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The long-term clinical results of a novel concept for total joint replacement called the Thrust Plate Prosthesis (TPP) are presented. Only a restricted number of patients were provided with this new prosthesis (115 at the Orthopedic Department, Canton Hospital, Chur, and 47 at the Department of Orthopedic Surgery, University of Zurich). All patients have undergone clinical and radiological follow-up covering a period from 1980 to 1991. The basic feature of the Thrust Plate Prosthesis is the direct load transfer to the medial cortical bone of the femoral neck, and this has been unchanged since 1978. Titanium alloy has been used since 1986. The good clinical and radiological results are confirmed by a histological examination of an 8-year-old implant: In the crucial area of load transfer newly formed bone can be seen in direct contact with the thrust plate without fibrous tissue in between. The clinical results and histological findings have confirmed the validity of the biomechanical principle of the TPP. The TPP is therefore to be considered a true alternative to the conventional hip prosthesis. In contrast to the conventional intramedullary anchored stem prosthesis the TPP requires the removal of a minimum amount of bone stock, which is certainly important in young patients.

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The problems related to infections of hip- and knee-prostheses are generally known. The aim of the operation- a mobile and painless joint is jeopardized. The best therapeutic measure has to be evaluated individually by a differentiated diagnostic procedure. The health condition of the patient, type and localization of the infection, bacteriology and resistance of the microbes as well as the biomechanical condition of the artificial hip joint and the trophic quality of bone and soft tissue play an important role. The different therapeutic concepts we can dispose of should take these factors into account, so that a successful healing may be expected in 80 to 90% of the cases.

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A new femoral prosthesis with a stemless design, different from conventional types, has been conceived in an effort to preserve the physiological stress distribution in magnitude and direction within the living bone as far as possible. The most important feature is that the hip joint forces are transmitted directly to the cortical bone of the resected femoral neck by means of a thrust plate, which maintains the physiological stress an the proximal end of the femur. The prosthesis, the instruments required for its implantation and the surgical technique are described in detail. Up to now, 3 patients have received this new prosthesis.

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Following drug-induced agranulocytosis and antibiotic and steroid treatment, sepsis due to candida albicans together with bilateral fungal coxitis developed in a 41-year-old female patient. Satisfactory eradication of the inflammatory process was achieved with combined treatment with amphotericin B and 5-fluorocytosine, so that mobilisation was possible after surgical fitting of bilateral total endoprothesis.

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The instable fractures of os calcis are usually treated by conservative methods with early functional mobilization. In a few cases we think that in the Tongue Type and especially in the Joint Depression Type of Essex-Lopresti a surgical treatment may be useful to reestablish the congruence and the gometry of the joint surfaces. Some typical cases are described. Even if this active treatment of fractures of the os calcis may be generally regarded as hazardous, we think that especially in young selected individuals an operative anatomical reduction and stable fixation may be appropriate.

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A comparison of the stresses determined in an expoxy model of the human femur both with and without an intramedullary endoprosthetic replacement indicates how loosening of the implant could occur due to inappropriate mechanical loading of the bone. The stress pattern explains the manner in which the prosthesis stem is loaded and also indicates how hip-joint forces are transmitted from the prosthesis to the bone. The results obtained were verified by strain measurements on prostheses implanted within fresh human cadaver femora.

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The instable fractures of os calcis are usually treated by conservative methods with early functional mobilization. In a few cases we think that in the Tongue Type and especially in the Joint Depression Type of Essex-Lopresti a surgical treatment may be useful to reestablish the congruence and the geometry of the joint surface.

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A muscle activated dynamic plastic reconstruction of the fibular ligaments of the posttraumatic weak ankle is presented and the operative technique is described. The most important advantages of this operation are compared with known methods.

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