Young Adult Hip [YAH] pathology is now better recognised and treated than decades ago. However, our patients have suggested to us that they encountered delays in recognition and referral.

For the past four years incoming referrals of YAH have been questioned away from the ROH clinic environment in groups of 100 incoming referrals by TS Gambling, Senior Lecturer in Psychology.

Time from onset of symptoms to clinic attendance; number of GP visits; Consultants seen before accurate diagnosis; validity of earlier investigations; severity and effects of symptoms on their daily lives and careers; social effects; body image; self-confidence; oxford hip scores.

The median age was 28 years; the mean delay in being seen at a YAH clinic was 8.3–8.6 years.

The mean number of consultants seen before the YAH clinic was 2.3 – 2.6.

Fewer than 5% were properly investigated by these consultants.

The mean oxford hip score was 30; in only 8% was it less than 20, the common level for hospital referral.

22% were unable to work. In 8% their career was unaffected.

Although 70% were working or pursuing a career, almost all required adaptations /redeployment to sedentary work/Long-term sickness testing employers' tolerance/Intermittent sickness/putting off promotion/ further education/part time working/change of career.

Only 8% were unaffected at work.

In addition, there were profound social effects upon self-esteem, body image, relationships, as well as comfort during sex.

These results do not make comforting news.

In addition to the above difficulties, all our patients expressed; Powerlessness; Frustration; Anger; Not being listened to; being unsupported; Undermined; Humiliation.

The family doctor/ GP services are poor at appreciating the disability in YAH patients.

YAH onset is characteristically at 19.5 years, just when youngsters are becoming independent and self-reliant.

The OHS is an invalid/misleading discriminator in these patients when considering referral.

The hospital orthopaedic service is poor at recognising and investigating YAH disease.

Introduction

Perthes' disease is associated with coxa breva, plana and magna, and a high riding prominent greater trochanter causing abductor shortening and weakness, leg shortening and extra-articular impingement. A trochanteric advancement with an infero-lateralising oblique sliding osteotomy of the proximal femur would lengthen femoral neck, improve abductor length and strength, relieve impingement and improve leg length. We assessed the mid-term outcomes for this procedure.

Introduction

Patients who are symptomatic with concurrent acetabular dysplasia and proximal femoral deformity may have Perthes disease. Osteotomies to correct both the acetabular and proximal femur deformities may optimise biomechanics and improve pain and function. In this study, we assessed the long-term results for such a combined procedure.

Introduction

Patients who are symptomatic with concurrent acetabular dysplasia and proximal femoral deformity may have Perthes disease. Osteotomies to correct both the acetabular and proximal femur deformities may optimise biomechanics and improve pain and function. In this study, we assessed the long-term results for such a combined procedure.

Introduction

Perthes disease is associated with coxa breva, plana and magna, and a high riding prominent greater trochanter causing abductor shortening and weakness, leg shortening and extra-articular impingement. A trochanteric advancement with an infero-lateralizing sliding osteotomy of the proximal femur would lengthen femoral neck, improve abductor length and strength, relieve impingement and improve leg length. We assessed the mid-term outcomes for this procedure.

The management of developmental dysplasia of the hip (DDH) requiring open reduction between 12 and 18 months of age is controversial. We compare the outcome of medial approach open reduction (MAOR) versus delayed anterior open reduction with Salter osteotomy in such patients.

17 consecutive patients who underwent MAOR aged 12–20 months were reviewed (mean follow-up of 40 months, range 6–74). This group was compared to 15 controls who underwent anterior reduction and Salter osteotomy aged 18–23 months (mean follow-up of 44 months, range 14–134).

13 of the 17 (76%) MAOR patients required subsequent Salter osteotomy at a mean of 22 months post-reduction, with a further 2 patients under follow-up being likely to require one. Acetabular index improved from 42 (32–50, SD − 5.5) to 16 (7–24, SD − 4.5) in the MOAR group after Salter osteotomy compared to an improvement of 40 (30–53, SD − 6) to 13 (4–24, SD − 5) in the control group (p>0.05). Acetabular index at last follow-up was within normal limits in 15 of 17 (88%) MAOR patients. All patients in the control group had acetabular indices (or centre-edge angles of Wiberg) within the normal range.

There was 1 subluxation (7%) in the control group. There were 6 cases (33%) of post-operative avascular necrosis (5 Kalamchi & MacEwen Grade I, 1 Grade 2) in the MAOR group and 6 (40%) in the control group (5 Grade 1, 1 Grade 4).

All of the MAOR patients had good or excellent clinical results according to McKay's criteria, compared to 14 out of 15 (93%) controls.

This study suggests that MAOR or delayed open reduction and Salter osteotomy is a reasonable treatment for children with DDH presenting between the ages of 12 and 18 months. However, the majority of MAORs are likely to require a subsequent Salter osteotomy.

Purpose of study

This study is to determine the survival and outcomes of the Birmingham Interlocking Triple Pelvic Osteotomy. A dysplastic hip predisposes to early arthritis. The Triple Pelvic Osteotomy (TPO) is a joint-preserving option for the treatment of young adults with hip dysplasia. The long term success of the procedure is not known.

Introduction

Paediatric hip fracture accounts for less than one percent of paediatric fractures. Previous studies report complication rates between 20 and 92%.