Aims

The aim of this study was to evaluate the suitability of the tapered cone stem in total hip arthroplasty (THA) in patients with excessive femoral anteversion and after femoral osteotomy.

Aims

Perthes' disease (PD) is a relatively rare syndrome of idiopathic osteonecrosis of the proximal femoral epiphysis. Treatment for Perthes' disease is controversial due to the many options available, with no clear superiority of one treatment over another. Despite having few evidence-based approaches, many patients with Perthes' disease are managed surgically. Positive outcome reporting, defined as reporting a study variable producing statistically significant positive (beneficial) results, is a phenomenon that can be considered a proxy for the strength of science. This study aims to conduct a systematic literature review with the hypothesis that positive outcome reporting is frequent in studies on the treatment of Perthes' disease.

Aims

Although there are various pelvic osteotomies for acetabular dysplasia of the hip, shelf operations offer effective and minimally invasive osteotomy. Our study aimed to assess outcomes following modified Spitzy shelf acetabuloplasty.

Aims

Total hip arthroplasty (THA) is considered the preferred treatment for displaced proximal femoral neck fractures. However, in many countries this option is economically unviable. To improve outcomes in financially disadvantaged populations, we studied the technique of concomitant valgus hip osteotomy and operative fixation (VOOF). This prospective serial study compares two treatment groups: VOOF versus operative fixation alone with cannulated compression screws (CCSs).

Abstract. INTRODUCTION. Fracture neck of femur is aptly called as “the fracture of necessity” owing to the various factors responsible for its non-union. Pauwel's inter-trochantric valgus osteotomy is a useful approach to deal with such fractures. AIM. The aim of this study is to evaluate the functional outcome of valgus osteotomy in treatment of neglected and non-union fracture neck of femur using Harris Hip Scoring system (HHS). MATERIAL AND METHODS. This observational study included 25 patients of the age between 25 years and 50 years with more than 3 weeks since injury and the patients with failed primary fixation. Valgus osteotomy using120° double angled blade plate was done. The patients were followed up till one year. The patients' functional outcome was evaluated with pre-operative and post-operative Harris Hip Score (HHS) at 6 months and one year. RESULTS. Outcome was excellent in 14 patients (HHS>90), good in 8 patients (HHS between 80–90) and fair in one patient (HHS=75.6). Two patients ended up in non-union with blade cut out. The mean HHS at the end of one year was 89.18 + 7.822. The mean change in HHS values pre-operatively and one year post-operatively came out to be 69.58 + 20.032. CONCLUSION. We conclude that for the patients under 50 years of age with neglected fracture of the femoral neck, the Pauwel's osteotomy produces many good results

Introduction. We assessed the role of four different High Tibial osteotomies (HTOs) for medial compartment osteoarthritis of knee (MCOA): Medial Opening Wedge High Tibial Osteotomy (MOWHTO), Focal Dome Osteotomy with Ilizarov Fixator (FDO-I), intra-articular, Tibial Condylar Valgus Osteotomy with plating (TCVO-P) and intra-articular plus extra-articular osteotomy with Ilizarov(TCVO-I); in correcting three deformity categories: primary coronal plane varus measured by Mechanical Axis deviation (MAD), secondary intra-articular deformities measured by Condylar Plateau Angle (CPA) and Joint Line Convergence Angle (JLCA), and tertiary sagittal, rotational and axial plane deformities in choosing them. Materials and Methods. We retrospectively studied HTOs in 141 knees (126 patients). There were 58, 40, 26, and 17 knees respectively in MOWHTO, FDO-I, TCVO-P and TCVO-I. We measured preoperative (bo) And postoperative (po) deformity parameters. Results. Average age was 56.1, average follow-up was 44.6 months. Mean bo-MAD in MOWHTO, FDO-I, TCVO-P, and TCVO-I were 8.8, −14.7, −11.5, −30.8% respectively. po-MAD was close to Fujisawa point in all except TCVO-P (45.2%). CPA corrected from −4.9° to −1.4° (p=0.02)and JLCA from 5.6° to 3.2° (p=0.001); CPA was better corrected by Intra-articular osteotomies (p=0.01). Conclusions. MOWHTO corrects isolated mild primary varus deformities (bo-MAD≥ 0%). Primary varus (bo-MAD= −25% −0%) with associated tertiary sagittal, rotational, or axial deformities, without secondary intra-articular deformities needed FDO-I. Primary varus (bo-MAD= −25% −0%) with secondary intra-articular deformities, without tertiary deformities, corrected well with TCVO-P. TCVO-I corrects severe primary varus (bo-MAD< −25%) with large deformities in secondary and tertiary categories

Aims

Perthes’ disease (PD) often results in femoral head deformity and leg length discrepancy (LLD). Our objective was to analyze femoral morphology in PD patients at skeletal maturity to assess where the LLD originates, and evaluate the effect of contralateral epiphysiodesis for length equalization on proximal and subtrochanteric femoral lengths.

