Aim: Patients treated with one-stage combined operations after walking age for developmental dysplasia of the hip (DDH), and whose follow-up revealed both clinical and radiological complete healing underwent flexor and extensor isokinetic muscle strength (IMS) measurements of the hip and results were evaluated in comparison with the contralateral hips.

Methods: A total of 22 patients with unilateral DDH and treated with one-stage combined operations after walking age were included in the study. All patients were operated by the same surgeon. In their last follow-up visit, all patients were functionally excellent in accordance with the Barrett’s Modified McKay Criteria and according to the Severin’s Classification for radiological grading of the hip all cases were type I. IMS of hip flexors and extensors were tested by Biodex 3 Pro isokinetic test device at 120º/sc and 240º/sc. In all patients, peak torque (PT), peak torque angle (PTA), total work (TW), and average power (AP) values of operated and non-operated hips were measured at both angular velocities and recorded separately for flexors and extensors. For comparative evaluation, values of the operated and non-operated hips were used for determining the differences in IMS (DIMS), total work (DTW), and average power (DAP). In statistical assessment; Student’s t test, paired t test, and Spearman’s Rank correlation analysis were used.

Results: The mean age of patients were 12,8±2,9 (9–18) years old. At the last control visit, the mean value of follow-up periods were 112,6±32,0 (68–159) months. Parameters like age, age at the time of operation, and the length of postoperative follow-up period showed no statistical relation with IMS measurements (p> 0,05). For flexors, TW was lower at the operated hip when compared with the non-operated hip at 120º/sc and 240º/sc (p=0,001 and p=0,002, respectively). AP was lower at the operated hip at 120º/sc and 240º/sc (p=0,011 and p=0,003, respectively). PT was lower at the operated hip (22,5±11,3) when compared with the non-operated hip (27,1±12,1) only at 120º/sc (p=0,001). For extensor muscles, PT, TW, AP, and PTA showed no statistically significant difference (p> 0,05). For flexors, the DIMS between operated and non-operated hips at 120º/sc and 240º/sc were measured as −15,3±22,2% (median;-14,4) and −8,0±21,4% (median;−2,5), respectively.

Conclusions: In operated DDH patients with a mean follow-up period of around 10 years, IMS measurements revealed that the flexor muscle strength of the operated hip was still weaker than the non-operated hip. At 120º/sc, which represented evaluation against higher resistance, DIMS, DWF, and DAP were higher when compared with 240º/sc. This finding shows that hip flexors of these patients may remain weak in activities like sports, which require more resistance.

Aim: Complete tenotomy was performed on the most important flexor hip muscle; namely the iliopsoas during open reduction in patients with developmental dysplasia of the hip (DDH). The iliopsoas and other flexor-extensor muscles in operated and contralateral hips were evaluated comparatively by magnetic resonance imaging (MRI).

Methods: A total of 22 patients with unilateral DDH after the walking age and treated with one-stage combined surgery were analyzed. All patients were operated by the same surgeon with complete tenotomy of iliopsoas muscle hindering open reduction. All patients had functionally excellent results in accordance with the Barrett’s Modified McKay Criteria in their last follow-up visits and according to Severin’s classification all cases were type 1. The imaging was performed by 1,5 T GE Excite MRI device at the supine position, without contrast material and sedation. The sagittal sections for iliopsoas muscle and T2-W FSE axial images for flexor and extensor muscle groups were used. The operated and contralateral sides were compared. Student’s t test, paired t test, and Spearman’s Rank correlation analysis were used for statistical assessment.

Results: The mean age was 12,8±2,9 (9–18) years old. The mean postoperative follow-up period was 112,6 ± 32,0 (68–159) months. The reattachment of the iliopsoas to trochanter minor was observed in 7 patients, with no significance in terms of age, postoperative follow-up period, and the duration of postoperative period (p> 0,05). The atrophy in the operated side was significant in the length of iliopsoas muscle section area (p=0,0001); and the section areas of rectus femoris (p=0,002), tensor fascia lata (p=0,0001), and gluteus maximus (p=0,0001). No significance was detected in sartorius muscle section area (p=0,886). However, unlike other muscles; the ratio of operated versus contralateral side mean muscle section areas was above 1 (1,1± 0,3) for the sartorius muscle. Iliopsoas muscle reattachment was not significant for ratios of the other muscles’ operated versus contralateral side muscle section areas (p> 0,05). The atrophy was significant for the second (p=0,03) and the third (p=0,022) section’s diameter ratios in the non-reattachment versus reattachment group for the iliopsoas muscle.

Conclusion: The reattachment of the iliopsoas muscle to trochanter minor after complete tenotomy was observed in 32% of patients. Following complete iliopsoas tenotomy, the expected compensatory hypertrophy in other flexor hip muscles was not detected. At the operated side, all evaluated muscles were atrophic except for the sartorius muscle. The atrophy of iliopsoas muscle was significant for the operated hip with non-reattachment to insertion site versus reattachment group.

