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We report the clinical and operative details of seven cases of fracture of the femoral stem of the Ring TiMESH cementless hip prosthesis (two were cemented and five uncemented). Six fractures occurred in the proximal one-third of the stem and one at mid-stem. The failures are attributed mainly to two defects in stem design, the narrowness of the anteroposterior dimensions and the depth of the recess for the titanium mesh pads. Great difficulty was experienced in removing the osseo-integrated distal fragments of the broken stems.

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Modern day fast bowling places immense strain on the spine. Stress fractures of the lumbar region are common. If a period of conservative treatment fails to return a fast bowler to professional sport, surgery is considered. Good results have been reported using a direct screw repair of the spondylolytic defect. A case is presented of a failed surgical intervention with an alternative technique.T he physical demands of the modern game of cricket is known to cause a variety of injuries. The professional era has resulted in most players being involved for the entire year, and this intensity places a huge strain on these sportsmen especially the fast bowlers.The action of fast bowling places immense stresses on the spine, taking place as many as 300-600 times a week.1 The movements of hyperextension, lateral flexion, and thoracolumbar rotation in combination with a jerk force occurring when the fast bowler lands during his delivery stride are all major factors in the development of spondylolysis and spondylolisthesis.2 Stress fractures of the lumbar spine are common, and indeed the incidence of spondylolysis in a prospective group of young fast bowlers has been reported to be as high as 54%. 3 We report a case of a failed operative procedure in a young fast bowler. CASE REPORTThis case involved a very promising 19 year old fast bowler who developed bilateral L5 spondylolysis, diagnosed radiologically, after he had experienced an acute episode while playing for his county side. After three months of conservative treatment of rest and wearing of a corset, he was still unable to resume bowling and so it was decided that he would benefit from surgical intervention.He underwent an L3/L4/L5/S1 fusion which involved posterior stabilisation of the lumbar spine with MeurigWilliams plates secured either side of the midline by screw fixation through the respective spinous processes. This procedure was performed outside our department at the end of that cricket season (September 1982). Postoperative recovery and rehabilitation were uneventful, and he returned to start the following season at full fitness without pain. However, during the early part of the season, he noticed swelling in the lumbar region, increasing in response to the exertion of bowling. Radiographs taken at this time showed that the lowermost screw had broken. It was decided to remove this screw as it was thought to be the cause of the swelling. Postoperative recovery was swift, and he again returned to full fitness. However, during this season he again noticed the lumbar swelling, but this did not impair his performance and he was selected to play at international level. Repeat radiographs showed that further screws had broken and the metalwork had become loose (fig 1). On examination at this stage there was a large fluctuant inflammatory swelling (some 25 cm in diameter), and this required regular drainage over the five days of his debut Test match. Microbiological assessment found no evidence of infection, and over 1 litre of fluid was aspirated. He was abl...