Aims

The Fassier Duval (FD) rod is a third-generation telescopic implant for children with osteogenesis imperfecta (OI). Threaded fixation enables proximal insertion without opening the knee or ankle joint. We have reviewed our combined two-centre experience with this implant.

Objectives

The purpose of this study was to evaluate the existing literature from 2005 to 2016 reporting on the efficacy of surgical management of patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE).

Although the vast majority of fractures of the proximal femur will heal with well-done internal fixation, occasionally failure of fixation will occur. Having effective salvage options is important to restore function and minimise complications. In general, it is logical to separate salvage options into those for fractures of the femoral neck, and those for fractures of the intertrochanteric region. Additionally, patient age and remaining bone stock should be considered. Femoral neck fracture fixation failure salvage, young patients: All efforts are focused on preserving the native femoral neck. Valgus producing osteotomy is typically indicated, and can be successful even with small patches of AVN. Femoral neck fracture fixation failure salvage, older patients: Total hip arthroplasty is generally most predictable. Be prepared for very poor bone quality. Supplement uncemented acetabular component with multiple screws. Be prepared to cement femoral component, if necessary. Intertrochanteric fracture fixation failure salvage, young patients: Repeat internal fixation attempts with fixed angle devices (such as a 95-degree blade plate) and bone grafting generally preferred. Avoid varus of proximal fragment and target inferior femoral head bone. Intertrochanteric fracture fixation failure salvage, older patients: Total hip arthroplasty preferred. Long stems to bypass femoral shaft stress risers and “calcar replacement” stems may be necessary due to proximal bone defects. Trochanteric fixation must be stable. Results are generally good but trochanteric complaints are common

Although the vast majority of fractures of the proximal femur will heal with well-done internal fixation, occasionally failure of fixation will occur. Having effective salvage options is important to restore function and minimise complications. In general, it is logical to separate salvage options into those for fractures of the femoral neck, and those for fractures of the intertrochanteric region. Additionally, patient age and remaining bone stock should be considered. Femoral neck fracture fixation failure salvage, young patients: All efforts are focused on preserving the native femoral neck. Valgus producing osteotomy is typically indicated, and can be successful even with small patches of AVN. Femoral neck fracture fixation failure salvage, older patients: Total hip arthroplasty is generally most predictable. Be prepared for very poor bone quality. Supplement uncemented acetabular component with multiple screws. Be prepared to cement femoral component, if necessary. Intertrochanteric fracture fixation failure salvage, young patients: Repeat internal fixation attempts with fixed angle devices (such as a 95 degree blade plate) and bone grafting generally preferred. Avoid varus of proximal fragment and target inferior femoral head bone. Intertrochanteric fracture fixation failure salvage, older patients: Total hip arthroplasty preferred. Long stems to bypass femoral shaft stress risers and “calcar replacement” stems may be necessary due to proximal bone defects. Trochanteric fixation must be stable. Results are generally good but trochanteric complaints are common

Most hip fractures treated with modern internal fixation techniques will heal. However, failures occasionally occur and require revision procedures. Salvage strategies employed during revision are based on whether the fixation failure occurs in the femoral neck, or in the intertrochanteric region. Patient age and remaining bone stock also influence decision making. For fractures in young patients, efforts are generally focused on preserving the native femoral head via osteotomies and repeat internal fixation. For failures in older patients, some kind of hip replacement is usually selected. Disuse osteopenia, deformity, bone loss, and stress-risers from previous internal fixation devices all pose technical challenges to successful reconstruction. Attention to detail is important in order to minimise complications. In the majority of cases, good outcomes have been reported for the various salvage strategies.

Cite this article: Bone Joint J 2013;95-B, Supple A:7–10.

