Aim: To investigate the functional and radiological outcome of shelf acetabuloplasty in adults with significantly symptomatic acetabular dysplasia, with a minimum of a 5 year follow-up.

Material and Methods: 77 consecutive shelf procedures (68 patients) with an average follow-up of 10.9 years (range: 6–14) were reviewed. The Oxford hip score (OHS) was used for clinical assessment. Centre-edge angle (CEA) and acetabular angle (AA) were measured as indicators of joint containment. The severity of osteoarthiritis was based primarily on the extent of joint space narrowing. Survivorship analyses using conversion to THR as an endpoint were performed. Logrank tests were used to compare the survivorship of the shelf procedure against the variables of age, preoperative osteoarthiritis, pre and postoperative AA, CEA angles.

Results: The average age at time of surgery was 33 years (range: 17–60). At the time of the last follow-up, the mean OHS was 34.6 (maximum score: 48). Mean postoperative CEA was 55 (Pre-operatively: 13 degrees) while mean postoperative AA was 31 (Pre-operatively: 48 degrees). Thirty percent of hips needed THR at an average duration of 7.3 years. The survival in the 45 patients with only slight or no joint space narrowing was 97% (CI, 93%–100%) at 5 years and 80% (CI, 56%–100%) at 10 years. This was significantly higher (p= 0.0007) than the survival in the 32 patients with moderate or severe osteoarthiritis, which was 72% (CI, 55%–89%) at 5 years and 29% (CI, 13%–45%) at 10 years. There was no significant relationship between survival and age, pre and postoperative AA, CEA angles (p> 0.05).

Conclusion: Shelf-acetabuloplasty offers symptomatic relief to adults with acetabular dysplasia but overall deteriorates with time. About 50% of the patients do not need THR for over 10 years. Best results with shelf-acetabuloplasty were achieved in patients with slight or no joint narrowing.

We present our experience from use of acetabular reinforcement rings in revision total hip arthroplasty when bone defects are present. From 1987 to 2000, acetabular reinforcement rings were utilized in 59 revisions, in 52 patients with a mean age of 60 years (31–81). In 48 hips, Ganz rings were used and in 11 hips, Burch-Sch-neider rings. For the existing defects of the acetabulum, morsellized bone allograft was used. The patients were evaluated clinically with the modified Merle d’ Aubigne-Postel scale and radiologically with the criteria of Gill-Sledge-Muller. Acetabular reconstruction was successful in 51 of 59 hips (86.5%) after a mean follow-up period of 7 years (2–15). One of the 11 Burch-Schneider rings failed (9.1%) and 7 of the 48 Ganz, raising the failure rate of this ring up to 14.6%. Complications included dislocation in 5 cases, deep vein thrombosis in 2, superficial infection in 1 and pubis rami fracture in 2 cases.

Reinforcement rings in our opinion could be of valuable help in reconstruction of the bone deficient acetabulum. Although in this study, it is not possible for these two rings to be directly compared, Burch-Schneider one appears to have a more clear role and lower failure rate. However, in order to evaluate in a more reliable way the true fate of the acetabular reinforcement rings, especially in the presence of the limited role of biological fixation, longer follow-up time is needed.

Background: Hip dysplasia is a complex developmental process. Untreated acetabular dysplasia is the most common cause of secondary hip osteoarthiritis. With increased interest in redirectional pelvic osteotomies, the role of the shelf procedure needs to be re-defined.

Aim of the study: to investigate the effectiveness of the shelf procedure in adults with symptomatic acetabular dysplasia by assessing the functional and radiological outcome at a minimum of five years follow-up.

Material and Methods: Seventy-six consecutive adults with symptomatic acetabular dysplasia treated with acetabular shelf augmentation, have been followed up for an average period of 11 years (range: 6–14). The mean age was thirty-three years (range: 17–60 years). The Oxford hip score (OHS) was used for clinical assessment. Centre-edge angle (CEA) and acetabular angle (AA) were measured to determine femoral head coverage. Osteoarthiritis severity was based primarily on the width of the joint space using the De Mourgues classification. Survivorship analyses using conversion to THR as an endpoint were performed. logrank test was used to compare the outcome of the shelf against the variables of age, preoperative osteoarthiritis, preoperative and postoperative AA, CEA angles.

