Dislocations have impact on quality of life, but it is difficult to quantify this impact for each patient. The Quality-of-Life Time Trade-Off assesses the percentage of a patient's remaining life that the patient would be willing to trade for perfect health [1]. This technique has been used for non-unions [2], but never proposed for dislocation. 154 patients (with 3 recurrent dislocations) undergoing revision were asked to choose between living with their associated dislocation risk or trading a portion of their life expectancy for a period of perfect health without dislocation, thus determining their Quality-of-Life score. This score may range from 0.1 (willing to trade nine years among 10) to 1.0 (unwilling to trade any years). Additionally, patients were assessed on their willingness to trade implant survival time for a reduced risk of dislocation, considering various implant options that might offer lower (but not necessary) survival time before revision than the theoretical best (for the surgeon) “standard” implant, thus determining a “Survival Implant Quality” score. Patients diagnosed with 3 hip dislocations have a low health-related quality of life. The score of our “dislocation” cohort was average 0.77 with patients willing to trade average 23% of remaining lifespan for perfect health (range 48% to 12%). This score is below that (0.88) of illnesses type-I diabetes mellitus [3] and just higher than tibial non-union (0.68) score [2]. The mean “Survival Implant Quality” score of our recurrent dislocation cohort was 0.71 (range 0.59 to 0.78) which means that patients accept to trade average 3 years (range 2 to 4 years) among 10 theoretical years of survival of the implant. Hip dislocation has a devastating impact that can be quantified for each patient when discussing revision and choice of implants for instability. For references, please contact the author directly

Fixation only of Vancouver B Proximal Femoral Fractures (PFF's), specifically with Cemented Taper Slip stems (CTS) with an intact bone cement interface, has been shown to have reduced blood transfusion requirements and reoperations, compared to revision arthroplasty. This potentially carries the risk of stem subsidence and loosening, which negatively impacts functional outcome. The incidence of stem subsidence and associated fracture morphology have not previously been reported. We retrospectively reviewed all Vancouver B PFF's in primary THR around CTS stems treated with internal fixation only between June 2015 and March 2021 for fracture morphology (Low Spiral (LS), High Spiral (HS), Metaphyseal Split (MS) and Short Oblique (SO)), fracture union and stem subsidence. Interprosthetic fractures and inadequate follow up were excluded. Secondary outcomes were collected. Out of 577 cases on our local periprosthetic database, 134 Vancouver B PFF's around CTS stems were identified, of which 77 patients underwent ORIF only. Of these, 50 procedures were identified, 21 were lost to follow up and 6 patients died before 6 months. Age, mortality rate and ASA is presented. Review of Fracture morphology showed: 100% (3/3) of HS subsided (1 revised for loosening); 68 % (19/28) of MS subsided (1 revised for loosening); 11.1 % (2/18) of LS subsided (0 revised for loosening); 0% (1/1) of SO subsided. There were 2 revisions for non-union (LS group). No dislocations were recorded. There was a statistically significant association between Morphology and Subsidence P value 0.0004). Major subsidence was observed in 8 patients (3 HS, 4 MS and 1 LS) which was associated with a significance reduction in mobility. Subsidence was associated with negative symptoms (P value < 0.0001). Fixation of all Vancouver B PFF's does not produce uniformly good results. Revision rates following ORIF do not fully reflect patient outcomes. This trend will affect the NJR, stem rating and patient satisfaction. Subsidence after ORIF was associated with certain morphologies (HS & MS) and stem revision may be preferrable, in keeping with GIRFT. A morphology-based classification system can inform decision making

