Restoration of anatomy is paramount in total hip arthroplasty (THA) to optimise function and stability.
We evaluated an operative technique, described
by the Exeter Hip Unit, to assist accurate introduction of the femoral
component. We assessed whether it led to a reduction in the rate
of
Aims. Children treated for osteosarcoma around the knee often have
a substantial
Transtrochanteric curved varus osteotomy was designed to avoid some of the disadvantages of varus wedge osteotomy, such as post-operative
The aim of this study was to assess whether a femoral component which retained the neck reduced the incidence of
We investigated the spines of 15 patients who had significant
Aims. The purpose of this study was to examine whether
We have developed a clinical method for the graphic recording, analysis and planning of treatment of
We have reviewed the results of amputation through the ankle in the management of 37 children with congenital
Achieving accurate implant positioning and restoring native hip biomechanics are key surgeon-controlled technical objectives in total hip arthroplasty (THA). The primary objective of this study was to compare the reproducibility of the planned preoperative centre of hip rotation (COR) in patients undergoing robotic arm-assisted THA versus conventional THA. This prospective randomized controlled trial (RCT) included 60 patients with symptomatic hip osteoarthritis undergoing conventional THA (CO THA) versus robotic arm-assisted THA (RO THA). Patients in both arms underwent pre- and postoperative CT scans, and a patient-specific plan was created using the robotic software. The COR, combined offset, acetabular orientation, and leg length discrepancy were measured on the pre- and postoperative CT scanogram at six weeks following surgery.Aims
Methods
We present the results of 38 children with leg inequality treated by circumferential periosteal release.
Introduction. Correct postoperative leg length restoration is among the most important goals of hip arthroplasty. Therefore, we developed, validated and clinically applied a novel software algorithm based on surgical navigation, which allows the surgeon to restore a defined femur position without establishing a femoral coordinate system or the hip joint center and measure the leg length accurately and simply. Material and Methods. This new leg length algorithm was used in 154 hips (145 patients) that underwent CT-based computer-assisted THA (VectorVision Build 274 prototype; BrainLAB AG, Helmstetten, Germany) with a tissue preserving superior capsulotomy. Intraoperatively, a pelvic and a femoral dynamic reference bases (DRB) were applied and the anterior pelvic plane (APP) was set as the pelvic coordinate system. Then, the hip joint was put in a neutral position and this position, and the relative position of the femoral DRB relative to the pelvic DRB, was captured and stored by the navigation system. After implantation of the prosthesis the same above described femoral position with the same amplitude of flexion/extension, abduction/adduction and rotation was restored. Now, any resulting difference was due to linear changes. Validation of this new algorithm was performed by comparing the navigated results to measurements from calibrated antero-posterior pre- and postoperative radiographs. The radiographic results were compared to the mean leg length change measured with the navigation system. Results. No significant difference was found between radiographic leg length change and the results from the navigation system (p=0.658). The mean difference between the radiographic results and the results from the navigation system was −0.5 (1–8 mm (range, −5–4 mm). The mean registration accuracy of the navigation system was 2.04 (0.58 mm (range, 0.70–3.00 mm). Discussion. This novel tool has the potential to increase the accuracy and consistency of
Leg length discrepancy (LLD) is a common sequalae of limb reconstruction procedures. The subsequent biomechanical compensation can be directly linked to degenerative arthritis, lower back pain, scoliosis and functional impairment. It becomes particularly problematic when >2cm, established as a clinical standard. This two-arm experimental study assesses how reliable an iPhone application is in the measurement of LLD at different distances in control and LLD patients. 42 participants were included in the study, divided evenly into 21 control and 21 LLD patients. A standardised measurement technique was used to obtain TMM and iPhone application measurements, taken at a distance of 0.25m, 0.50m and 0.75m.Introduction
Materials and Methods
Percutaneous drill epiphyseodesis is an effective method of achieving physeal ablation with no significant complications. While the growth remaining method is a crude estimate of the timing of epiphyseodesis, it was accurate in the majority of cases in this small series. The determination of skeletal age was found to be a useful adjunct to management in a small proportion of cases.
