacements have focused on a limited number of cytokines, primarily tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1, and IL-6, with use of enzyme-linked immunosorbent assay and immunohistochemistry techniques. In this study, we utilized high-throughput protein chips to profile twenty-nine inflammatory cytokines around failed total joint replacements. Peri-implant granulomatous tissues were harvested from around the failed total hip prostheses of thirteen patients. Synovial lining capsular tissues from thirteen patients with end-stage degenerative joint disease were used as controls. After homogenization, twenty-nine cytokines were quantified with use of high-throughput protein chips. IL-6 and IL-8 were found consistently in failed joint replacement tissues, reaffirming their prominent role in osteoclastogenesis and end-stage bone resorption. High levels of interferon-gamma-inducible protein of 10 kDa (IP-10) and monokine induced by interferon-gamma (MIG), both chemoattractants of activated Th1 lymphocytes, were also detected. Soluble intercellular adhesion molecule (sICAM) and transforming growth factor-beta1 (TGF-beta(1)) were not detected universally, nor were TNF-alpha or IL-1. After a twenty-four-hour organ culture, IL-1beta levels increased substantially along with those of other mediators. We measured but did not detect any activators of cytotoxic T-cells, antibody-producing Bcells, or eosinophils involved in delayed-type hypersensitivity. Variations from patient to patient were seen across all cytokines and highlight the unique response of individual patients to their joint replacements. In failed total joint replacements in patients with end-stage osteolysis, IL-6 and IL-8 may be the primary drivers of osteoclastogenesis. The presence of IP-10 and MIG imply a role for T-cells, while TGF-beta(1) and sICAM may represent a systemic attempt to modulate the inflammation. TNF-alpha and IL-1 do not appear to play a major role in the end stages of the disease.

Pharmakotherapeutische Aspekte der Femurkopfnekrose

Avascular necrosis (AVN) of the hip is one of the unsolved problems in orthopedics, especially with regard to drug therapy. Only a few studies exist using a long-term approach with vasodilating agents such as prostaglandins, anticoagulants, hormones, as well as lipid lowering and bone protective drugs such as bisphosphonates. However, using these medications several studies have demonstrated a significant reduction in pain, in the destruction of the femoral head as well as in overall disability. This resulted in a reduced need for joint replacement in patients with AVN and to a substantial improvement in quality of life. Of note, drug therapy should be initiated in the early phases of AVN as later stages appear to be less responsive to medication.

Assessing Osteolysis with Use of High-Throughput Protein Chips

Background: Previous studies of bone resorption around failed joint replacements have focused on a limited number of cytokines, primarily tumor necrosis factor-α (TNF-α), interleukin (IL)-1, and IL-6, with use of enzyme-linked immunosorbent assay and immunohistochemistry techniques. In this study, we utilized high-throughput protein chips to profile twenty-nine inflammatory cytokines around failed total joint replacements. Methods: Peri-implant granulomatous tissues were harvested from around the failed total hip prostheses of thirteen patients. Synovial lining capsular tissues from thirteen patients with end-stage degenerative joint disease were used as controls. After homogenization, twenty-nine cytokines were quantified with use of high-throughput protein chips. Results: IL-6 and IL-8 were found consistently in failed joint replacement tissues, reaffirming their prominent role in osteoclastogenesis and end-stage bone resorption. High levels of interferon-γ-inducible protein of 10 kDa (IP-10) and monokine induced by interferon-γ (MIG), both chemoattractants of activated Th1 lymphocytes, were also detected. Soluble intercellular adhesion molecule (sICAM) and transforming growth factor-β1 (TGF-β1) were not detected universally, nor were TNF-α or IL-1. After a twenty-four-hour organ culture, IL-1β levels increased substantially along with those of other mediators. We measured but did not detect any activators of cytotoxic T-cells, antibody-producing Bcells, or eosinophils involved in delayed-type hypersensitivity. Variations from patient to patient were seen across all cytokines and highlight the unique response of individual patients to their joint replacements. Conclusions: In failed total joint replacements in patients with end-stage osteolysis, IL-6 and IL-8 may be the primary drivers of osteoclastogenesis. The presence of IP-10 and MIG imply a role for T-cells, while TGF-β1 and sICAM may represent a systemic attempt to modulate the inflammation. TNF-α and IL-1 do not appear to play a major role in the end stages of the disease. Clinical Relevance: These results demonstrate that proteomic tools can provide a foundation for understanding the cytokine-driven osteolysis cascade and a base from which to identify and evaluate potential targets for blockage or augmentation.

