Coxarthrosis is a common problem. Changes in all articular structures during coxarthrosis were described extensively, besides labrum. This study was designed to:

describe histological changes in the labrum during coxarthrosis, and correlate them with radiographic changes

Methods: Consecutive patients scheduled for THR were analyzed. Cases of systemic disorders, septic arthritis of the hip, previous hip surgeries were excluded. All hips were assessed radiographically, and staged according to Hip Osteoarthrosis Radiographic Grading System (HORGS) and for etiology to: dysplastic, idiopathic and avascular necrosis (AVN) groups. From the group of 90 patients in 77 hips we were able to harvest hip labrum during THR. All labra were examined by histological techniques for the presence of: labral matrix degeneration of, granular matrix breakdown, pseudocysts formation, matrix calcifications, chondrocyte apoptosis, macrophage and lymphocyte infiltration, vascular ephiteliar cell and blood vessel formation. After analysis labral histological degeneration score (LHDS) (0–11 points) was designed and computed.

Results: Degeneration of the labral matrix was found in all specimens, granular matrix breakdown in 98%, pseudocysts in 91%, calcifications in 22 %, apoptosis in 19%, macrophage infiltration in 30%, lymphocyte infiltration in 19 %, vascular ephiteliar cell in 39 % and blood vessel formation in 35 % of specimens. Average LHDS for all cases was 5.4, and was the highest (6.1) in dysplastic coxarthrosis, followed by idiopathic changes (LHDS 5.7). Significantly lower (p=0.02) values were found in AVN group (LDHS 3.7). In 35 randomly selected patients anterior, middle and posterior portion of labrum was evaluated separately. The highest LDHS was found in middle portion 5.9, comparing to anterior (LDHS 3.5) and posterior (LDHS 4.25) portion, and this difference was significant (p=0.002). Radiographic assessment showed that 10 % of patients had grade 1 changes according to HORGS, 28 % grade 2, and 62% grade 3 changes. Strong correlation (p=0.0002) was found between LDHS and radiographic HORGS scores. Labra of the patients with severe coxathrosis showed more degeneration changes.

Conclusions: Hip labrum shows various degenerative changes in the course of coxarthrosis like other structures in the joint. Degree of histological degeneration correlates well with radiographic changes. Small labral changes were found in AVN group with no destruction of acetabulum, the highest labral degeneration was found in cases of dysplastic coxarthrosis. The biggest changes were noted in the middle portion of the labrum. The results of this study proved that degeneration of the labrum is simultaneous with other articular structures and labral degeneration itself promotes coxarthrosis.

In the last decades the number of anterior cruciate ligament (ACL) injury in skeletally immature patients (SIP) increased as a result of the participation in competitive sports at younger age and improved diagnostic tools allowing early diagnosis of ACL injury. Although the eminence avulsion fracture is more frequent in SIP and considered the ACL injury pediatric equivalent, intra-substance ACL injury in children is a growing problem. With torn ACL injured knee remains unstable. This instability is poorly tolerated in teens since it is difficult to limit their activity and leads to meniscal and chondral tears and causes resignation from sport carrier. Intraarticular transphyseal ACL reconstruction seems to be effective technique to restore knee stability despite potential iatrogenic complications such as epiphisiodesis, leg length discrepancy and axial malalignment. The main aim of this study was to evaluate the efficacy and results of this method and assess frequency of potential complications.

Material: From 2006 to 2007 we performed 15 reconstructions (7 boys, 8 girls) of ACL in skeletally immature patients (Tanner 3). All patients were athletes. Average age of girls was 11,2 years and boys 12,3 years. The period from injury to reconstruction were shorter than 10 months. All patients were operated by the same surgeon using the same surgical technique – gracilis-semitendinosus autograft, with transphyseal tibial and femoral tunnels and extraarticular fixation with AO screws. Average tunnel diameter was 7 mm. All beside one ACL injuries were isolated, with 1 meniscus tear.

Methods: In prospective study without control group patients were examined before reconstruction, and 6, 12, 24 months after surgery IKDC, Lysholm and Tegner score. We assessed the growth, leg length and axial disturbances by clinical and radiological assessment and the return to prior level of sport activity.

Results: In 12 and 24 months follow-up no disturbance of angular and longitudinal growth were observed, 11/12 patients returned to previous sport activity after mean of 7 months post- op with scores: IKDC 96,5 after 12 months and 97 after 24 months, Lysholm 95 after 12 months and 96 after 24 months. Average gain of growth was 5,5cm/12 months on average.

Conclusion: The use of complete transphyseal reconstruction is a safe, reliable technique in patients who have significant growth remaining, providing adequate knee stability, good satisfaction and allowing return to sport activity.

Ischemic necrosis of the femoral head occurring after the treatment of congenital dysplasia of the hip can negatively affect the long-term prognosis of the involved hip.

The purpose of the study was to evaluate a number of clinical and radiological risk factors for AVN after non-operative treatment of DDH.

Clinical data and radiographs of 77 patients with103 abnormal hips treated because of developmental dysplasia of the hip by closed reduction followed by cast immobilization were reviewed retrospectively. The average age of patients at the time of reduction was 16 months (ranged, 4 to 28) and the average final follow up was 22,4 years (ranged from 13 to 47 years). Kalamchi and MacEwen classification system was used for evaluation of the AVN. Avascular necrosis was found in 35,9% of the treated hips. We established the influence of several radiological and clinical data on the incidence and severity of AVN.

Conclusion: In our analysis the degree of initial dislocation according to Tönnis classification is an important risk factor for AVN. Age at the onset of treatment, presence and size of ossific nucleus, the use and period of preliminary traction, previous treatment with Frejka pillow or Pavlik splint, sex and side were not associated with the incidence and severity of ischemic necrosis. The results have been analysed statistically.

Introduction: Thanks to early ultrasound diagnosis of DDH the number of late diagnosed cases decreased in the last ten years. The surgical intervention because of dislocated hip is also reduced to the few cases a year. We still however have in our practice patients after operative treatment of DDH. One of the methods used for proper hip reduction is transiliacal pelvic osteotomy described by Dega.

The aim of this study is to evaluate the late results of one stage procedure with Dega transiliacal pelvic osteotomy in the treatment of DDH with dislocation.

Material and Methods: In our Institution 256 dislocated hips were treated surgically by means of open hip reduction, femoral directional osteotomy and Dega’s transiliacal osteotomy. From this group 102 patients (91 female and 11 male), presented 144 operated hips were seen for the final follow-up. The left hip was affected in 45 cases, right in 17, and bilateral in 41 patients. The mean age at the surgery was 23,5 months. Mean follow-up was 19.8 years (minimum 15 years after surgery). Patients were evaluated clinically (Barrett modification of McKay classification) and radiologically using Severin classification. All radiograms from whole period of treatment were collected and evaluated.

Results: In 90 hips the final result was classify as very good (57%), good in 36 hips (23%), satisfactory in 10 hips and poor in 8 hips. Radiologically very good result (group IA) was seen in 51 hips, good in 65 hips (group IB, IIA, IIB), satisfactory in 24 hips and poor in 4 hips. It was a good correlation between clinical and radiographic classification.

Conclusions : The late results after one stage hip reconstruction with Dega’s transiliacal osteotomy gives a long lasting good results and is recommended for operative treatment of DDH with dislocation.