Ollier’s disease is characterised by severe deformity of the extremities and retarded growth because of multiple enchondromas. For correction of deformity, the Ilizarov method has been used although it has many complications. A 17-year-old boy with Ollier’s disease had a limb-length discrepancy of 17.4 cm, with a valgus deformity of the right knee and recurvatum of the femur of 23°. He had undergone three unsuccessful attempts to correct the deformities by using external fixators. We used a fully implantable, motorised, lengthening and correction nail (Fitbone) to achieve full correction of all the deformities without complications. We decided to carry out the procedure in three stages. First, we lengthened the femur by 3.6 cm and the tibia by 4 cm. We then exchanged the femoral nail for a longer implant and achieved a further 6 cm of length. This reduced the shortening to 3.8 cm. When the boy has finished secondary school we will adjust the remaining discrepancy.
Aims. The hypothesis of this study was that thigh circumference, distinct from body mass index (BMI), may be associated with the positioning of components when undertaking total hip arthroplasty (THA) using the direct anterior approach (DAA), and that an increased circumference might increase the technical difficulty. Patients and Methods. We performed a retrospective review of prospectively collected data involving 155 consecutive THAs among 148 patients undertaken using the DAA at an academic medical centre by a single fellowship-trained surgeon. Preoperatively, thigh circumference was measured at 10 cm, 20 cm, and 30 cm distal to the anterior superior iliac spine, in quartiles. Two blinded reviewers assessed the inclination and anteversion of the acetabular component, radiological
Objectives. The primary objective of this study was to compare accuracy in restoring the native centre of hip rotation in patients undergoing conventional manual total hip arthroplasty (THA) versus robotic-arm assisted THA. Secondary objectives were to determine differences between these treatment techniques for THA in achieving the planned combined offset, component inclination, component version, and
Aims. The aim of this study was to describe, analyze, and compare the survival, functional outcome, and complications of minimally invasive (MI) and non-invasive (NI) lengthening total femoral prostheses. Patients and Methods. A total of 24 lengthening total femoral prostheses, 11 MI and 13 NI, were implanted between 1991 and 2016. The characteristics, complications, and functional results were recorded. There were ten female patients and ten male patients. Their mean age at the time of surgery was 11 years (2 to 41). The mean follow-up was 13.2 years (seven months to 29.25 years). A survival analysis was performed, and the failures were classified according to the Modified Henderson System. Results. The overall implant survival was 79% at five, ten, and 20 years for MI prostheses, and 84% at five years and 70% at ten years for NI prostheses. At the final follow-up, 13 prostheses did not require further surgery. The overall complication rate was 46%. The mean revision-free implant survival for MI and NI prostheses was 59 months and 49 months, respectively. There were no statistically significant differences in the overall implant survival, revision-free survival, or the distribution of complications between the two types of prosthesis. Infection rates were also comparable in the groups (9% vs 7%; p = 0.902). The rate of
Introduction. Restoration of anatomy is essential in total hip arthroplasty (THA) to optimize function and stability.
We sought to determine the short to medium-term clinical and radiographic outcomes using a short stem in young adults with a proximal femoral deformity (PFD). We prospectively studied 31 patients (35 hips) with PFDs treated with an uncemented primary THA using a short stem with cervicometaphyseal fixation between 2011–2018. There were 19 male (23 hips) and 12 female (12 hips) patients, with a mean BMI of 26.7±4.1 kg/m. 2. Twelve cases had a previous surgical procedure, and six of them were failed childhood osteotomies. Mean age of the series was 44±12 years, mean follow-up was 81±27 months and no patients were lost to follow-up. PFDs were categorized according to a modified Berry´s classification. Average preoperative
The variables involved in a robotic THA can exceed 52: many parameters as pelvic orientation with CT scan, templating, offset, and
Percutaneous physiodesis is an established technique for treating mild
Aims. The aim of this study was to examine whether hips with unilateral osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) have significant asymmetry in femoral length, and to determine potential related factors. Patients and Methods. We enrolled 90 patients (82 female, eight male) with DDH showing unilateral OA changes, and 43 healthy volunteers (26 female, 17 male) as controls. The mean age was 61.8 years (39 to 93) for the DDH groups, and 71.2 years (57 to 84) for the control group. Using a CT-based coordinate measurement system, we evaluated the following vertical distances: top of the greater trochanter to the knee centre (femoral length GT), most medial prominence of the lesser trochanter to the knee centre (femoral length LT), and top of the greater trochanter to the medial prominence of the lesser trochanter (intertrochanteric distance), along with assessments of femoral neck anteversion and neck shaft angle. Results. The percentages of hips with an absolute difference of > 5 mm in femoral GT and LT lengths were significantly larger in the DDH group (24% for both) compared with those of the control group (2% and 7%, respectively). The femoral length GT of the affected femur was significantly shorter in Crowe I and longer in Crowe IV than that of the unaffected side. The affected-to-unaffected difference of the intertrochanteric distance showed positive correlation with that of the femoral length GT in Crowe I and Crowe II/III, and negative correlation with that of the femoral length LT in the Crowe I and Crowe IV groups. Conclusion. Hips with unilateral end-stage OA secondary to DDH show significant asymmetry in femoral length between both the greater and lesser trochanter and the knee compared with controls. The intertrochanteric distance was a morphological factor related to femoral-length asymmetry. When undertaking total hip arthroplasty (THA) in the presence of DDH, long leg radiographs or CT measurements should be used to assess true
Aims. The use of a noninvasive growing endoprosthesis in the management
of primary bone tumours in children is well established. However,
the efficacy of such a prosthesis in those requiring a revision
procedure has yet to be established. The aim of this series was
to present our results using extendable prostheses for the revision
of previous endoprostheses. Patients and Methods. All patients who had a noninvasive growing endoprosthesis inserted
at the time of a revision procedure were identified from our database.
