Thirty-three Girdlestone's arthroplasties used to salvage infected total hip replacements were followed for a mean of 6.2 years to assess the efficacy of this procedure. Subjective and objective assessment was obtained at the time of review. Gram-negative organisms, retained cement, bony sequestra and secondary healing were common features of the five patients (15%) whose wounds discharged for more than four weeks after operation. Girdlestone's arthroplasty provided satisfactory pain relief in 91% of patients, and control of infection in 97%. Although leg-length discrepancy (mean 4 cm) and a Trendelenburg gait made walking difficult and tiring , 42% were satisfied with their functional ability; 85% needed walking aids, and 3 patients could not walk at all and were confined to bed or a chair. Overall, 79% were satisfied. Objectively, the mean Harris hip rating was 60; however, if patients with multiple joint problems were excluded, this score increased to 77. Girdlestone's arthroplasty seems a reasonable salvage procedure in the management of an infected total hip replacement and the results seem to improve with time.

From the Hospitalfor Sick Children, Toronto Eighteen patients with acute dislocation of the patella had associated osteochondral fractures. This fracture complicates approximately 5 per cent of all acute dislocations of the patella occurring in children. Three types of fracture patterns were noted. All patients who were freated by immediate arthrotomy and

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We measured the detailed pressure distribution under pneumatic tourniquets and Esmarch bandages in canine limbs. The results showed that pressure concentration can occur in the tissue under the tourniquet. The Esmarch-bandage tourniquet was shown to be capable of producing pressures in excess of 1000 millimeters of mercury immediately beneath the tourniquet. There is a wide variation between cuff pressure and the pressures in the underlying tissues. CLINICAL RELEV ANCE: Because pressure concentration can occur in certain situations, the pressure on nerves underlying a tourniquet may be higher than expected. Although the precise relationship has not been determined, a wider tourniquet relative to limb diameter will generally lead to greater pressure concentration in the deep tissues. In these situations, the risk of nerve injury is increased. * T hi s work was supported by a gra nt fro m the Ph y ic ia ns• Services. Incorporated. of the Province of Ontario. t Orthopaedic Assoc iates. Suite 3 12 Victoria Building. 111 Wate rl oo Street. London. Ontari o N6B 2M6. Canada. + Uni versi ty Hospita l. 339 Winde rmere Road. Londo n. O nt ario N6A 5AS , Canada .

Providing a long-lasting total hip arthroplasty for patients younger than 50 years remains one of the greatest challenges for modern arthroplasty surgery. We retrospectively reviewed 221 patients younger than 50 years who underwent 299 uncemented total hip arthroplasties from 1983 to 2000. We assessed 5- to 15-year survival with revision as the endpoint. Femoral stem survival was 99.3% (range, 98.4-100%), 98.9% (range, 97.7-100%), and 96.8% (92.5-100%) at 5, 10, and 15 years, respectively. Including all component designs acetabular survival was 98.7% (range, 97.4-100%), 84.6% (78.8-90.4%), and 52.5% (40.7-64.3%) at 5, 10, and 15 years, respectively. Overall survival was 46.8% (33.5-58.1%) at 15 years. Total hip arthroplasties performed for hip dysplasia had lower 10-year and 15-year survival. Zirconium-on-polyethylene articulations had lower acetabular revision rates compared with cobalt-chrome-on-polyethylene. Sixty-nine revisions were performed, most commonly for polyethylene wear. Uncemented femoral stems resulted in 90% survival at 15 years followup in patients younger than 50 years at index operation. Contemporary bearing surfaces in association with such stems may provide long-lasting total hip arthroplasties, even in young, active patients.