Introduction. The prevalence of ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) is rising in concert with life expectancy, putting more patients at risk for interprosthetic femur fractures (IPFF). Our study aimed to assess treatment methodologies, implant survivorship, and clinical outcomes of patients with IPFF. Methods. 77 patients treated for an IPFF from 1985–2017 at a single large referral center were reviewed. Prior to the fracture, at the hip/knee sites respectively 46 femurs had primary/primary, 21 had revision/primary, 3 had primary/revision and 7 had revision/revision components. Mean age and BMI were 74 years and 30 kg/m. 2. , respectively. Mean follow-up after fracture treatment was 7 years. Results. Sixty fractures were classified as Vancouver C (UCS D) while 17 were Vancouver B (UCS B). Fifty-seven patients (74%) were treated with ORIF; 3 developed a non-union, 3 developed a PJI, and 2 developed aseptic loosening. Nineteen patients (25%) were treated with revision arthroplasty including: 13 revision THAs, 4 distal femoral replacements, 1 revision TKA, and 1 total femoral replacement of which 2 developed aseptic loosening and 2 developed a non-union. Survivorship free from any reoperation for the entire cohort was 79% at 2 years. Patients in the ORIF group who went on to union tended to have stemmed components and greater interprosthetic distance (IPD=189mm vs. 163mm, p=0.55) than non-united fractures. Patients who went on to nonunion in the revision arthroplasty group had higher medullary diameter: cortical width ratio (2.5 vs. 1.3, p=0.01) and lower IPD (36mm vs. 202mm, p=0.002). 95% of patients were ambulatory at latest follow-up. Conclusion. Interprosthetic femur fractures are technically and biologically challenging cases. An individualized approach of internal fixation versus revision arthroplasty led to a 79% success rate free of reoperation at 2 years with 95% of patients ambulatory. Continued improvements in management are warranted

Safe and meticulous removal of the femoral cement mantle and cement restrictor can be a challenging process in revision total hip arthroplasty (rTHA). Many proximal femoral osteotomies have been described to access this region however they can be associated with fracture, non-union and revision stem instability. The aim of this study is to report outcomes of our previously unreported vascularised anterior window to the proximal femur. We report on a cohort of patients who underwent cemented single and staged rTHA at our single institution by the same surgeon between 2012 and 2017 using a novel vascularised anterior window of the femur to extract the cement mantle and restrictor safely under direct vision. We describe our technique, which maintains the periosteal and muscular attachments to the osteotomised fragment, which is then repaired with a polymer cerclage cable. In all revisions a polished, taper slip, long stem Exeter was cemented. Primary outcome measures included the time taken for union and the patient reported WOMAC score. Thirty-two rTHAs were performed in 29 consecutive patients (13 female, 16 male) with a mean age of 63.4 years (range, 47–88). The indications for revision included infection, aseptic loosening and implant malpositioning. Mean follow up was 5.3 (range, 3.2–8 years). All femoral windows achieved radiographic union by a mean of 7.2 weeks. At the latest point in follow-up the mean WOMAC score was 21.6 and femoral component survivorship was 100%. There were no intraoperative complications or additional revision surgery. Our proposed vascularised anterior windowing technique of the femur is a safe and reproducible method to remove the distal femoral cement and restrictor under direct vision without the need for perilous instruments. This method also preserves the proximal bone stock and provides the surgeon with the option of cemented stems over uncemented revision implants that predominantly rely on distal fixation

Periacetabular osteotomy (PAO) has been established as an effective technique to treat symptomatic hip dysplasia in young patients. Its role in treating borderline dysplasia and acetabular retroversion is evolving. The aim of this study was to:. Examine the prospectively collected outcomes following a minimally invasive PAO in a large cohort of patients. Compare the outcomes of patients with severe dysplasia, borderline dysplasia and acetabular retroversion. This is a single-surgeon review of patients operated in a high-volume centre with prospectively collected data between 2013 and 2020, and minimal followup of six months. PAO was performed using a minimally invasive modified Smith Peterson approach. 387 patients were operated during the study period and 369 eligible patients included in the final analysis. Radiographic parameters were assessed by two authors (GS and KB) with interrater reliability for 25 patients of 84–95% (IntraClass Coefficient). Patient reported outcome measures (i-HOT 12, NAHS, UCLA and EQ-5D) were collected prospectively. Case note review was also performed to collate complication data and blood transfusion rates. Radiological parameters improved significantly after surgery with Lateral centre-edge angle (LCEA) improving by 16.4 degrees and Acetabular index (AI) improved by 15.8 degrees. Patient reported outcome measures showed significant improvement in post-op NAHS, iHOT and EQ5D at 2 years compared to pre-op scores (NAHS=30.45, iHOT=42, EQ5D=0.32, p=0.01). This significance is maintained over 2 years post procedure (p=0.001). There was no significant difference between the three groups (severe dysplasia, borderline dysplasia and acetabular retroversion). Clinical outcomes showed an overall complication rate n=31, 8.3% (Major complication rate: n=3, 0.81%). Non-union rate: n=11, 2.96% of which 3 required fixation (0.81%). Hip arthroscopy post PAO: n=7, 1.9%. Conversion to THR: n=4, 1.1%. Blood transfusion requirement: n=46, 12.5%. No patient developed a major neurovascular injury. In this large single-centre study, patients had radiological and reported outcome improvements following surgery. Overall, there was a low complication rate, providing further evidence of the safety and efficacy of PAO for ameliorating pain and long-lasting results in the management of symptomatic hip dysplasia