A total of 21 patients (seven female patients, 14 male) with a mean
age of 20.4 years (10 to 41) at the time of revision were included.
The indications for revision were mechanical failure, trauma or infection
with a residual
Introduction. Circumferential periosteal release is a rarely reported procedure for paediatric limb lengthening. The technique involves circumferential excision of a strip of periosteum from the metaphysis of the distal femur, tibia and fibula. This study aims to determine the mid to long-term effectiveness of this technique. Materials and Methods. A retrospective case series was performed of all patients undergoing circumferential periosteal release of the distal femur and/or tibia between 2006 and 2017. Data collected included demographics, surgical indication, post-operative limb-lengths and complications. Data collection was stopped if a further procedure was performed that may affect limb-length (except a further release).
When performing total hip replacement (THR) in high dislocated hips, the presence of soft-tissue contractures means that most surgeons prefer to use a femoral shortening osteotomy in order to avoid the risk of neurovascular damage. However, this technique will sacrifice femoral length and reduce the extent of any
Robotic assisted surgery aims to reduce surgical errors in implant positioning and better restore native hip biomechanics compared to conventional techniques for total hip arthroplasty (THA). The primary objective of this study was to compare accuracy in restoring the native centre of hip rotation in patients undergoing conventional manual THA versus robotic-arm assisted THA. Secondary objectives were to determine differences between these treatment techniques for THA in achieving the planned combined offset, cup inclination, cup version, and
Introduction. Primary robotic-arm assisted total hip arthroplasty (THA) yields more accurate and reproducible acetabular cup placement, nonetheless, data is scarce in terms of outcomes. The purpose of the present study was to report on patient-reported outcomes (PROMs) in a large group of patients who underwent robotic-arm assisted THA. The authors hypothesized that (1) patients who underwent robotic-arm assisted primary THA would achieve favorable and significant improvement in PROMs, (2) an accurate and reproducible acetabular cup placement with respect to the defined SafeZones would be obtained, and (3) a low rate of THA dislocation would be observed. Methods. Prospectively collected data were retrospectively reviewed between April 2012 to May 2017. Primary THA using Mako Robotic-Arm [Mako Surgical Corp. (Stryker), Fort Lauderdale, FL, USA] with minimum two-year follow-up for the Harris Hip Score (HHS) and the Forgotten Joint Score-12 (FJS-12) were included. Exclusion criteria were: bodymass index (BMI) > 40 kg/m2, age < 21-year old, worker's compensation, or unwilling to participate. Visual analog scale (VAS) for pain and patient satisfaction were obtained. Intraoperative measurements for
Aims. The aim of this study was to identify the association between
asymmetrical skin creases of the thigh, buttock or inguinal region
and pathological developmental dysplasia of the hip (DDH). Patients and Methods. Between 1 January 1996 and 31 December 2016, all patients referred
to our unit from primary or secondary care with risk factors for
DDH were assessed in a “one stop” clinic. All had clinical and sonographic
assessment by the senior author (RWP) with the results being recorded
prospectively. The inclusion criteria for this study were babies and
children referred with asymmetrical skin creases. Those with a neurological
cause of DDH were excluded. The positive predictive value (PPV)
for pathological DDH was calculated. Results. A total of 105 patients met the inclusion criteria. There were
71 girls and 34 boys. Only two were found to have pathological DDH.