Results: The shelf procedure improved the mean preoperative CEA from 11° (range: 20° to 17°) to 50° postoperatively (range: 30° to 70°) and the mean preoperative AA from 52° (range: 46° to 64°) to 32° postoperatively (range: 18° to 57°). The Mean OHS was 34.6 (hip score maximum: 48). Thirty percent of hips needed THR at an average duration of 7.3 years. Survival analysis using conversion to THR as an endpoint was 86% (CI, 76%–95%) at five years and 46% (CI, 27%–65%) at ten years. The survival in the 44 patients with only slight or no joint space narrowing was 97% (CI, 93%–100%) at 5 years and 75% (CI, 51%–100%) at 10 years. This was significantly higher (p= 0.0007) than the survival in the 32 patients with moderate or severe osteoarthiritis, which was 76% (CI, 55%–89%) at 5 years and 22% (CI, 5%–38%) at 10 years. There was no significant relationship between survival and age (p= 0.37), pre and postoperative centre-edge angle (p= 0.39), or acetabular angle (p= 0.85).

Conclusion: Shelf acetabuloplasty is a reliable, safe procedure offering medium-term symptomatic relief for adults with acetabular dysplasia. The best results were achieved in patients with slight or no joint space narrowing.

Aim: To investigate the functional and radiological outcome of shelf acetabuloplasty in adults with significantly symptomatic acetabular dysplasia, with a minimum of a 5 year follow-up.

Material and Methods: 77 consecutive shelf procedures (68 patients) with an average follow-up of 10.9 years (range: 6–17) were reviewed. The Oxford hip score (OHS) was used for clinical assessment. Centre-edge angle (CEA) and acetabular angle (AA) were measured as indicators of joint containment. The severity of osteoarthiritis was based primarily on the extent of joint space narrowing. Survivorship analyses using conversion to THR as an endpoint were performed. Logrank tests were used to compare the survivorship of the shelf procedure against the variables of age, preoperative osteoarthiritis, pre and postoperative AA, CEA angles.

Results: The average age at time of surgery was 33 years (range: 17–60). At the time of the last follow-up, the mean OHS was 34.6 (maximum score: 48). Mean postoperative CEA was 55 (Pre-operatively: 13 degrees) while mean postoperative AA was 31 (Pre-operatively: 48 degrees). Thirty percent of hips needed THR at an average duration of 7.3 years. The survival in the 45 patients with only slight or no joint space narrowing was 97% (CI, 93%-100%) at 5 years and 75% (CI, 51%-100%) at 10 years. This was significantly higher (p≤= 0.0007) than the survival in the 32 patients with moderate or severe osteoarthiritis, which was 76% (CI, 55%-89%) at 5 years and 22% (CI, 5%-38%) at 10 years. There was no significant relationship between survival and age, pre and postoperative AA, CEA angles (p> 0.05).

Conclusion: Shelf-acetabuloplasty offers symptomatic relief to adults with acetabular dysplasia but overall deteriorates with time. About 50% of the patients do not need THR for over 10 years. Best results with shelf-acetabuloplasty were achieved in patients with slight or no joint narrowing.

Aim: To present our experience concerning late infections in operated scoliosis. Methods: 118 patients were treated surgically using multiple hook and screw instrumentation systems over the last 10 years. 103 patients had idiopathic (mean age 22.1) and 15 had neuromuscular scoliosis (mean age 12.2 years). All patients were instrumented posteriorly. Bovine xenografts were used were used in all cases where fusion was the goal. Additional anterior fusion was necessary in 8 patients. To date 10 patients (7 idiopathic and 3 neuromuscular) presented late deep wound postoperative infections. None of these patients had signs of generalized septic condition. The latent period of the infection varied from 1 to 5 years. Two patients presented rod failure. Initial pus cultures were negative in 5 patients. A common þnding was pus lining on the instrumentation surface with increased concentration under the cross-links. All patients had at least one loose cross-link nut. Local corrosion of the hardware and metal inþltration of the surrounding tissues was also present. The instrumentation was removed in all cases. All patients but one had satisfactory bony fusion. A variety of pathogens were cultured from intra-operative specimens (5 CNS, 2 A. baumannii, 1 peptostreptococcus, 2 St. epidermidis). A continuous irrigation system was used for 5 days in all patients, combined with antibiotics IV for 7 days and po for 45 days. Results: Protocol treatment was successful in all patients. No recurrence of the infection was observed after the removal of the instrumentation. Conclusions: The exact etiology of those infections seems to be an interesting subject for investigation. The extended surface and bulky nature of the construct are a probable predisposing factor, as is instrumentation failure and loosening. No bone involvement was noticed. Removal of instrumentation appears to be effective treatment.

