Background: The major objectives in total hip replacement for coxarthrosis secondary to DDH are: – Anatomical restoration of the hip rotation center – The restoration of the acetabular contention function – The reconstruction of the acetabular bone stock

Patients and Method: Between 1999 – 2003 there were operated 83 cases of coxarthrosis secondary to hip dysplasia, by total hip arthroplasty both cemented and uncemented. 27 cases were operated with uncemented cups and acetabular reconstruction 20 cases received a HA coated Stryker Secure Fit 40–42 mm cup 7 cases received Zweimuller screwed cup The mean age of the patients was 39 years (21–57 years) The mean weight was 69.5 kg (58–82 kg) Body mass index 28 (25–31) The dysplasia grade was Crowe II 11 cases, Crowe III 16 cases

Results: The mean dimension of the graft (S2), measured on the AP Rx was 43 % of the cup weight bearing surface The S2/S1 fraction exceeded 1 in one case that necessitated revision at 4,5 years due to the resorbtion of the graft All the grafts healed to the host bone in a 6 month interval

Discussions and Conclusions For defects smaller than 20% of the weight bearing surface of the cup, there was an intrinsic stability of the cup and the acetabuloplasty was optional For defects between 20–50% of the cup weight bearing surface it was necessary to perform acetabuloplasty with auto graft from the femoral head fixed with screws in compression For defects larger than 50 % of the weight bearing surface of the cup the fraction S2/S1 is greater than 1 with risk of the resorbtion and collapse of the graft. In such cases we recommend slight ascending of the cup in a position with better bone stock or a protrusion technique method

Aim: To test the null hypothesis that older instrumentations with their complications do not produce a clinical improvement.

Introduction: Surgical treatment of adult scoliosis is difficult with a high incidence of complications. The presenting complaints and expectations from the surgery are different to those in adolescent scoliosis.

Methods and results: Inclusion: All cases of adult idiopathic scoliosis presenting at or after the age of 20 and requiring surgical treatment. Exclusions: Revisions. Average age of follow-up is 6 years (range 2 to 14 years) with 107 patients. For analysis three groups were decided on the basis of the age. A number of different instrumentation systems were used with time. Treatment varied according to senior author’s planning for the individual patient, ranging from posterior instrumentation, anterior release and posterior instrumentation, and combined anterior and posterior instrumentation.

Group I: Age 20–30 years, consisted of 64 patients. Average pre-operative primary curve was 56° with post-operative correction 50%. Deformity was the most common presenting complaint. Seventy-one per cent felt an overall improvement, the rest noticed no benefit.Twenty-two per cent would prefer not to have the surgery. Complications included four pseudoarthrosis, nine required further surgery, and one late infection.

Group II: Age 31–40 years, 20 patients with an average primary curve of 63°, and a correction of 56%. Fifteen per cent had significant pain at presentation. Seventy per cent felt an overall benefit although all noticed a cosmetic improvement. Complications: two pseudarthrosis, three subsequent surgical procedures.

Group III: Age > 41 years, 23 patients, an average primary curve of 72° with a correction of 39%. Eleven out of 23 had significant pain on presentation. Complications: four pseudoarthrosis, metal pull out in one. Further surgery was performed in nine. All felt some benefit from the treatment and despite the high proportion of complications, would have the surgery again.

Conclusions: There is a clinical benefit from surgical treatment of adult idiopathic scoliosis. There is a higher number of complications in the older age group.