Patients with longstanding hip fusion are predisposed to symptomatic degenerative changes of the lumbar spine, ipsilateral knee and contralateral hip. 1. In such patients, conversion of hip arthrodesis to hip replacement can provide relief of such symptoms. 2 – 4. However, this is a technically demanding procedure associated with higher complication and failure rates than routine total hip replacement. The aim of this study was to determine the functional results and complications in patients undergoing hip fusion conversion to total hip replacement, performed or supervised by a single surgeon. Twenty-eight hip fusions were converted between 1996 and 2016. Mean follow up was 7 years (3 to 18 years). The reasons for arthrodesis were trauma 11, septic arthritis 10, and dysplasia 7. The mean age at conversion was 52.4 years (26 to 77). A trochanteric osteotomy was performed in all hips. Uncemented components were used. A constrained liner was used in 7 hips. Heterotopic ossification prophylaxis was not used in this series. HHS improved a mean of 27 points (37.4 pre-op to 64.3 post-op). A cane was used in 30% of patients before conversion and 80% after. Heterotopic ossification occurred in 12 (42.9%) hips. There was 2 peroneal nerve injuries, 1 dislocation, 1 GT non-union and 1 infection. There have been 5 revisions; 2 for aseptic loosening, 1 for infection, 1 for recurrent dislocation and 1 for leg length discrepancy. Conversion of hip fusion to hip replacement carries an increased risk of heterotopic ossification and neurological injury. We advise prophylaxis against heterotropic ossification. When there is concern about hip stability we suggest that the use of a constrained acetabular liner is considered. Despite the potential for complications, this procedure had a high success rate and was effective in restoring hip function

Aims

With increasing burden of revision hip arthroplasty (THA), one of the major challenges is the management of proximal femoral bone loss associated with previous multiple surgeries. Proximal femoral arthroplasty (PFA) has already been popularized for tumour surgeries. Our aim was to describe the outcome of using PFA in these demanding non-neoplastic cases.

Standard practice in revision total hip replacement (THR) for periprosthetic fracture (PPF) is to remove all cement from the femoral canal prior to implantation of a new component. This can make the procedure time consuming and complex. Since 1991 it has been our practice to preserve the old femoral cement where it remains well fixed to bone, even if the cement mantle is fractured, and to cement a new component into the old mantle. We have reviewed the data of 48 consecutive patients, treated at our unit between 1991 and 2009, with a first PPF around a cemented primary THR stem where a cement in cement revision was performed. 8 hips were revised to a standard length stem, 39 hips to a long stem & 1 patient had the same stem reinserted. All fractures were reduced and held with cerclage wires or cables and four had supplementary plate fixation. Full clinical and radiographic follow up was available in 38 patients & clinical or radiographic follow up in a further 6 patients. The other 4 patients. without follow up but whose outcome is known, have suffered no complications and are pain free. Of the remaining 44 patients, forty-two went on to union of the fracture and two have required further surgery for non-union. One patient has ongoing undiagnosed hip pain. Our long term experience with cement in cement revision for periprosthetic femoral fractures shows that this is a viable technique with a low complication rate and high rate of union (95%) in what is generally regarded as a very difficult condition to treat

