Purpose of Study: In light of the proposed abolishment of the health visitor seven month assessment, we examined the treatment pathways for all patients born in the year 2003 in Northern Ireland who were treated for Developmental Dysplasia of the Hip. We wished to identify those patients who had presented late, to determine if they could have been referred earlier to the paediatric orthopaedic service.

Method: All patients treated conservatively and operatively for DDH were identified retrospectively from nurse procedure records and theatre logs. Patient charts were retrieved and data collected.

Results: One hundred and twelve cases were identified (5.17/1000 births). The mean age at diagnosis was 3.9 months. 33% were referred from maternity units. There was a wide variation in the rate of cases identified from each maternity unit (range 0 to 6.2/1000).

Seventy-four patients presented before the age of six months. Of these, fifteen required operative intervention. Of the thirty-eight patients presenting over the age of six months, twenty-four required operative intervention. The incidence of late presentation of DDH was 1.11 per 1000.

Ten of the late referrals had risk factors for DDH. At the seven month assessment the health visitor successfully identified and referred thirteen patients.

Conclusions: Despite routine clinical screening at birth and at eight weeks, children continue to present late with DDH. The wide variation in referral rates from maternity units suggests that the present method of screening should be closely examined. The health visitor plays an invaluable role in detecting DDH in children at the seven month assessment.

Introduction: The Orthopaedic Leg Trolley (OLT) is an alternative to crutches in the management of patients treated non-weight bearing. Advantages of the OLT include ease of use and the avoidance of problems such as painful hands and axillae, thus promoting greater mobility and facilitating early discharge. It also leaves the hands free for other purposes. The aim of this study was to investigate the benefit of the OLT following major elective foot and ankle surgery, using a questionnaire.

Methods: A prospective clinical audit was conducted on thirty patients undergoing elective foot and ankle surgery. Post-operatively, each patient was provided with an OLT. A questionnaire, measuring patient experience and satisfaction, was administered after the period of non-weight bearing.

Results: There were 13 males and 17 females, mean age 56 years, range 22 to 81 years. All patients had undergone major hindfoot reconstruction, and many had significant co-morbidities which rendered routine crutch use difficult. The mean duration of use was 4 weeks. After one week’s use, 80 of patients reported having no difficulty; 13.3% had slight difficulty; 6.7% had great difficulty; and no patients found the OLT impossible. All patients had used crutches pre-operatively: 76.7% rated the OLT as being easier to use than crutches; 13.3% felt that it was the same; and 10% reported that crutches were easier to use. Overall 53.3% rated the OLT as “invaluable”; 36.6% as being “very helpful”; 6.7% as being “quite helpful”; and 3.3% as being “not at all helpful”.

Conclusion: This study shows that the OLT is a useful alternative to crutches. It is particularly helpful in the rehabilitation of patients who are treated non-weight bearing following major foot and ankle surgery and have significant co-morbidities making crutch use difficult.

Dislocation is a recognised complication following the posterior approach in total hip arthroplasty. The senior surgeons involved in this study had routinely repaired the short external rotators and capsule by directly suturing ‘tendon to tendon’ and ‘capsule to capsule’ using No 1 Vicryl®. Over a two-year period this had no impact on the incidence of dislocation as compared to “no soft tissue repair” that had been done historically. In order to assess the effectiveness of ‘soft tissue to soft tissue’ repair fifteen patients were assessed using radiographic markers inserted during surgery. In 14 of the 15 patients the repair was found to have failed by the time of the post-operative x-ray which was taken on day 3 to 5. Since then we have changed the repair so that the capsule and rotators are reattached to bone with No 5 Ethibond® using drill holes in the trochanteric region. This modification was evaluated using the same method. Of 15 patients in the second type of repair only 2 showed a failure of repair on the post operative X-ray. This appears to be a more secure form of repair. The impact of this on the incidence of dislocation is being evaluated.

We performed a prospective clinical study in order to assess the effectiveness of repair of the short hip rotators, divided in the course of total hip replacement by the posterior approach, by the use of radio-opaque markers.

Fifteen patients, each with a diagnosis of osteoarthritis of the hip, were selected consecutively from a single surgeon’s operating list. Uncemented Duraloc® acetabular components and custom made cemented femoral components were implanted via the posterior approach in all patients.

Following implantation, the capsule and the short rotator tendons were sutured on to tendinous soft tissue around the greater trochanter using No 1 Vicryl. One radio-opaque marker clip was attached to the short rotators and capsule and a second marker was attached to the greater trochanter.

Standard antero-posterior pelvic X-rays were taken at three to five days post-operatively, and at three months following surgery. Significant separation of the radio-opaque markers in fourteen of the fifteen patients was demonstrated on the day three to five X-ray, indicating failure of the repair.

We conclude that this soft tissue repair is unsatisfactory. It may be of value to develop a more effective repair technique, with the overall aim of reducing total hip replacement dislocation, and as such we are currently investigating a soft tissue to bone repair.