Ergebnisse endoprothetischer Versorgung bei Patienten vor dem 50. Lebensjahr

Arthroplasty has become the most successful surgical procedure in developed countries. Replacement of severely damaged joints results in a substantial relief of pain, as the main symptom of osteoarthritis, in the majority of treated patients. With improved results in endoprosthetic surgery over the last decades, however, patients are increasingly undergoing the procedure to enhance their functional capacity and physical mobility. Especially younger patients, who cannot accept a restriction in their professional or sports activity, have become demanding candidates for surgery. This review summarizes the published results on shoulder, hip, knee, ankle and first metatarsophalangeal joint replacement in patients who are younger than 50 years of age. Mid- and long-term follow-up studies in this age group are evaluated in terms of prosthesis survival as well as functional improvement.

Total joint replacement in patients with inhibitors

Today, total joint replacement is the treatment of choice for chronic haemophilic arthropathy of the knee and hip in developed and developing countries. After the last World Haemophilia Congress and Musculoskeletal Congress, we cannot say the same for haemophilic patients with inhibitors because elective surgery today is still limited to few centres and extremely few patients. This is because until the first half of the 1990s, performing surgery in haemophilic patients with inhibitors was associated with a high risk of bleeding. With the availability of activated recombinant factor VII, the first surgical procedures were performed, but they still remain limited because of the elevated costs of replacement therapy. Our goal for the future must be to ensure the same possibility of surgical intervention in haemophilic patients both with and without inhibitors. This will be possible, thanks to the experience of some centres with an increased number of patients, where today this kind of surgery is routinely performed.