Both also had unilateral limited abduction of the hip in flexion
and a positive Galeazzi sign with apparent
Aims. Extendible endoprostheses have been available for more than 30
years and have become more sophisticated with time. The latest generation
is ‘non-invasive’ and can be lengthened with an external magnetic
force. Early results have shown a worryingly high rate of complications
such as infection. This study investigates the incidence of complications
and the need for further surgery in a cohort of patients with a
non-invasive growing endoprosthesis. Patients and Methods. Between 2003 and June 2014, 50 children (51 prostheses) had a
non-invasive growing prosthesis implanted for a primary bone sarcoma.
The minimum follow-up was 24 months for those who survived. Their
mean age was 10.4 years (6 to 14). The incidence of complications
and further surgery was documented. Results. The mean follow-up was 64 months (20 to 145). The overall survivorship
of the patients was 84% at three years and 70% at five years. Revision-free
survival was 81.7% at three years and 61.6% at five years with competing
risk analysis. Deep infection occurred in 19.6% of implants at a
mean of 12.5 months (0 to 55). Other complications were a failure
of the lengthening mechanism in five prostheses (9.8%) and breakage
of the implant in two (3.9%). Overall, there were 53 additional
operations (0 to 5 per patient). A total of seven patients (14%)
underwent amputation, three for local recurrence and four for infection.
Their mean limb length discrepancy was 4.3 mm (0 to 25) and mean Musculoskeletal
Tumor Society Score functional score was 26.5 (18 to 30) at the
final follow-up. Conclusions. When compared with previously published early results, this mid-term
series has shown continued good functional outcomes and compensation
for
We analysed retrospectively the risk factors
leading to femoral overgrowth after flexible intramedullary nailing
in 43 children (mean age 7.1 years (3.6 to 12.0)) with fractures
of the shaft of the femur. We reviewed their demographic data, mechanism
of injury, associated injuries, the type and location of the fractures,
the nail–canal diameter (NCD) ratios and femoral overgrowth at a
mean follow-up of 40.7 months (25.2 to 92.7). At that time, the
children were divided into two groups, those with femoral overgrowth
of <
1 cm (Group 1), and those with overgrowth of ≥ 1 cm (Group
2). The mean femoral overgrowth of all patients was 0.6 cm at final
follow-up. Overgrowth of ≥ 1 cm was noted in 11 children (25.6%).
The NCD ratio was significantly lower in Group 2 than in Group 1,
with an odds ratio of 30.0 (p = 0.003). We believe that a low NCD ratio is an indicator of an unstable
configuration with flexible intramedullary nailing, and have identified
an association between a low NCD ratio and femoral overgrowth resulting
in
We compared the accuracy of the growth remaining
method of assessing
We present a case of early retrieval of an Oxinium femoral head and corresponding polyethylene liner where there was significant surface damage to the head and polyethylene. The implants were retrieved at the time of revision surgery to correct
Congenital pseudarthrosis of the tibia remains one of the most difficult orthopaedic problems. We describe early excision and the use of the Masquelet technique to reconstruct the bone defect in a child aged 14 months. Consolidation sufficient for complete weight-bearing was achieved by seven weeks. After two and a half years, the child was asymptomatic with a fully reconstructed tibia and no
We describe the application of a non-invasive extendible endoprosthetic replacement in skeletally-mature patients undergoing revision for failed joint replacement with resultant limb-length inequality after malignant or non-malignant disease. This prosthesis was developed for tumour surgery in skeletally-immature patients but has now been adapted for use in revision procedures to reconstruct the joint or facilitate an arthrodesis, replace bony defects and allow limb length to be restored gradually in the post-operative period. We record the short-term results in nine patients who have had this procedure after multiple previous reconstructive operations. In six, the initial reconstruction had been performed with either allograft or endoprosthetic replacement for neoplastic disease and in three for non-neoplastic disease. The essential components of the prosthesis are a magnetic disc, a gearbox and a drive screw which allows painless lengthening of the prosthesis using the principle of electromagnetic induction. The mean age of the patients was 37 years (18 to 68) with a mean follow-up of 34 months (12 to 62). They had previously undergone a mean of six (2 to 14) open procedures on the affected limb before revision with the non-invasive extendible endoprosthesis. The mean length gained was 56 mm (19 to 107) requiring a mean of nine (3 to 20) lengthening episodes performed in the outpatient department. There was one case of recurrent infection after revision of a previously infected implant and one fracture of the prosthesis after a fall. No amputations were performed. Planned exchange of the prosthesis was required in three patients after attainment of the maximum lengthening capacity of the implant. There was no failure of the lengthening mechanism. The Mean Musculoskeletal Tumour Society rating score was 22 of 30 available points (18 to 28). The use of a non-invasive extendible endoprosthesis in this manner provided patients with good functional results and restoration of
We describe 11 children with fibular hypoplasia and three- or four-ray feet, two bilaterally. This deformity is a less severe form of the better known congenital short tibia with absent or dysplastic fibula. If the
Survivors of infantile meningococcal septicaemia often develop progressive skeletal deformity as a result of physeal damage at many sites, particularly in the lower limb. Distal tibial physeal arrest typically occurs with sparing of the distal fibular physis leading to a rapidly progressive varus deformity. There have been reports of isolated cases of this deformity, but to our knowledge there have been no papers which specifically describe the development of the deformity and the options for treatment. Surgery to correct this deformity is complex because of the patient’s age, previous scarring and the multiplanar nature of the deformity. The surgical goal is to restore
Tibial nonunion represents a spectrum of conditions
which are challenging to treat, and optimal management remains unclear
despite its high rate of incidence. We present 44 consecutive patients
with 46 stiff tibial nonunions, treated with hexapod external fixators
and distraction to achieve union and gradual deformity correction.
