Fractures through cystic lesions of the greater trochanter. A cause of late pain after cementless total hip arthroplasty

Four patients who presented with sudden onset of hip pain 7 to 11 years after successful porous-coated cementless hip arthroplasty are described. These four patients were all diagnosed to have fractures through osteolytic cysts in the greater trochanter. One patient was seen initially with a displaced fracture of the greater trochanter. Two patients were treated operatively with curettage of the cystic area and with polyethylene exchange. One of these patients underwent revision of the femoral component in addition to the polyethylene exchange. Two patients were treated nonoperatively. The fractures treated nonoperatively have healed and the patients have resumed their normal activities. This report should stimulate an awareness of fractures through cystic lesions of the greater trochanter as a late cause of hip pain after porous-coated cementless hip arthroplasty.     

Treatment of major defects of bone with bulk allografts and stemmed components during total knee arthroplasty

We reviewed the results an average of fifty months (range, twenty-four to 120 months) after the use of thirty-five allografts in thirty patients during primary or revision total knee replacement. Twenty-nine femoral-head allografts, five distal femoral allografts, and one proximal tibial allograft were used in conjunction with a long-stemmed implant to reconstruct large osseous defects. The patients were evaluated clinically, radiographically, and subjectively (with use of a questionnaire). Twenty-six (87 per cent) of the thirty patients had a good or excellent clinical result, and no revisions were necessary. As none of the patients had collapse of the graft, subsidence of the implant, or revision, we believe that the outcome of treatment with a femoral-head allograft, particularly in association with a component inserted with cement, is excellent. Four non-porous-coated components were placed without cement on structural allografts. Radiographically, three of those components subsided, but none of the three needed revision and two were associated with a good clinical result. Our current practice is to cement components in all arthroplasties involving grafting. Our findings suggest that the use of a stemmed component reduces the stress on the allograft, host bone, and fixation interface. In addition, such a component contributes to the longevity of a total knee replacement associated with a bone graft. Additional studies with long-term follow-up are necessary to confirm this outcome.     

A critical look at ISO 9000 for software quality management

A considerable number of software suppliers report improvements in product and service quality, development costs and time to market achieved with the help of the ISO 9000 standards. Nevertheless, the ISO 9000 family has received unfavourable criticism in journals, textbooks and at software quality conferences. The paper summarizes, discusses and reviews eleven of the most popular arguments against the ISO 9000 standards. The review of the criticism is based on findings of two empirical surveys among European software suppliers that have implemented an ISO 9000 quality system. The paper concludes with suggestions and guidelines for advances in software quality management concepts, such as the ISO 9000 family, CMM, BOOTSTRAP and the emerging SPICE standard.