Anaesthesia for total hip replacement in Gaucher's disease

EDITOR: Gaucher's disease, the most common lysosomal storage disorder, is an enzymatic defect with consequent accumulation of undegraded glucocerebroside in cells of the monocyte–macrophage system [1]. Most patients present with enlargement of the spleen and liver resulting in hypersplenism, with thrombocytopaenia generally more significant than anaemia. Skeletal involvement, particularly osteonecrosis of large joints and pathological fractures, invariably is the most significant cause of morbidity and decreased quality of life. In spite of enzyme replacement therapy, osteopaenia and osteonecrosis continue to be clinically important. The need for total hip replacement (THR), and subsequent revision, is relatively common in these patients at a relatively young age. With regard to the anaesthetic management for orthopaedic surgery in patients with Gaucher’s disease, only one case report appears in the literature of an adult with a sub-capital hip fracture who underwent subarachnoid anaesthesia [2]. We wish to report the anaesthetic management of all cases seen in our institution for THR or revision from 1990 to 2005. Patient characteristics and perioperative data are summarized from the clinical records and presented in Table 1.Table 1: Patients with Gaucher’s disease: patient characteristics and perioperative data expressed as mean ± SD (range) or number (%) of patients.There were 14 patients, 10 males and 4 females, who underwent THR. Five of these underwent a revision. Six patients (43%) were homozygous for the mild N370S (1226) mutation; eight patients (57%) had been splenectomized; and six patients (43%) had pulmonary hypertension at the time of surgery. Fifty-three percentage of patients underwent general anaesthesia. Five of the operations (21%) were performed with preoperative platelet counts <80 × 103 mm−3. Perioperative blood product transfusion was required in 68% of the operations. All patients with general anaesthesia were orally intubated utilizing direct laryngoscopy and ventilated with tidal volume 6–8 mL kg−1 and respiratory rate of 10–16 min−1. There were no difficulties in airway management. All patients were given preoperative antibiotic prophylaxis mainly with cefamezine; nonetheless, 37% experienced postoperative wound infections presenting significantly higher rates compared to similar patients in our institution (2%) and the rate reported in medical literature (0.3–2%) [3]. A wound infection was defined as one of the following: wound redness, excessive pain, tissue necrosis, local oedema, purulent discharge from the operation wound and maximal temperature >38.5 and/or white cell count >10 000. Other complications included one inadvertent spinal, one failed spinal and one patient with severe postoperative thrombocytopaenia (21 × 103 mm−3). Joint replacement for patients with Gaucher's disease is an important therapeutic intervention that dramatically reduces pain, improves functionality and increases quality of life. For patients with Gaucher's disease, the preoperative evaluation of haematological status is of primary concern. Many have very low platelet counts with or without abnormal platelet function [4]. Thrombocytopaenia may be sufficiently severe as to preclude regional anaesthesia [5]. In minor procedures (e.g. dental extractions) we have successfully used platelet transfusions immediately prior to and directly after surgery. Coagulation factor deficiencies are also common in this population and may occur independently of platelet abnormalities. A relatively large percentage (44%) in this cohort had pulmonary hypertension at surgery. This complication reflects disease severity but we have also posited a possible connection with enzyme replacement therapy [6], so that a history of enzyme treatment does not preclude abnormal lung function. In these most severe cases, regional anaesthesia may be preferred because of pulmonary hypertension. In conclusion, patients with Gaucher’s disease undergoing THR may have associated medical conditions such as pulmonary hypertension and coagulopathy that complicate their anaesthetic management and postoperative course. Further, they are at high risk for development of postoperative infection. We strongly recommend a multi-disciplinary approach that includes internal medicine, anaesthesiology and orthopaedic surgery when planning of major orthopaedic procedures in patients with Gaucher’s disease.

A Comparative Study of Outcome between the Neuflex and Swanson Metacarpophalangeal Joint Replacements

This prospective double blind trial compares the clinical findings of Swanson and Neuflex metacarpophalangeal joint replacements in patients with rheumatoid arthritis, up to 2 years follow-up. There were 37 joints (10 patients) in the Swanson group and 40 joints (12 patients) in the Neuflex group. Assessments of range of movement, grip strength and hand function were undertaken in a double blind fashion, pre-operatively and up to 2 years following implantation. The mean and standard deviation of the data were calculated. A two-tailed student's t-test was used when comparing groups of data. An X-ray analysis was also undertaken to identify any implant failure. There was no significant difference between the two groups with respect to flexion and extension before surgery. At follow-up there was also no significant difference in the extensor lag, with mean extension lags of 19 degrees and 16 degrees for the Swanson and Neuflex implants, respectively. However, there was a significant difference in flexion, with mean active flexion values of 59 degrees and 72 degrees for the Swanson and Neuflex implants, respectively. There were no differences between the two groups in respect to arc of metacarpophalangeal joint motion, ulnar deviation, grip strength or the SODA function test at follow-up. At this early stage there was no evidence of any case of implant failure. In conclusion, patients who underwent Neuflex metacarpophalangeal joint replacements obtained greater flexion than those who underwent a Swanson replacement.

Total joint replacement in patients with dementia syndromes: a report of thirteen cases.

The hospital course and clinical outcomes of 14 joint replacement surgeries in 13 patients with dementia syndromes were evaluated. Eight patients were disoriented postoperatively. Complications included slow progress in physical therapy, getting out of bed unattended, aggressive behavior, pulling out an intravenous or Foley catheter, and falling out of bed. Three patients were unable to comprehend their movement restrictions, resulting in one dislocated hip from bending and twisting. Eleven of twelve joints available for follow-up were believed to be painless and functional. One patient was inactive due to fractures secondary to osteoporosis. Although complications arise from patients' disoriented status, total joint replacement relieves pain, and the patients' relatives indicated satisfaction with the results of the surgery. The family of a patient with dementia syndrome must be actively involved in all aspects of care after total joint replacement.

Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip.

Total joint replacement in patients suffering from developmental dysplasia of the hip poses specific technical difficulties due to insufficient bone stock at the site of the original and secondary acetabulum and a narrow, cranially displaced proximal femur. Twelve hips with severe congenital dislocation (4 Crowe type II, 5 type III, 3 type IV) were treated with cementless, porous structured total hip replacement. The cup was implanted at the anatomic height, a femoral segment was resected below the minor trochanter to reduce the femoral component in all cases. One femoral component was exchanged for a longer stem after 2 months due to insufficient fit and fill. After a mean follow-up of 5.1 years, there were no further revisions or radiographic signs of loosening. No cup was revised or loose radiographically. Harris hip score (mean) improved from 36 to 82 points, mean leg length discrepancy was reduced from 5.4 to 1.3 cm. The cementless technique described is useful in cases of severe congenital dislocation of the hip when the cup is implanted at the anatomic level, and implant reduction is not possible despite thorough soft-tissue release or not advisable because of excessive limb lengthening. A reconstruction of the original joint center and good mid-term results are demonstrated.

Evaluation of respiratory status and mandibular movement after total temporomandibular joint replacement in patients with rheumatoid arthritis

We performed total TMJ replacement to improve respiratory status and correct occlusion in six patients with destruction of the temporomandibular joint (TMJ) caused by rheumatoid arthritis. Morphological changes were evaluated on lateral cephalograms before and after surgery. Respiratory function and mandibular movement were assessed with the use of an apnea-monitor and an LED mandibular tracking device, respectively. After surgery, symptoms such as snoring and daytime sleepiness improved, and solid food could be masticated. Postoperative cephalograms showed that both the posterior airway space and ramal height were significantly improved by surgery. Postoperative records of mandibular movement indicated stability of the occlusion and improvement of mandibular movement, as compared with the preoperative records. Mean oxygen saturation significantly improved 1 month after surgery, whereas apnea and apnea-hypopnea indices did not change significantly.

Changes in the concentration of plasma matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases-1 (TIMP-1) after total joint replacement in patients with arthritis.

Matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) have been reported to be associated with arthritis. Total joint replacement results in total resection of cartilage and synovium at the joint. We investigated longitudinal changes in plasma MMP and TIMP after total joint replacement. Eight patients with osteoarthritis (OA) and 15 patients with rheumatoid arthritis (RA) had total knee or total hip replacements. Plasma was collected from all patients before surgery and at 1 week and 6 weeks after surgery. In RA patients the plasma MMP-3 and the MMP-3/TIMP-1 ratio decreased after total joint replacement, whereas CRP and ESR did not change. Therefore, CRP and ESR reflect systemic inflammation; however, plasma MMP-3 and the MMP-3/TIMP-1 ratio may reflect inflammation and/or degeneration of the affected joint.

Evaluation of explicit criteria for total hip joint replacement

We tested an appropriateness of indications tool for total hip joint replacement in patients with osteoarthritis. Criteria were developed using a modified Delphi panel judgment process. Ratings were analyzed regarding level of agreement among panelists. Another panel rated the same indications; results were compared with the main panel. Test-retest of the main panel was performed. Regression models were used to assess the contribution of each algorithm variable. Appropriateness indication judgment was applied to 84 patients and compared to health-related quality-of-life improvement before and 3 months following intervention. Main panel ratings compared to those of a second panel resulted in a kappa statistic of 0.77. Test-retest kappa for the main panel was 0.81. Patients considered appropriate candidates for surgery, based on their composite indication scores, showed more improvement in health-related quality of life after 3 months than those considered inappropriately by composite indication scores. The previous parameters tested showed acceptable results for an evaluation tool. These results support the use of this indications algorithm as a screening tool for assessing the appropriateness of hip replacement surgery in osteoarthritis.