There were 31 men and 13 women with a mean age of 35 years (18 to
68) and a mean follow-up of 12 months (6 to 40). No tibial osteotomies
or bone graft procedures were performed. Bony union was achieved
after the initial surgery in 41 (89.1%) tibias. Four persistent
nonunions united after repeat treatment with closed hexapod distraction,
resulting in bony union in 45 (97.8%) patients. The mean time to
union was 23 weeks (11 to 49).
We report a case of spontaneous physeal growth arrest of the distal femur in a nine-year-old child with Ewing’s sarcoma of the proximal femur treated with chemotherapy and endoprosthetic replacement. Owing to the extent of disuse osteoporosis at the time of surgery, the entire intramedullary canal up to the distal femoral physis was filled with cement. Three years later, the femur remained at its pre-operative length of 19 cm. Pre-operative calculations of further growth failed to account for the growth arrest, and the initial expandable growing prosthesis inserted has been revised to a longer one in order to address the
We reviewed 16 patients with spina bifida and unilateral dislocation of the hip at an average age of 17 years. Nine had a high neurological level (thoracic to L3) and seven a low lesion (L4 to sacral). We assessed the influence of unilateral dislocation of the hip on
Fifteen patients who limped and had early fatigue on walking caused by ischaemic necrosis after treatment for congenital dislocation of the hip had distal and lateral transfer of the greater trochanter. Nine of them in whom the predicted
We have compared the biomechanical nature of the reconstruction of the hip in conventional total hip arthroplasty (THA) and surface replacement arthroplasty (SRA) in a randomised study involving 120 patients undergoing unilateral primary hip replacement. The contralateral hip was used as a control. Post-operatively, the femoral offset was significantly increased with THA (mean 5.1 mm; −2.8 to 11.6) and decreased with SRA (mean −3.3 mm; −8.9 to 8.2). Femoral offset was restored within . sd. 4 mm in 14 (25%) of those with THA and in 28 (57%) of the patients receiving SRA (p <
0.001). In the THA group, the leg was lengthened by a mean of 2.6 mm (−6.04 to +12.9), whereas it was shortened by a mean of 1.9 mm (−7.1 to +2.05) in the SRA group, compared with the contralateral side.