We reviewed 91 patients (103 feet) who underwent a Ludloff osteotomy combined with additional procedures. According to the combined procedures performed, patients were divided into Group I (31 feet; first web space release), Group II (35 feet; Akin osteotomy and trans-articular release), or Group III (37 feet; Akin osteotomy, supplementary axial Kirschner (K-) wire fixation, and trans-articular release). Each group was then further subdivided into severe and moderate deformities.

The mean hallux valgus angle correction of Group II was significantly greater than that of Group I (p = 0.001). The mean intermetatarsal angle correction of Group III was significantly greater than that of Group II (p < 0.001). In severe deformities, post-operative incongruity of the first metatarsophalangeal joint was least common in Group I (p = 0.026). Akin osteotomy significantly increased correction of the hallux valgus angle, while a supplementary K-wire significantly reduced the later loss of intermetatarsal angle correction. First web space release can be recommended for severe deformity. Additionally, K-wire fixation (odds ratio (OR) 5.05 (95% confidence interval (CI) 1.21 to 24.39); p = 0.032) and the pre-operative hallux valgus angle (OR 2.20 (95% CI 1.11 to 4.73); p = 0.001) were shown to be factors affecting recurrence of hallux valgus after Ludloff osteotomy.

Cite this article: Bone Joint J 2013;95-B:803–8.

Aims

The aim of this study is to evaluate the surgical treatment with the best healing rate for patients with proximal femoral unicameral bone cysts (UBCs) after initial surgery, and to determine which procedure has the lowest adverse event burden during follow-up.

Objective: To study the role of anterior spinal surgery in scoliosis in Indian settings and to discuss the complications. Study Design: Prospective study. Subjects: The present study comprises of forty patients of scoliosis in growing age group (10–25 years) with Cobbs angles ranging from 52”–98”. They were treated with Leeds procedure which is by anterior loosening followed by Posterior Harrington fixation + Luque derotation + Fusion and Costoplasty. Results: Average correction of the deformity after surgery was 45%. Satisfaction level of patients and parents was good in 60% of the cases. Majority of the curves were thoracic (60%), and right sided (72%). The modality of treatment was decided on the basis of personality of each case, its demand and requirement, time of presentation and the potential for increasing severity. Anterior spinal surgery for scoliosis is an effective procedure in hands of experienced surgeons and it reduces stiffness of the curve, shortens the anterior column, and decreases thoracic lordosis that leads to some improvement of pulmonary function. But there is greater risk of damage to vital structures with higher risks of cardio-respiratory failure. The potential risks have to be balanced with the expected rewards. The optimum method of correction has to be decided by careful preoperative evaluation. Conclusions: This study reaffirms the role of anterior spinal surgery in India as the patients due to lower levels of health awareness present late and with severe deformities. Combined procedure of anterior and posterior surgery causes lesser decrease in pulmonary functions than costoplasty alone, and achieves better cosmetic correction

Introduction The standard surgical practice for athletes with recurrent anterior shoulder instability who play contact or collision sports is to perform either the Bankart repair or Bristow procedure. The purpose of this study was to investigate the outcome of a combined Bankart and Bristow procedure for recurrent anterior shoulder instability in high contact and collision athletes. Methods Ninety-one patients underwent 100 combined Bankart and Bristow procedures for anterior shoulder instability (nine bilateral cases). Combined procedures were indicated in athletes participating in contact and collision sports. We were able to follow-up 71% of cases (71 shoulders in 65 patients) at an average of 6.5 years after surgery (range 2.1 to 12.3 years). The average age at the time of surgery was 23 years (range 15 to 47 years). There were 63 males and only two females. All patients were participating in competitive level sport at the time of injury of which 76.1% was rugby. A Rowe rating was calculated for each patient. Results Forty-four percent were graded excellent, 18% good, 27% fair and 11% poor. Overall 66% of athletes returned to their pre-injury level of sport or better, whilst 25% return to a lower level of their sport. Nine percent did not return to sport after surgery. This cohort included 37 professional or semi-professional players of whom 73% were able to return to their pre-morbid or a higher level of sport. Only six percent have experienced further dislocations since surgery. A further 12% have experienced shoulder subluxation and another 19% report feelings of insecurity. Four percent have required an additional procedure. Eighty-nine reported no or only mild limitation of function or discomfort and 87% were either very satisfied or satisfied with their outcome. Conclusions The combined open Bankart repair and Bristow procedures gives good results in athletes who participate in contact and collision sports. It has proved to be a robust procedure in the long term, allowing almost 75% of professional and semi-professional athletes to return to the same level or higher of sporting participation

Aims

To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up.