We carried out a prospective study looking at the functional outcome and post-procedure segmental instability after lumbar decompression using a flip osteotomy technique that involved unilateral subperiosteal muscle dissection with hinging of the spinous processes thereby preserving the integrity of the posterior elements for unilateral or bilateral lumbar spine decompression.

Between February 2007 and February 2008, 51 patients (29 male and 22 female) diagnosed with degenerative and congenital lumbar stenosis with an average age of 60, underwent central and lateral canal decompression using the flip osteotomy technique. An average of two segments (range 1-3 segments) was decompressed. Patients with a history of previous spinal surgery, spinal fusion, existing degenerative spondylolisthesis or cauda equina syndrome were excluded.

All patients were followed up for a mean of 1.5 years. Five outcome measures were used – visual analogue scale for pain, Likert scale for functional status, symptom specific well-being score, general well-being score, number of days incapacitated in last 4 weeks. The outcomes measures were recorded pre-operatively, 6 weeks and one year post-operatively. Successful surgical outcome was defined as an improvement in at least four out of five outcome measures.

90% (46 patients) of patients had a successful surgical outcome. There was a statistically significant improvement in all outcome criteria (p<0.005) at the 6-week post-operative mark as compared to pre-operatively, with marginal improvement at one year post-surgery. There was no evidence of progressive lumbar segmental instability at one year post-operatively using our flip osteotomy technique

Decompression of the lumbar spine for lumbar stenosis using the flip osteotomy technique is a safe approach for one or multi-level stenosis with good outcomes and no evidence of significant iatrogenic segmental spinal instability.

We declare no conflict of interest and ethical approval was obtained

Introduction: Of all hip arthroplasties conducted annually, a proportion will subsequently require revision for aseptic loosening and periprosthetic osteolysis. Osteolysis may develop ‘silently’ and monitoring of patients is recommended. This should include x-rays as progressive changes in size of a lesion may indicate a potential failure. Area measurement of osteolysis has been achieved in a number of ways but with techniques that are not readily available in routine clinical practice. The aim of this study was to develop a method for routine assessment of hip arthroplasty to quantify osteolytic changes seen on x-ray, applicable by any health professional and with good inter-observer reliability.

Methods: A morphometric grid is superimposed on an object of interest and the number of test points that fall within a defined area counted. A specialized grid was developed and initial testing was conducted on twenty simulated osteolytic lesions. Subsequent testing was on thirty-five arthroplasty x-rays with evidence of osteolytic lesions. Four observers recorded the number of crosses seen over each lesion. The observers were representative of health professions and levels of experience involved in arthroplasty review.

Data was analysed for both inter-observer and test-retest reliability using the intra-class correlation coefficient and the Bland-Altman method (use of two methods provides a better estimation of accuracy).

Results: The results for intra-class correlation coefficients on both simulated and actual lesions were all excellent (range 0.90 to 0.98) as confirmed by visual representation using the Bland-Altman method.

Discussion: Regular follow-up of hip arthroplasty with x-ray ensures that changes are monitored even when symptoms are absent. We believe that this tool can improve the process through quantitative assessment of osteolytic lesions. The scientific development supports the reliability of the tool when used by a number of raters and the simplicity of application makes it a useful addition to an arthroplasty clinic.

Introduction: Blount’s disease is an idiopathic, non-physiological form of genu varum. Deformity usually occurs in the proximal tibia with progressive varus, but also with valgus in the distal femur. Treatment in the infantile stage includes observation or bracing, and surgery for acute marked proximal tibial varus. Recurrence is common with conventional surgery after the age of four.

Method: A new surgical technique is proposed as definitive treatment of this condition which includes an arthrogram to visualise the knee joint, acute elevation of the varus aligned medial tibia plateau with second plane correction of posterior slope deformity, lengthening and derotation of the tibia by application of a Taylor spatial frame, application of an 8 plate on the distal femur to correct valgus deformity and finally proximal tibial and fibular epiphysiodesis to prevent recurrence.