Between 1996 and 2003 six institutions in the United States and France contributed a consecutive series of 234 fractures of the femur in 229 children which were treated by titanium elastic nailing. Minor or major complications occurred in 80 fractures. Full information was available concerning 230 fractures, of which the outcome was excellent in 150 (65%), satisfactory in 57 (25%), and poor in 23 (10%). Poor outcomes were due to
We undertook a retrospective study of 50 consecutive patients (41 male, 9 female) with an infected nonunion and bone defect of the femoral shaft who had been treated by radical debridement and distraction osteogenesis. Their mean age was 29.9 years (9 to 58) and they had a mean of 3.8 (2 to 19) previous operations. They were followed for a mean of 5.9 years (2.0 to 19.0). The mean duration of the distraction osteogenesis was 24.5 months (2 to 39). Pin-track infection was observed in all patients. The range of knee movement was reduced and there was a mean residual
We performed a paired study of mature patients with Perthes’ disease to compare the radiological results after treatment between conservatively- and surgically-treated groups. One patient was selected from each group to create the pairs for this study. Each pair was strictly matched for gender, body mass index, age at onset, stage at the first visit, necrotic area and radiological at-risk signs and each was assessed by comparing the values of six radiological measurements. Eighteen pairs (36 hips) fitted the criteria. The radiological measurements which showed a statistically better result in the surgical groups were Mose’s method, the acetabular-head index and
Delayed sciatic nerve palsy is uncommon after primary hip replacement. Two kinds of sciatic palsy have been reported with regard to the time of onset: early palsy related to wound haematoma or lumbosacral nerve elongation which occurs between surgery and 18 days, is more frequent than delayed palsy, occurring between 10 and 32 months, which is usually caused by cement extrusion or heat produced by cement polymerisation. We present two cases of delayed, transient sciatic nerve palsy arising at three weeks and four months after primary cementless arthroplasty, respectively, without haematoma and with a normal lumbar spine. These palsies were possibly caused by excessive tension from minor limb lengthening of 2 cm to 4 cm required to achieve
Introduction. Computer navigation is a highly sophisticated tool in orthopedic surgery for component placement in total hip arthroplasty (THA). A number of recommendations have been published. Although Lewinnek's safe-zone is the best-known among these its significance is questioned in recent years since it addresses the acetabular socket only ignoring the femoral stem. Modern target definitions consider both socket and stem and provide well-defined recommendations for complementary component positioning. We present a new small-sized hand-held imageless navigation system that implies these targets and supports the surgeon in realizing the concept of combined anteversion and combined Target-Zone (cTarget- Zone) in THA and to control leg length and offset without altering the standard surgical work-flow and we report initial results. Methods. The targets for positioning the components of a total hip as expressed by radiographic cup inclination (cRI) and anteversion (cRA), stem antetorsion (sAT) and neck-to-shaft angle (sNSA) are determined for a specific prosthesis system using a computerized 3D-model. The optimizing goal is maximizing the size of the cSafe-Zone providing the largest target zone for an impingement-free prosthetic range of motion (pROM) in order to minimize the risk for dislocation in physiologic and combined movements. Independent parameters like head size, head-to-neck ration and also component orientations like cRI, cRA, sAT and sNSA were varied systematically and the optimal cSafe-Zone was computed in semi-automated batch runs. These optimized prosthesis-specific results were introduced into the software of the hand-held navigation system. This system measures leg length, offset, acetabular and femoral head centers intraoperatively. Results. In contrast to Lewinnek the outline of our cSafe-Zone is not rectangular but polygonal. Its size shows prosthesis-specific maxima. The largest zones are found for optimal sNSA values at 126° +/−4°, optimal ranges for cRI depend on head size and range from 44° to 36°, best sAT range from 10° to 18°, cRA from 18° to 25°. There is a prosthesis- specific linear correlation between sAT and cRA that denotes the combined anteversion. The target value for combined anteversion is not dependent on pelvic tilt but on sNSA. The hand-held navigation system displays all these orienting parameters as well as
The fear of high complication rates, repeated surgery and component mal positioning, especially early in the surgeon’s experience, can be an obstacle for starting a new technique like minimally invasive THR. The aim of the present investigation was to report on our learning curve of the first 100 consecutive minimally invasive total hip replacements through an anterior approach and to focus on intraoperative and postoperative complications as well as on the quality of implant positioning. In order to have a comparison, the last 100 THR performed through our previously used direct lateral approach were retrospectively evaluated. In both groups, complex acetabular and femoral reconstructions were excluded as they were performed though a digastric trochanteric osteotomy. Every change of the initial surgical plan was considered an intraoperative, every change in the rehabilitation plan considered a postoperative complication. The quality of implant positioning was evaluated in a standardized anteroposterior pelvic x-ray and a cross table lateral view at the 3 month follow-up visit and included the positioning of the cup and the stem in both views and the amount of
From 1990 to 2003 the Ilizarov technique was used to treat 41 patients affected by the following congenital or acquired deformities : post-poliodeformity (n=8), hemimelia (n=6), pseudoachondroplasia (n=5), idiopathic genu valgum/varum (n=5), hypoplasia (n=3), osteomyelitis with growth arrest (n=3), DDH (n=2), rickets (n=2), Blount disease (n=2), Ollier disease (n=1), Perthes disease (n=1), arthrogryposis (n=1), hypochondroplasia (n=1) and congenital genu flexum (n=1). Post-traumatic deformities and simple