Although the vast majority of fractures of the proximal femur will heal with well-done internal fixation, occasionally failure of fixation will occur. Having effective salvage options is important to restore function and minimize complications. In general, it is logical to separate salvage options into those for fractures of the femoral neck, and those for fractures of the intertrochanteric region. Additionally, patient age and remaining bone stock should be considered. Femoral neck fracture fixation failure salvage, young patients: All efforts are focused on preserving the native femoral neck. Valgus producing osteotomy is typically indicated, and can be successful even with small patches of AVN. Femoral neck fracture fixation failure salvage, older patients: Total hip arthroplasty is generally most predictable. Be prepared for very poor bone quality. Supplement uncemented acetabular component with multiple screws. Be prepared to cement femoral component if necessary. Intertrochanteric fracture fixation failure salvage, young patients: Repeat internal fixation attempts with fixed angle devices (such as a 95 degree blade plate) and bone grafting generally preferred. Avoid varus of proximal fragment and target inferior femoral head bone. Intertrochanteric fracture fixation failure salvage, older patients: Total hip arthroplasty preferred. Long stems to bypass femoral shaft stress risers and “calcar replacement” stems may be necessary due to proximal bone defects. Trochanteric fixation must be stable. Results are generally good but trochanteric complaints are common

It is very difficult to perform total knee arthroplasty (TKA) for severe varus bowing deformity of femur. We performed simultaneous combined femoral supra-condyle valgus osteotomy and TKA for the case had bilateral varus knees with bowing deformity of femurs.

We reviewed the long-term radiological outcome, complications and revision operations in 19 children with quadriplegic cerebral palsy and hip dysplasia who underwent combined peri-iliac osteotomy and femoral varus derotation osteotomy. They had a mean age of 7.5 years (1.6 to 10.9) and comprised 22 hip dislocations and subluxations. We also studied the outcome for the contralateral hip. At a mean follow-up of 11.7 years (10 to 15.1) the Melbourne cerebral palsy (CP) hip classification was grade 2 in 16 hips, grade 3 in five, and grade 5 in one. There were five complications seen in four hips (21%, four patients), including one dislocation, one subluxation, one coxa vara with adduction deformity, one subtrochanteric fracture and one infection. A recurrent soft-tissue contracture occurred in five hips and ten required revision surgery.

In pre-adolescent children with quadriplegic cerebral palsy good long-term outcomes can be achieved after reconstruction of the hip; regular follow-up is required.

Cite this article: Bone Joint J 2013;95-B:259–65.

Introduction. Despite the multiple patho-aetiological basis of Hallux valgus (HV), corrective osteotomy is a common and globally performed orthopaedic procedure. Over-correction of the inter-metatarsal angle (IMA), however, is not without consequence. Through increased joint pressures, over-correction may predispose to joint degeneration. Hypothesizing that over-correction leads to an increase in intra-articular joint pressures, we constructed a mechanical simulation of the 1. st. metatarsal-phalangeal joint. Methods. The vector forces of Flexor Hallucis Longus, Extensor Hallucis Longus, Extensor Hallucis Brevis and Adductor Hallucis, acting upon the 1. st. proximal phalanx were simulated with tensioned weighted rope. A Foley catheter balloon inflated to 1.5ml, simulated intra-articular distractive vector forces. The joint was freely mobile. At 5° IMA intervals from 10° valgus to 15° varus, intrarticular pressures were recorded using a contact pressure (Graseby™, Hertfordshire, UK) transducer attached to a calibrated manometer (Digitech Instruments™, Ulhasnagar, India). At each angle, measurements were repeated five times with removal and recalibration of the pressure monitor after each measurement. Results. A decline and subsequent increase in mean pressure was observed at each 5° interval from 10°valgus to neutral and then to 15° varus (mean±s.d.; 48.02±5.67, 24.72±1.01, 12.34±0.84, 18.96±2.46, 32.88±5.06, 42.92±4.99 milibar for 10°, 5° valgus, neutral, 5°, 10°and 15° varus IMA). One-way analysis of variance with post-hoc Tukey multiple comparison test revealed a significant increase in pressure from neutral and 5° valgus to 10° and 15° varus (p< 0.05). [First Metatarsal Phalangreal joint pressures]. Conclusion. This is the first description demonstrating increases in intrarticular pressures as the IMA tended from 5° to 15° varus, replicating inatrogenic Hallux Varus iatrogenically produced through osteotomy and over-correction of the IMA. Over-correction and increased intrarticular joint pressure may have an aetiological basis to post-operative 1. st. MTPJ degeneration. Over-correction is not a benign entity requiring consideration in Hallux Valgus corrective osteotomy

Background

Femoral neck nonunion is a challenging problem. If it is not treated properly, it will be ended with a catastrophe because the victims are younger and active patients and missing hip joint will result in a handicapped like person. If the head is viable, the best treatment is valgus osteotomy. In the original technique, site of nonunion was not explored but in our technique, there is exploration and cleaning of nonunion site and after reduction of fragments, fixation and subtrochanteric osteotomy were done.