A Retrospective Study of Two Measures of Functional Outcome for Metacarpophalangeal Joint Replacement in Patients with Rheumatoid Arthritis

With the aim of determining the relative merits of two functional assessments used to measure outcome for metacarpophalangeal joint arthroplasty and their relationship to range of motion a retrospective study was carried out on patients with rheumatoid arthritis who underwent Swanson Silastic® metacarpophalangeal joint replacement between 1986 and 1997. Records of pre-operative and post-operative functional tests were completed for 30 hands in 27 patients (64 joint replacements) and range of motion measurements on 29 hands in 26 patients (60 joint replacements). Two functional tests had been used: the Upper Extremity Function Test (33 sub-tests) for 19 hands (Group A) and the Hand Grip Test (20 sub-tests) for 11 hands (Group B). The pre-operative timing of assessments was on average 4.1 months for Group A and six months for Group B and the post-operative timing 4.1 months and 4.3 months respectively. The functional tests demonstrated an average change of 22% (CI 15.8 to 28.3) in Group A and 7.5% (CI −1.1 to 16.1) in Group B. Range of motion was calculated as Total Active Motion for all fingers and demonstrated in Group A an average change for index of 11.5° (CI −6.5 to 29.5), middle 27.3° (CI 3.3 to 51.3), ring 23.3° (CI 1.1 to 45.5) and little finger 31.7° (CI 2.8 to 59.7). Total Active Motion in Group B averaged a change for index of 12° (CI −4.0 to 28.0), middle 18.5° (CI −8.1 to 45.2), ring 9.5° (CI −13.1 to 32.0) and little finger 17.7° (CI −8.3 to 43.8). Overall a greater improvement was demonstrated with the Upper Extremity Function Test while Total Active Motion did not always show improvement. The more severe pre-operatively deformed hands showed most improvement. For those with less severely deformed hands, the Hand Grip Test may not be sensitive enough to detect functional difficulties.

Total hip replacement in presence of acetabular dysplasia type II according to the AAOS classification

Incorporation of the acetabular cup in ideal position in patients with a primary dysplastic acetabulum. Two thirds of the surface of the cup must be covered by bone. Joint replacement in patients with acetabular dysplasia type II according to the AAOS classification. Presence of acetabular dysplasia types I and III according to the AAOS classification. Radiographic measurement of the acetabular depth and width using templates. Supine, affected side of pelvis slightly elevated. General or spinal anaesthesia. Special set of instruments mandatory. Insertion of an acetabular cup through a lateral approach. Reaming of the acetabulum and filling of the defect under compression with a mixture of autogenous, morcellized bone from the resected femoral head and fibrin glue. Coverage of the transplanted bone with a pedicled capsular flap. Phlebitis prophylaxis. Walking with 2 forearm crutches on the first postoperative day. Removal of stitches after 10 days. Thereafter gradual increase of weight bearing (10 kg every second day, use a bathroom scale to check loading). Once full weight bearing and full muscle control have been reached, use of 1 crutch is allowed. Radiographic control after 6 weeks, 3,6 and 12 months and yearly thereafter. Perforation of the bony acetabulum. Fracture of the anterior or posterior acetabular rim. Thrombophlebitis, lung embolism, infection and/or periarticular ossification. Between 1986 and 1994 the technique has been used in 140 hips with congenital dysplasia (type II according to the AAOS classification) and secondary osteoarthritis. 132 hips were regularly assessed and the mean of follow-up was 6.2 years (1 to 9 years). The mean age of the mostly female patients was 48 years (28 to 62 years). Only porous surfaced metallic cups without cement were used. The following complications were observed: thrombophlebitis 1, superficial infection 1, transient paresis of the fibular nerve 1 and transient irritation of the femoral nerve 3 (see Table 2). Additional complications such as thigh pain, periarticular ossification and resorption of the bone graft are listed in Table 3. Complete bony incorporation of the bone grafts was seen in 122 hips. Resorption up to 8 mm occurred in the remaining 10 hips.