The results of 34 knees with stage IV to VI Blount’s disease were reviewed. 24 patients were treated over the seven-year period from 1994 to 2000.

The surgical technique addressed the medial joint line depression with an elevating osteotomy maintained with a tricortical wedge from the iliac crest. The tibial varus and intorsion was corrected with an osteotomy proximal to the apophysis. In the more recent patients a proximal lateral tibial and fibular epiphyseodesis was done concomitantly. The average preoperative mechanical varus angle of 30.6°(range 14° to 60°) was corrected to 0–4° mechanical valgus in 29 knees. In five knees an undercorrection of 2–4° mechanical varus occurred. At follow-up a further 8 knees developed residual varus due to a delayed epiphyseodesis. The tibial varus angle (ie. angle subtended by the mechanical axis of the tibia with the lateral tibial joint line) increased at an average of 1°/ month due to the inevitable medial growth plate fusion.

The average pre operative joint depression angle of 49° (range 40° to 60°) was corrected to an average of 26°(mean 20°–30°). There was no significant preoperative frontal plane f emoral deformity to warrant a femoral correction. At long term follow up of 3.5 years (range 2 to 5 years) all knees had a full range of movement without any varus instability. However in eight cases a delay of more than six months occurred before a lateral epiphysiodesis was performed, and in these patient’s mechanical axis varus recurred although the joint line correction was maintained. Neutral or valgus mechanical axis was maintained in all patients who underwent an epiphysiodesis within six months.

We concluded that although the joint elevation correction was maintained in our series, mechanical axis varus recurs if lateral epiphysiodesis is not performed early.

We reviewed the results in 24 children (34 knees) following double-elevating osteotomy for late presenting infantile Blount’s disease.

The mean age of our seven male and 17 female patients was 9.1 years (7 to 13.5). Obesity was noted in 15 (above the 95th percentile). Previous valgus osteotomy had been performed on nine knees.

Ten knees were Langenskîld stages IV, six stage V and 18 stage VI. The surgical technique addressed the medial joint line depression with an elevating osteotomy, which was maintained by insertion of a tricortical wedge from the iliac crest and the excised fibula. The tibial varus and internal torsion was corrected with an osteotomy proximal to the apophysis. In the more recent patients, a proximal lateral tibial and fibular epiphysiodesis was done concomitantly.

The mean preoperative mechanical varus of 30.6( (14( to 60() was corrected to 0( to 4( mechanical valgus in 29 knees. In five knees there was under-correction to 2( to 4( mechanical varus. At follow-up a further eight knees developed varus owing to late epiphysiodesis. The tibial varus angle (the angle subtended by the mechanical axis of the tibia and a line along the lateral tibial joint line) increased at a mean of 1( a month due to inevitable medial growth plate fusion.

The mean preoperative joint depression angle of 49( (40( to 60() was corrected to 26( (20( to 30(), which was maintained at follow-up. There was no noteworthy femoral valgus or varus present preoperatively to warrant femoral osteotomy.

In order to assess the incidence of avascular necrosis (AVN) following septic arthritis of the hip in children, we retrospectively reviewed the outcome of 227 hips with septic arthritis treated over an 18-year period. The mean age at presentation of the 221 patients, six of who had bilateral conditions, was 5.6 years (5 months to 14 years).

All patients underwent open arthrotomy and pus was found at surgery. Patients were treated with cloxacillin and patients aged six months to two years also received ampicillin. Staphylococcus areus was cultured in 51% of hips, Haemophilus influenzae in 9%, Streptococcus pneumoniae in 4% and Streptococcus pyogenes in 6%. The remaining 30% had no growth. Septicaemia was present in 20 patients at presentation.

AVN developed in 24 hips (10.5%), and chondrolysis in five (2.2%). Of the hips with AVN, seven were septicaemic. The most important factor in the development of AVN was a delay of five or more days from onset of symptoms to surgery. The risk of AVN with five days’ delay was 50% and increased exponentially with a longer delay. Septicaemia did not constitute a risk per se, but did contribute to a delay in diagnosis of hip involvement. The total head was involved in 14 of the 24 hips with AVN, while 10 had partial head involvement, with a better long-term outcome.

To assess the role of pelvic osteotomy during the closure of bladder and cloacal exstrophy, we retrospectively reviewed 10 patients treated from 1990 to 1999.

Six patients had cloacal exstrophy and four had bladder exstrophy. Two patients had no primary osteotomy. Two had posterior, two anterior pubic and two midiliac oblique osteotomies. Osteotomies were performed at a median age of 5.3 weeks.

The mean follow-up time was five years (2 to 11). We assessed facilitation of closure, reconstitution of pelvic anatomy, maintenance of interpubic distance (IPD), urinary continence and gait.

All osteotomies facilitated soft tissue closure at the time of surgery. Subjectively, the best restoration of pelvic anatomy was with a midiliac oblique osteotomy. In all patients, IPD increased progressively with increasing age (mean pre-operatively 3.3 cm, postoperatively 1.9 cm and 5.0 cm at follow-up).

The results of soft tissue surgery to provide continence and maintain abdominal wall closure were poor. All procedures to address incontinence failed and there was a 100% dehiscence/sepsis rate. Although half the children had increased external rotation of the hip at review, only one child had an externally rotated joint. .