Purpose

To evaluate the clinical and radiologic midterm results of rotational acetabular osteotomy (RAO) in incongruent hip joints.

Sugioka trans-trochanteric valgus osteotomy (TVO) has originally been described for advanced osteoarthritis of hip. This has many advantages over conventional subtrochanteric osteotomies such as early union with simple fixation and preserving proximal femoral geometry to enable standard femoral components for a future hip replacement. Lateral displacement and distalisation of the greater trochanter increases the lever arm and improves abductor limp. The use of TVO has never been reported in children. We report our experience of TVO for hinge abduction in children (mostly in Perthes' disease).

Twenty four patients of mean age 10.2 years at surgery, (range 7- 17 years) underwent TVO between 1998 and 2007. The diagnosis was Perthes' disease in 19 and avascular necrosis from other causes in the remaining five. Average follow-up was 4.4 years (18 months to 11 years). All patients had pre-operative confirmation of hinge abduction by arthrogram. Osteotomies were performed at inter-trochanteric level and fixed with screws and wire.

The neck shaft angle increased by mean 11.75 degrees (range 6 to 23). Migration index increased by mean 3.88% (-14% to + 29%). Average limb length discrepancy at final follow-up was 10.8 mm (range -30 to +10mm). Final articulo-trochanteric distance was 4.5mm (range -15 to +21 mm) less than the opposite side. Functional assessment was carried out using the Modified IOWA hip scores. The mean hip score was 75.1 (range 38.8 to 97.6). Complications were one case of trochanteric non-union requiring further surgery, one case of stiffness which responded to manipulation under anaesthesia.

Our results indicate that Sugioka TVO is a successful procedure for hinge abduction of the hip.

Purpose: The current literature lacks a truly comprehensive examination of the use of a valgus osteotomy to treat osteonecrosis of the femoral head and Perthes disease in the pediatric and adolescent population. Owing to the severity of the pathology, a retrospective examination of the success of valgus osteotomies in treating avascular necrosis and Perthes disease in children and adolescents is warranted.

Method: Twenty-four patients with diagnosis of osteo-necrosis of the femoral head or Perthes disease treated between 1995 and 2007 with a proximal femoral valgus osteotomy were identified. The causes of avascular necrosis were Perthes (N=14, 60.9%), slipped capital femoral epiphyses, (N=4, 17.4%), femoral neck fracture (N=2, 8.7%), hip septic arthritis (N=2, 8.7%) and developmental delays and idiopathic osteonecrosis (N=1, 4.3%). The average age of receiving a femoral valgus osteotomy was 10± 3.6 years. The average age at follow-up was 12.2± 4 years, mean time of follow-up from the initial valgus osteotomy to last assessment was 23± 15.3 months.

Results: Postoperative pain improved significantly compared to preoperative pain (p=.002). Seventy five percent of patients (n=9) who had limitations in their daily activities preoperatively reported that they no longer experienced them after the treatment. External rotation (p=.005) and abduction (p=.003) improved significantly at follow up. Postoperative Ficat & Arlet classification was significantly better when compared to the classification before valgus osteotomy (p=0.007). Univariate analysis showed that sixty percent of patients (n=6) who had Perthes had improved in their Ficat & Arlet stage whereas one (14.3%) patient with a different diagnosis improved (p=.082). Complications from the surgery were reported in 5 of the 23 (21.7%) cases.

Conclusion: The results of this study suggest that proximal femoral valgus osteotomy is a safe and effective treatment method for osteonecrosis of the femoral head in the pediatric population. Perthes patients improved their femoral head shape more than all other etiologies; there was a trend toward statistical significance in this change. Proximal femoral valgus osteotomy may improve pain and activity limitations in children with osteonecrosis of the femoral head. It is also effective at improving range of motion and femoral head x-ray appearance of the femoral head for these children.