Introduction. Epiphysiodesis, defined as the process of closing the growth plate (physis), have been used for several years as a treatment option of cases where the predicted leg-length discrepancy (LLD) falls between 2 to 5 cm. The aim of this study was to systematically review the existing literature on the effectiveness of three different epiphysiodesis techniques with implant usage for the treatment of leg-length discrepancy in the pediatric population. The secondary aim was to address the reported complications of staples, tension-band plates (TBP) and percutaneous epiphysiodesis screws (PETS). Method. This systematic review was performed according to PRISMA guidelines. We searched MEDLINE (PubMed), Embase, Cochrane Library, Web of Science and Scopus for studies on skeletally immature patients with LLD treated with epiphysiodesis with an implant. The extracted outcome categories were effectiveness of epiphysiodesis (LLD measurements pre/post-operatively, successful/unsuccessful) and complications that were graded on severity. Result. Forty-four studies (2184 patients) were included, from whom 578 underwent TBP, 455 PETS and 1048 staples. From pooled analysis of the studies reporting success rate, 64% (150/234) successful TBP surgeries (10 studies), 78% (222/284) successful PETS (9 studies) and 52% (212/407) successful Blount staples (8 studies). Severe complications rate was 7% for PETS, 17% for TBP and 16% for Blount staples. TBP had 43 cases of angular deformity (10%), Blount staples 184 (17%) while PETS only 18 cases (4%). Conclusion. Our results highlighted that PETS seems to be the most successful type of epiphysiodesis surgery with an implant, with higher success rate and lower severe complications than TBP or Blount staples

Restoration of anatomy is paramount in total hip arthroplasty (THA) to optimise function and stability. Leg-length discrepancy of ≥10mm is poorly tolerated and can be the subject of litigation. We routinely use a multimodal protocol to optimise soft tissue balancing which involves pre-operative templating, leg-length measurement supine and in the lateral position after positioning, and the use of an intra-operative leg-length measurement device to ensure optimisation of leg-length. We have analysed the results of our protocol in restoring leg-length in primary THA. Radiological leg-length was measured in a consecutive series of 50 patients who had THA for unilateral arthritis by an independent observer pre- and post-operatively using validated methods utilising radiological software. The measurements pre- and post-operative were compared. Patients with bilateral hip arthritis and poor imaging were excluded. Leg-length was successfully restored to within 5.0mm of the target leg-length in 84.0% of patients (mean +0.7mm (95% CI +0.2 to +1.1)). The other 14.0% of patients were restored to within 5.1–8.0mm (mean +2.2mm (95% CI −2.7 to +7.1)) and 2.0% of patients were restored to within 8.1–10.0mm. Leg length was accurately restored across the subset of patients within a narrow range of either side of the mean target leg length. Intra-operative measurement of leg length can be difficult but is vital in ensuring appropriate restoration of leg-length. We recommend a similar multimodal protocol to ensure restoration of leg-length within narrow limits to maximise function and patient satisfaction

Instability following total hip arthroplasty (THA) is an unfortunately frequent and serious problem that requires thorough evaluation and preoperative planning before surgical intervention. Prevention through optimal index surgery is of great importance, as the management of an unstable THA is challenging even for an experienced joints surgeon. However, even after well-planned surgery, a significant incidence of recurrent instability still exists. Moreover leg-length discrepancy (LLD) after THA can pose a substantial problem for the orthopaedic surgeon. Such discrepancy has been associated with complications including nerve palsy, low back pain, and abnormal gait. Consequently we may use a big femoral head or increase femoral offset (FO) in unstable THA for avoiding LLD. However we do not know the relationship between FO and STT. The objective of this study is to assess hip instability of three different FOs in same patient undergoing THA during an operation. We performed 70 patients who had undergone unilateral THA using CT based navigation system at a single institution for advanced osteoarthoritis from May 2013 to May 2014. We used postero-lateral approach in all patients. After cup and stem implantation, we assessed soft tissue tensioning in THA during operation. Trial necks were categorized into one of three groups: standard femoral offset (sFO), high femoral offset (hFO, +4mm compared to sFO) and extensive high femoral offset (ehFO, +8 mm compared to sFO). We measured distance of lift-off about each of three femoral necks using CT based navigation system and a force gauge with hip flexed at 0 degrees and 30 degrees under a traction of lower extremity. Traction force was 40% of body weight. Forty patients had leg length restored to within +/− 3mm of the contralateral side by post-operative CT analysis. We examined these patients. Traction force was 214±41.1Nm. The distances of lift-off were 8.8±4.5mm (sFO), 7.4±4.1mm (eFO), 5.1±3.9mm (ehFO) with 0 degrees hip flexion and neutral abduction(Abd) / adduction(Add) and neutral internal rotation(IR)/ external rotation(ER). The distance of lift-off were 11.5±5.9mm (sFO),10.5±5.5mm (eFO),9.1±5.9mm (ehFO) with 30 degrees hip flexion and neutral Abd / Add and neutral IR/ER. Significant difference was observed between 0 degrees hip flexion and 30 degrees hip flexion on each FO (p<0.05). On changing the distance of lift-off, hFO to ehFO (2.2±1.6mm)was more stable than sFO to hFO (1.4±1.7mm)with 0degrees hip flexion.(p<0.05). On the other hands, hFO to ehFO (1.4±1.6mm) was more stable than sFO to hFO (1.0±1.3mm) with 30 degrees hip flexion. However, we did not find significant difference (p=0.18). Hip instability was found at 30 degrees hip flexion more than at 0 degrees hip flexion. We found that changing ehFO to sFO can lead to more stability improvement of soft tissue tensioning than sFO to eFO, especially at 0 degrees hip flexion. Whereas In a few cases, the distance of lift-off did not change with increasing femoral offset by 4mm. When you need more stability in THA without LLD, We recommend increasing FO by 8mm

Objectives

The purpose of this study was to compare the results and complications of tibial lengthening over an intramedullary nail with treatment using the traditional Ilizarov method.

The aim of our study was to investigate whether placing of the femoral component of a hip resurfacing in valgus protected against spontaneous fracture of the femoral neck.

We performed a hip resurfacing in 20 pairs of embalmed femora. The femoral component was implanted at the natural neck-shaft angle in the left femur and with a 10° valgus angle on the right. The bone mineral density of each femur was measured and CT was performed. Each femur was evaluated in a materials testing machine using increasing cyclical loads.

In specimens with good bone quality, the 10° valgus placement of the femoral component had a protective effect against fractures of the femoral neck. An adverse effect was detected in osteoporotic specimens.

When resurfacing the hip a valgus position of the femoral component should be achieved in order to prevent fracture of the femoral neck. Patient selection remains absolutely imperative. In borderline cases, measurement of bone mineral density may be indicated.