Ponseti method has become the most common and validated initial non-operative and/or minimally invasive treatment modality of idiopathic clubfoot regardless of the severity of the deformity worldwide. Despite hundreds of publications in the literature favoring Ponseti method, the data about secondary procedures performed in the follow-up period of clubfoot and their incidence remains sparse and given as small details in the articles. The objective of this study was to analyse our incidence of secondary procedures performed in the midterm followup period of idiopathic clubfoot patients treated with Ponseti method and review of the relevant literature. For this purpose 86 feet of 60 patients with idiopathic clubfoot who were treated with original Ponseti method were enrolled in this retrospective case control study. Unilateral ankle foot orthosis (AFO) was used rather than standart bar-connected foot abduction orthosis varying from 12 months to 25 months in the follow-up period and 74 of 86 (86%) feet required percutaneous achilles tenotomy. The average age of initial cast treatment was 12.64 days (range 1 to 102 days). The mean follow-up time was 71 months (range 19 to 153 months). Thirty seven feet of 24 patients recieved secondary procedures (43%) consisting of; supramalleolary derotational osteotomy (SMDO) (1 patient/2 feet), complete subtalar release (3 patients/5 feet), medial opening lateral closing osteotomy (double osteotomy) (2 patients/3 feet), double osteotomy with transfer of tibialis anterior tendon (TTAT) (2 patients/3 feet), partial subtalar release (PSTR) (3 patients/5 feet), PSTR with SDO (1 patient/1 foot), posterior release (PR) with repeated achillotomy (1 patient/2 feet), TTAT (6 patients/10 feet), TTAT with PR (2 patients/2 feet), TTAT with Vulpius procedure (1 patient/1 foot) and TTAT with SMDO (2 patients/3 feet) respectively.

The amount of percutaneous achilles tenotomy (86%) in our study correlated with the literature which ranged from 80 to 90 %. The transfer of tibialis anterior tendon continued to be the most performed secondary procedure both in our study (51%) and in the literature, but the amount of total secondary procedures in our study (43%) was determined to be higher than the literature data varying from 7 to 27 percent which may be due to unilateral AFO application after Ponseti method for idiopathic clubfoot deformity in our study.

To evaluate the clinical and radiographic correction obtained by distal and lateral advancement of the greater trochanter in patients with a positive Trendelenburg’s sign and a “gluteus medius lurch” kind of limp due to avascular necrosis of the capital femoral epiphysis following treatment of developmental dysplasia of the hip (DDH) or septic arthritis (SA).

The results of trochanteric advancement were evaluated in 24 hips of 18 patients with relative overgrowth of the greater trochanter because of avascular necrosis of the femoral head. There were 10 girls and eight boys with a mean age of 12 years (range 8 to 18 years). The deformity was bilateral in six and unilateral in 12 patients. Etiology was DDH in 20 hips of 15 patients and SA in four hips of three patients. The mean follow-up period was four years and two months (range 1 to 7 years). Radiographically, the articulotrochanteric distance (ATD) is used to assess the position of the greater trochanter in relation to the femoral head. All patients showed both clinical and radiographic improvement postoperatively. The Trendelenburg’s sign, which was positive in all patients preoperatively, became negative in 18 hips of 14 patients and Delayed positive in six hips of four patients. Abduction increased a mean of 25 degrees in 15 hips of 13 patients. On clinical evaluation, the results were excellent in 17 hips, good in five hips, and moderate in two hips. Radiographically, the ATD which was −10,5 mm (range −24 to +8 mm) preoperatively, became 22 mm (range −5 to +42 mm) postoperatively Trochanteric advancement leads to satisfactory clinical results in patients with a positive Trendelenburg’s sign and a gluteus medius lurch.

Although this operation does not affect the degenerative process in the hip joint. It improves the patients’ gait and the problem of getting tired easily are overcome. Furthermore, it provides a good understructure for future reconstructive operations of adult age

Purpose: To evaluate femoral head coverage with three-dimensional computed tomographic (3D CT) reconstruction after Pemberton’s pericapsular osteotomy with open reduction in cases with developmental dysplasia of the hip (DDH).

In a prospective study, routine anteroposterior (AP) radiographs and 3D CT reconstruction of the pelvis in 15 consecutive patients with DDH were obtained pre-operatively and six months after surgery. In all patients, a Pemberton’s pericapsular osteotomy with open reduction was performed. The mean age of the patients at the time of surgery was 26 months (range 18 to 34) and 32 months (range 24 to 40) months at the last follow-up. Twelve of the patients were girls and three were boys. The 3D images were studied by using the anterior, posterior, lateral, and inferior views to analyse changes in the acetabular position in the frontal, sagittal, and trns-verse planes. Acetabular indices on radiographs and anterolateral acetabular lip angle (ALAL) on anterior view, posterolateral acetabular lip angle (PLAL) on posterior view, lateral acetabular inclination (LAI) on lateral view, and transverse rotation of the acetabulum (TR) on inferior view were measured pre- and postoperatively. Furthermore, coverage of the femoral head was classified according to Azuma’s criteria on anterior and posterior views.

The mean acetabular index was 38 degrees (range 33 to 52) preoperatively and 19 degrees (range 16 to 23) postoperatively. Comparison between pre- and postoperative 3D CT reconstruction images revealed increased acetabular adduction and extension, and decreased ace-tabular anteversion in all cases. Sufficient coverage of the femoral head was documented in all patients. Pre- and postoperative mean measurements on 3D CT reconstruction images are as follows: ALAL, 33 (range 29-40) – 16 (range 14-20); PLAL, 49 (range 46-52) – 29 (range 26-31); LAI, 48 (range 40-64) – 27 (range 25-30); TR, 13 (range 9-15) – 6 (range 5-10). Coverage of the femoral head was grade I in all patients according to Azuma’s criteria.

Conclusions: Pemberton’s pericapsular osteotomy provides successful results in appropriate cases, with sufficient coverage of the femoral head. However, if there is any doubt, utilisation of 3D CT reconstruction images may contribute to a more precise evaluation of the outcome.