Proximal femoral replacements are commonly used in oncologic limb salvage procedures. Recently, these megaprostheses have been utilized in complex revision arthroplasties where proximal femoral bone is compromised. The purpose of this study is to evaluate the clinical and radiographic survivorship of proximal femoral replacements as a salvage treatment for bone loss after hip arthroplasty. We retrospectively reviewed the clinical and radiographic outcomes of 31 proximal femoral replacements of a single design between 2004 and 2013 at a single institution. The mean age at time of index surgery was 62 years, 58% were female, and mean BMI was 28.1 Kg/m. 2. The indications and complications associated with megaprosthesis implantation were collected. Average follow-up was 60 months (range 24–120 months). Kaplan-Meier survivorship assessed clinical and radiographic survivorship. Indication for revision, use of a constrained liner and construct length were assessed as risk factors for construct failure. The indications for proximal femoral replacement were periprosthetic infection (n=12, 38.7%), aseptic loosening (n=10, 32.3%), periprosthetic fracture (n=6, 19.3%), and non-union (n=3, 9.7%). A constrained liner was used in 22 hips (71%). The average length of bone resection was 148 cm (range 81–240 cm). There were nine revisions (29.2%): 3 for infection (9.7%) 2 for dislocation (6.5%), 2 for aseptic loosening (6.5%), and 2 for periprosthetic fracture (6.5%). Two of the 3 infections were in patients treated for infection. Overall survivorship was at 70.8%. There was no relation between the length of the bone resection, indication for revision and failure rate. Proximal femoral replacement in non-oncologic revision hip arthroplasty demonstrated a high failure rate at 2–10 year follow-up. Despite the high failure rate, the benefits of this salvage construct are that they allow full weight-bearing and allow rapid mobilization with minimal morbidity

Evaluation of the anatomical features, details of surgical technique and results of the THA in patients with CDH (type C1 and C2 by G. Hartofilakidis). From 2001 to 2016 years one surgical team performed 683 THA in patients with CDH. We retrospectively studied 561 total hip arthroplasties in 349 patients, follow-up rate was 82.1%, from 12 to 188 months (mean 69.4). The results were evaluated by clinical examination, X-rays analysis, Harris Hip Score. Unilateral high hip dislocation was observed in 175 patients (31.2%), in these cases often have underdeveloped half of the pelvis on the side of the dislocation. Type C1 was observed in 326 cases and type C2 – in 235 cases. Type C1 in comparison with C2 has less leg length discrepancy, developed shape of proximal femur, presence of supraacetabular osteophyte. The mean displacement of femoral head was 47.6 mm (from 29 to 55) for C1 and 63.4 mm (from 41 to 78) for C2. Average offset in C1 was 50.1 mm (37–63) and in C2 − 44.3 mm (34–52). Shortening osteotomy by T. Paavilainen performed in 165 cases (50.6%) with C1 dysplasia and in 235 cases (100%) with C2. The features of surgical technique were small size of the cups with obligatory additional screw fixation of the cup and small offset of the stems. The cup was positioned into the true acetabulum in 99.1% cases of C2 type, for C1 – only 69.0%). The cups size 44 mm were used in 97.3% cases for type C2 and in 78.6% cases for type C1. For shortening osteotomy in 76.3% cases Wagner Cone stems were used. Early complications included 9 dislocations (1.6%), 8 femoral nerve neuropathies (1.4%) and 3 infections (0.5%). There is no sciatic nerve palsy. Late complications included dislocation in two hips (1.1%), nonunion of the greater trochanter (8.4%), aseptic loosening of the femoral component − 2 (0.8 %), aseptic loosening of the cup − 11 (1.6%). Average Harris Hip score improved from 39.5 to 83.6 with unsignificant diffence between types C1 and C2 (from 37.3 to 81.4 and from 40.4 to 85.1 consequently). Revision rate was 2.1% for type C1 and 5.5% for type C2. Hip replacement surgery in patients with high hip dislocation is very challenging. Type C2 dysplasia has only one surgical option with good long-term results – placement of the cup into the true acetabulum and shortening osteotomy. Its advantages include leg length alignment and decreased risk of sciatic nerve injury. Type C1 dysplasia presents more heterogenic group of patients and allows to use several surgical options – different placement of the cup and surgical approach without shortening osteotomy. Functional results in patients with type C1 are a little bit worse in comparison with type C2, but C1 had less risk of complications. The main problem of shortening osteotomy by Paavilainen is delayed union and non-union of great trochanter

Aims

We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty.

Tapered, fluted, modular, titanium stems are increasingly popular in the operative management of Vancouver B2 and selected B3 peri-prosthetic femoral fractures. We have reviewed the results at our institution looking at stem survival and clinical outcomes and compared this with reported outcomes in the literature. Stem survival at a mean of 54 months was 96% in our series and 97% for combined published cases. Review of radiology showed maintenance or improvement of bone stock in 89% of cases with high rates of femoral union. Favourable clinical outcome scores have reported by several authors. No difference in survival or clinical scores was observed between B2 and B3 fractures. Tapered stems are a useful option in revision for femoral fracture across the spectrum of femoral bone deficiency.