Introduction: Persistent acetabular dysplasia is a recognized cause of premature hip arthritis. Treatment options include joint preservation (acetabuloplasty/osteotomy) or salvage procedures (THR). Presence of a deficient acetabulum and an elevated acetabular centre make THR technically demanding with uncertain outcome. Shelf ace-tabuloplasty is a viable option, however, most reports in the literature focus on results in children and adolescents.

Aim: To investigate the functional and radiological outcome of shelf acetabuloplasty in adults with significantly symptomatic acetabular dysplasia.

Material and Methods: 77 consecutive shelf procedures (68 patients) with an average follow-up of 10.9 years (range: 6–17) were reviewed. The Oxford hip score (OHS) was used for clinical assessment. Centre-edge angle (CEA) and acetabular angle (AA) were measured as indicators of joint containment.

Results: The average age at surgery was 33 years (range: 17–60). At the time of last follow-up; the mean OHS was 34 (maximum score: 48). Mean postoperative CEA was 59 (Pre-operatively: 16.2 degrees) while mean postoperative AA was 31 (Pre-operatively: 47.5 degrees). Thirty percent of hips needed THR at an average duration of 7.3 years. Pre-operative arthritis was present in 32 hips out of which 17 (53 percent) needed THR. Out of the remaining 45 hips, only 6 (13 percent) needed THR. No correlation was found between the acetabular indices and the outcome.

Conclusion: Shelf-acetabuloplasty offers symptomatic relief to adults with acetabular dysplasia and can delay the need for THR for over 10 years. Best results with shelf-acetabuloplasty were achieved in patients without preoperative arthritis.

Introduction: In cases of severe, rigid scoliotic curves, anterior or posterior fusion alone is inadequate and surgical treatment with a combined anterior and posterior) approach is required. The purpose of this study is to evaluate the effectiveness and the complications of these lengthy procedures.

Material and Methods: Between 1993 and 2002, 125 patients with scoliosis were surgically treated in our department. A total of 18 patients with scoliosis were treated with a combined anterior and posterior approach. The mean age of these patients was 19.6 years (range 5.5 – 60 years). Fourteen patients were subjected to a single-stage procedure, while 4 patients underwent a staged procedure. Thirteen patients underwent anterior release and posterior nstrumentation, while 5 patients underwent both anterior and posterior instrumentation. Additional thoracoplasty was performed in 3 cases. The mean duration of the operation was 12.1 hours (range 4.5 – 14 hours). All patients were monitored postoperatively in the Intensive Care Unit. The mean duration of follow-up was 4.5 years (0.6 – 9 years).

Results: Anterior release and posterior instrumentation achieved a mean 30% correction of curves that were corrected by only 15% with traction preoperatively. Combined anterior and posterior nstrumentation achieved a mean 44% correction of curves that were corrected by only 22% with traction preoperatively. One patient presented residual pneumothorax that was treated with chest tube. One patient with neuromuscular scoliosis presented wound dehiscence and early infection, which led to removal of the posterior instrumentation.

Conclusions: A combined anterior and posterior procedure is indicated in patients with severe, rigid curves. It achieves greater correction, and prevents the crankshaft phenomenon in immature patients. We recommend the single-stage procedure (if patient general condition permits), because: 1) total anesthesia time is reduced, 2) total intraoperative blood loss is reduced, 3) hospital stay is reduced, and 4) greater curve correction is achieved. Severe complications include respiratory dysfunction and diffuse intravascular coagulation in multiply transfused patients, especially with use of an intraoperative autotransfusion device.