Results: Five patients with Blount’s disease had this definitive corrective procedure performed at a mean age of 9.8. Radiographs and CT scans taken pre-operatively demonstrated marked medial plateau varus deformity and increased posterior slope. Surgery was performed by the senior author. Follow-up X-rays demonstrated satisfactory alignment, length and rotation of the lower limb.

Conclusions: This new surgical technique allows correction of all deformities of Blount’s disease at one operation and maintains alignment, length and rotation clinically and radiologically at follow-up.

Hip resurfacing is a relatively new concept in hip arthroplasty, but is being performed more frequently in the United Kingdom.

We compared anteroposterior radiographs of 30 patients who had undergone cemented hip resurfacing (Cormet) with those of 30 patients who had undergone uncemented hip resurfacing (Cormet). All operations were performed using the anterolateral approach. We measured the acetabular offset, femoral offset, stem shaft angle, medialisation of the cup, head/neck ratio, cup height, leg length, and the implant seating pre-operatively, immediately postoperatively and one year postoperatively. The data were analysed by paired t-tests.

There were no significant differences between any of the measurements at all three time periods. This demonstrates no loss of offset, no femoral neck thinning and no leg length reduction. We note a smaller femoral offset and a reduction on average of 2mm in seating of the femoral implant in the uncemented group as compared to the cemented group. This we attribute to movement of the femoral implant in the first year post-operatively, and as such restoration of the femoral offset to the pre-operative level.

We conclude that uncemented hip resurfacing does not show any statistical benefit over cemented hip resurfacing, although we did observe a more accurate reproducible femoral offset with better seating of the implant in the uncemented group. We also note that there was no neck thinning in any of these patients at one year post-operatively.

The results of a functional, clinical and radiological study of 30 children (60 hips) with whole body cerebral palsy are presented with a mean follow-up of ten years.

Bilateral simultaneous combined soft-tissue and bony surgery was performed at a mean age of 7.7 years (3.1–12.2).

Evaluation involved interviews with patient/carers and clinical examination.

Plain radiographs of the pelvis assessed migration percentage and centre-edge angle.

Twenty two patients were recalled. Five had died of unrelated causes and three were lost to follow-up.

Pain was uncommon, present in 1 patient (4.5%). Improved handling was reported in 18 of 22 patients (82%). Carer handling problems were attributed to growth of the patients. All patients/carers considered the procedure worthwhile.

The range of hip movements improved, with a mean windsweep index of 36 (50 pre-operatively)

Radiological containment improved, with mean migration percentage of 20 degrees (50 preoperatively) and mean centre-edge angle of 29 degrees (−5 preoperatively) No statistical difference was noted between the three year and ten year follow-up results demonstrating maintained clinical and radiological outcome improvement.

In conclusion, we consider that bilateral simultaneous combined hip reconstruction in whole body cerebral palsy provides painless, mobile and anatomically competent hips in the long term.

Purpose of study: To assess functional, clinical and radiological outcomes of 30 children (60 hips) with whole body cerebral palsy with a mean follow-up of ten years.

Method: Bilateral simultaneous combined soft-tissue and bony hip surgery was performed at a mean age of 7.7 years (3.1–12.2). Evaluation at ten years involved interviews with patient/carers and clinical examination. Plane radiographs of the pelvis assessed migration percentage and centre-edge angle.

Results: Twenty two patients were recalled. Five had died of unrelated causes and three were lost to follow-up. Pain was present in only 1 patient (4.5%). Improved handling was reported in 18 of 22 patients (82%). Carer handling problems were attributed to growth of the patients. All patients/carers considered the procedure worthwhile. The range of hip movements improved, with a mean windsweep index of 36 (50 pre-operatively) Radiological containment improved, with mean migration percentage of 20 degrees (50 preoperatively) and mean centre-edge angle of 29 degrees (−5 preoperatively) No statistical difference was noted between the three year and ten year follow-up results, demonstrating sustained improvement in the clinical and radiological outcome.

Conclusions: Bilateral simultaneous combined hip reconstruction in whole body cerebral palsy provides painless, mobile and anatomically competent hips in the longer term.

The majority of the available literature considers the short term outcome of surgical reconstruction of the hips in this condition. This paper demonstrates that the initial improvements in structure and function are maintained in the longer term.