Cite this article: Bone Joint J 2013;95-B, Supple A:17–20.

Aims

The optimal management of intracapsular fractures of the femoral neck in independently mobile patients remains open to debate. Successful fixation obviates the limitations of arthroplasty for this group of patients. However, with fixation failure rates as high as 30%, the outcome of revision surgery to salvage total hip arthroplasty (THA) must be considered. We carried out a systematic review to compare the outcomes of salvage THA and primary THA for intracapsular fractures of the femoral neck.

Options for the treatment of subcapital femoral neck fractures basically fall into two categories: internal fixation or arthroplasty (either hemiarthroplasty or total hip arthroplasty). Historically, the treatment option has been driven by a diagnosis-related approach (non-displaced neck fractures versus displaced neck fractures). More recently, the traditional paradigm has changed. Instead of a diagnosis-related approach, it has become more of a patient-related approach. Treatment options take in to consideration the patient’s age, functional demands, and individual risk profile. A simple algorithm can be helpful in terms of directing the treatment. Non-displaced fractures, regardless of age of the patient, should be treated with closed reduction and internal fixation. For displaced femoral neck fractures, the treatment differs depending on the age of the patient. The younger patient should be treated with urgent ORIF with the goal of an anatomic reduction. For displaced femoral neck fractures in the elderly, cognitive function should be determined. For those who are cognitively functioning, total hip arthroplasty appears to be the best option. In the cognitively dysfunctional, a bipolar hemiarthroplasty or a total hip arthroplasty with use of larger heads (32 mm or 36 mm) and/or constrained sockets are a viable option.

Periprosthetic femoral fracture (PFF) is a potentially devastating complication after total hip arthroplasty, with historically high rates of complication and failure because of the technical challenges of surgery, as well as the prevalence of advanced age and comorbidity in the patients at risk.

This study describes the short-term outcome after revision arthroplasty using a modular, titanium, tapered, conical stem for PFF in a series of 38 fractures in 37 patients.

The mean age of the cohort was 77 years (47 to 96). A total of 27 patients had an American Society of Anesthesiologists grade of at least 3. At a mean follow-up of 35 months (4 to 66) the mean Oxford Hip Score (OHS) was 35 (15 to 48) and comorbidity was significantly associated with a poorer OHS. All fractures united and no stem needed to be revised. Three hips in three patients required further surgery for infection, recurrent PFF and recurrent dislocation and three other patients required closed manipulation for a single dislocation. One stem subsided more than 5 mm but then stabilised and required no further intervention.

In this series, a modular, tapered, conical stem provided a versatile reconstruction solution with a low rate of complications.

Cite this article: Bone Joint J 2015;97-B:1031–7.

We report the clinical and radiographic outcomes of 208 consecutive femoral revision arthroplasties performed in 202 patients (119 women, 83 men) between March 1991 and December 2007 using the X-change Femoral Revision System, fresh-frozen morcellised allograft and a cemented polished Exeter stem. All patients were followed prospectively. The mean age of the patients at revision was 65 years (30 to 86). At final review in December 2013 a total of 130 patients with 135 reconstructions (64.9%) were alive and had a non re-revised femoral component after a mean follow-up of 10.6 years (4.7 to 20.9). One patient was lost to follow-up at six years, and their data were included up to this point. Re-operation for any reason was performed in 33 hips (15.9%), in 13 of which the femoral component was re-revised (6.3%). The mean pre-operative Harris hip score was 52 (19 to 95) (n = 73) and improved to 80 (22 to 100) (n = 161) by the last follow-up. Kaplan–Meier survival with femoral re-revision for any reason as the endpoint was 94.9% (95% confidence intervals (CI) 90.2 to 97.4) at ten years; with femoral re-revision for aseptic loosening as the endpoint it was 99.4% (95% CI 95.7 to 99.9); with femoral re-operation for any reason as the endpoint it was 84.5% (95% CI 78.3 to 89.1); and with subsidence ≥ 5 mm it was 87.3% (95% CI 80.5 to 91.8). Femoral revision with the use of impaction allograft bone grafting and a cemented polished stem results in a satisfying survival rate at a mean of ten years’ follow-up.

Cite this article: Bone Joint J 2015; 97-B:771–9.

