Introduction

The purpose of our study was to retrospectively analyze our patients who were treated for FH and PFFD by means of guided growth temporary Hemiepiphysiodesis.

We sought to determine the effectiveness of the procedure, as well as its success rates, complications, and rebound phenomena.

To investigate the proportion of dysplastic hips which are retroverted. We studied the radiographs of over seven hundred patients with dysplastic hips who had had a periacetabular osteotomy in the period 1984–1998. We excluded patients with neuromuscular dysplasia, Perthes’ disease of the hip, post-traumatic dysplasia and proximal focal femoral deficiency. We selected 232 radiographs of patients with congenital acetabular dysplasia. A number of parameters were measured including lateral centre-edge angle, anterior centre-edge angle, acetabular index of weight-bearing surface, femoral head extrusion index and acetabular index of depth to width. Also recorded were acetabular version and congruency between femoral head and acetabulum. The lateral centre-edge angle of Wiberg had a mean value of 6.4° (SD 8.9°), the mean anterior centre-edge angle was 1.3° (SD 13.5°) and the acetabular index of weight-bearing surface of the acetabulum had a mean value of 24.5° (SD 9.7°). The majority (192, 82.8%) of acetabula were anteverted as might be expected. However, a significant minority (40, 17.2%) were retroverted. The mean anterior centre-edge angle in retroverted hips was 6.7° (SD 9.4°) compared with 0.4° (SD 13.3°) in anteverted hips. The authors have shown that, in a typical group of patients with congenital acetabular dysplasia significant enough to warrant periacetabular osteotomy, the majority of hips as expected have anteverted acetabula. However, a significant minority are retroverted. This finding has an important bearing on the performance of the osteotomy. We have also found that most if not all the information required prior to and following periac-etabular osteotomy can be obtained from an orthograde view of the pelvis

It is generally agreed that in acetabular dysplasia the acetabulum lies excessively anteverted. Although this is true for the majority of hips, we have found that in some patients with dysplastic hips, the acetabulum lies unexpectedly in retroversion. Aim: To investigate the proportion of dysplastic hips which are retroverted. Method: We studied the radiographs of over seven hundred patients with dysplastic hips and who had had a periacetabular osteotomy in the period 1984–1998. We excluded patients with neuromuscular dysplasia, Perthes disease of the hip, post-traumatic dysplasia and proximal focal femoral deficiency. We selected 232 radiographs of patients with congenital acetabular dysplasia. A number of parameters were measured including, lateral centre edge angle, anterior centre-edge angle, acetabular index of weight bearing surface, femoral head extrusion index and acetabular index of depth to width. Also recorded was acetabular version and congruency between femoral head and acetabulum. Results: The lateral centre-edge angle of Wiberg had a mean value of 6.4° (SD 8.9°), the mean anterior centre-edge angle was 1.3° (SD 13.5°) and the acetabular index of weight bearing surface of the acetabulum had a mean value of 24.5° (SD 9.7°). The majority (192, 82.8%) of acetabula were anteverted as might be expected. However, a significant minority (40,17.2%) were retroverted. The mean anterior centre-edge angle in retroverted hips was 6.7° (SD 9.4°) compared with 0.4° (SD 13.3°) in anteverted hips. Conclusion: The authors have shown that in a typical group of patients with congenital acetabular dysplasia, significant enough to warrant periacetabular osteotomy, the majority of hips as expected have anteverted acetabula. However, a significant minority are retroverted. This finding has an important bearing in the performance of the osteotomy

Introduction and Aims: Third generation alumina ceramic-on-ceramic bearings are being increasingly used in hip replacement surgery as an alternative to polyethylene because of the unacceptably high wear of polyethylene bearings and associated osteolysis leading to failure of hip replacement. Follow-up time with these modern ceramic bearings is still short. Method: We report the minimum five-year follow-up of our first 300 hip replacements with these bearings in 283 patients, done between June 1997 and February 1999. Three hundred ceramic-on-ceramic Osteonics Securfit or Securfit Plus stems were used with the Osteonics Securfit cup in all cases – these are cement-free and hydroxyapatite coated. The bearings were third generation alumina ceramic femoral heads and cup inserts manufactured by CeramTec. The average age was 58 years and there were 52% females. Osteoarthritis was the diagnosis in 93% and inflammatory arthritis in four percent. We used 92% 32mm bearings and eight percent 28mm bearings. Results: Mean Harris hip score improved from 56 pre-operatively to 94 at five years. Complications included: three non-fatal and no fatal pulmonary emboli, one deep and four superficial infections. There were four revisions for periprosthetic femoral fracture, one for cup malposition and one for sciatic nerve palsy in a patient with proximal focal femoral deficiency. There were a further four re-operations for psoas tendonitis where the psoas tendon was released. There were no re-operations for bearing failure and none of the ceramic components failed catastrophically, although a small number of acetabular inserts chipped around the rim during insert and were discarded. Of particular interest is the fact that there was no osteolysis seen in any of these hips, either around the acetabulum or around the femur. The usual small lytic areas noted around the calcar and the trochanteric regions of the femur that are commonly seen with polyethylene bearings were completely absent in this group. Three of the hips squeak intermittently with vigorous activity. Conclusion: Third generation ceramic-on-ceramic bearings have only been available for seven or eight years. Early results using these new bearings are encouraging, in that osteolysis to date has not been seen in this series. No hip in this series has been revised for failure of these ceramic implants. It will be a further five to 10 years before we can be certain how these newer bearings will perform in the long term, but the five-year results are encouraging

Aims

The standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals.

The December 2013 Children’s orthopaedics Roundup³⁶⁰ looks at: Long term-changes in hip morphology following osteotomy; Arthrogrypotic wrist contractures are surgically amenable; Paediatric femoral lengthening over a nail; Current management of paediatric supracondylar fractures; MRI perfusion index predictive of Perthes’ progression; Abduction bracing effective in residual acetabular deformity; Hurler syndrome in the spotlight; and the Pavlik works for femoral fractures too!