We report the clinical and radiological outcome of subcapital osteotomy of the femoral neck in the management of symptomatic femoroacetabular impingement (FAI) resulting from a healed slipped capital femoral epiphysis (SCFE). We believe this is only the second such study in the literature.

We studied eight patients (eight hips) with symptomatic FAI after a moderate to severe healed SCFE. There were six male and two female patients, with a mean age of 17.8 years (13 to 29).

All patients underwent a subcapital intracapsular osteotomy of the femoral neck after surgical hip dislocation and creation of an extended retinacular soft-tissue flap. The mean follow-up was 41 months (20 to 84). Clinical assessment included measurement of range of movement, Harris Hip Score (HHS) and Western Ontario and McMaster Universities Osteoarthritis score (WOMAC). Radiological assessment included pre- and post-operative calculation of the anterior slip angle (ASA) and lateral slip angle (LSA), the anterior offset angle (AOA) and centre head–trochanteric distance (CTD). The mean HHS at final follow-up was 92.5 (85 to 100), and the mean WOMAC scores for pain, stiffness and function were 1.3 (0 to 4), 1.4 (0 to 6) and 3.6 (0 to 19) respectively. There was a statistically significant improvement in all the radiological measurements post-operatively. The mean ASA improved from 36.6° (29° to 44°) to 10.3° (5° to 17°) (p <  0.01). The mean LSA improved from 36.6° (31° to 43°) to 15.4° (8° to 21°) (p < 0.01). The mean AOA decreased from 64.4° (50° to 78°) 32.0° (25° to 39°) post-operatively (p < 0.01). The mean CTD improved from -8.2 mm (-13.8 to +3.1) to +2.8 mm (-7.6 to +11.0) (p < 0.01). Two patients underwent further surgery for nonunion. No patient suffered avascular necrosis of the femoral head.

Subcapital osteotomy for patients with a healed SCFE is more challenging than subcapital re-orientation in those with an acute or sub-acute SCFE and an open physis. An effective correction of the deformity, however, can be achieved with relief of symptoms related to impingement.

Cite this article: Bone Joint J 2014;96-B:1441–8.

Total hip replacement (THR) is a very common procedure undertaken in up to 285 000 Americans each year. Patient satisfaction with THR is very high, with improvements in general health, quality of life, and function while at the same time very cost effective. Although the majority of patients have a high degree of satisfaction with their THR, 27% experience some discomfort, and up to 6% experience severe chronic pain. Although it can be difficult to diagnose the cause of the pain in these patients, this clinical issue should be approached systematically and thoroughly. A detailed history and clinical examination can often provide the correct diagnosis and guide the appropriate selection of investigations, which will then serve to confirm the clinical diagnosis made.

Cite this article: Bone Joint J 2013;95-B, Supple A:70–3.

We have studied the placement of three screws within the femoral head and the degree of angulation of the screws in 395 patients with displaced intracapsular fracture of the hip to see if either was related to the risk of failure of the fracture to unite. No relationship between nonunion of the fracture was found regarding the position of the screws on the anteroposterior radiograph. However, we found that a reduced spread of the screws on the lateral view was associated with an increased risk of nonunion of the fracture.

We investigated the variables which determine the outcome after triple osteotomy of the pelvis for the treatment of congenital dysplasia of the hip. We reviewed 51 patients (61 hips) with a median age at operation of 23 years who were treated with a Tönnis triple osteotomy. The median follow-up was six years with a minimum of two years. Eight patients (eight hips) required a revision procedure. Of the remaining 53 hips, the results were good or excellent in 36 (68%) when evaluated according to the Harris hip score (median 90 points), and 33 patients (65%) were satisfied with the procedure. Logistic regression analysis indicated that the incidence of complications such as nonunion at an osteotomy site influenced patient satisfaction (p = 0.079). The incidence of complications correlated positively with increasing patient age at operation (p = 0.004). The amount of acetabular correction did not correlate with patient satisfaction. In univariate analysis, the groups of ’satisfied’ and ‘not satisfied’ patients differed significantly in Harris hip score, age, incidence of nonunion at the osteotomy sites, complications and late revisions. In conclusion, the patient’s age at operation and the incidence of complications influence patient satisfaction after triple osteotomy, but the amount of radiologically evident acetabular correction shows no correlation to outcome.