Introduction:. We report the outcomes of salvage procedures in total ankle replacement (TAR) in a single surgeon series. Methods:. This study was a retrospective review of patients who had undergone salvage procedures with tibio-talo-calcaneal (TTC) fusion for failed TAR over a period from 1999–2013 in a single centre. In this period, 317 TAR were performed of which 11 have failed necessitating conversion to TTC fusion. Clinical documentation and radiographs were reviewed for cause of failure, type of graft for fusion, time to radiological/clinical union and complications including further surgeries. Results:. The causes of failure of the TAR were pain from instability/impingement in 8, fracture in one, subsidence of the talar component in one and infection in one. From the group of 11 patients, 8 patients went onto union at a mean of 10 months (7–14). All 8 patients had femoral head structural allografts to maintain limb length for the procedure and 3 required a secondary procedure to dynamise the nail. 2 patients with femoral head structural allografts developed infections necessitating removal of the graft and conversion to an external fixator of which one united and the other developed a painless fibrous union. 1 patient developed non-union with progressive deformity of the ankle resulting in a Symes amputation. Conclusions:. From our series of patients we have demonstrated that failure of TAR requiring salvage procedures is a relatively rare event (3.5%). The use of TTC fusion is successful in the majority of patients and the use of femoral head structural allografts allows preservation of leg length with good rates of union

The aims of this study were to report functional outcomes of salvage procedures for patients with cerebral palsy (CP) who have chronic dislocation of the hip using validated scoring systems, and to compare the results of three surgical techniques. We reviewed 37 patients retrospectively. The mean age at the time of surgery was 12.2 years (8 to 22) and the mean follow-up was 56 months (24 to 114). Patients were divided into three groups: 14 who underwent proximal femoral resection arthroplasty (PFRA group 1), ten who underwent subtrochanteric valgus osteotomy (SVO group 2), and 13 who underwent subtrochanteric valgus osteotomy with resection of the femoral head (SVO with FHR group 3). All patients were evaluated using the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) and the Pediatric Quality of Life Inventory (PedsQL). Significant improvements occurred in most CPCHILD and PedsQL subsection scores following surgery in all patients, without significant differences between the groups. There were 12 post-operative complications. Less severe complications were seen in group 1 than in groups 2 and 3. Salvage surgery appears to provide pain relief in patients with CP who have painful chronic dislocation of the hip. The three salvage procedures produced similar results, however, we recommend the use of PFRA as the complications are less severe. Take home message: Salvage surgery can be of benefit to patients with CP with chronic painful hip dislocation, but should be limited to selected patients considering complications. Cite this article: Bone Joint J 2016;98-B:137–43

Purpose: The long-term experience of linked semicon-strained total elbow arthroplasty was investigated as a salvage procedure for patients with distal humerus non-union not amenable to internal fixation. Method: Ninety-two consecutive total elbow arthroplasties performed for the treatment of a distal humeral nonunion were reviewed at an average follow-up of 6.5 years (range, 0.5 to 20.3 years). There were twenty-two men and sixty-nine women with an average age of sixtyfive years (range, twenty-two to eighty-four years) at the time of elbow replacement. Seventy-six elbows (83 per cent) had undergone prior surgery, with an average of two previous operations (range, one to ten). Five elbows had had at least one prior operation due to infection. Results: Seventy-nine per cent of the patients had no pain or mild pain at latest follow-up compared with moderate or severe pain in 86 percent prior to surgery. Mean extension was improved from thirty-seven to twenty-two degrees and mean flexion from 106 to 135 degrees. Joint stability was restored in all patients, including nine with a grossly flail elbow. Complications included aseptic loosening in sixteen (four with periprosthetic fractures), component fracture in five, deep infection in five (three with previous infection), and bushing wear in one patient. At most recent follow-up, 85 per cent of the patients were satisfied with their outcome. Survivorship for not requiring removal or revision for any cause was 95.7 per cent at two years, 82.1 per cent at five years, 65.3 per cent at ten and fifteen years. Factors that increased the risk of implant failure were patient age less than sixty-five, two or more prior surgeries, and history of previous infection. Conclusion: Linked semiconstrained total elbow arthroplasty provides a reliable salvage procedure to provide pain relief and restoration of motion and function in patients with distal humerus nonunion not amenable to internal fixation. Risk factors for failure include younger patients, multiple previous surgeries, and history of infection

Introduction. Multiple ACL revisions represent an extremely demanding surgery, due to the presence of enlarged or malpositioned tunnels, hardware, injuries to the secondary stabilizers and difficulties in retrieving autologous tendons. An anatomical ACL reconstruction is not always possible. We analyzed the results in a series of patients operated with over the top reconstruction (OTTR) and lateral extra-articular plasty to the Gerdy's tubercle (LP) using Achilles (AT) or tibialis posterior tendon (TPT) allografts. Methods. From 2002 to 2008, twenty-four male athletes with a mean age of 30.8 years were operated. 20 of the patients had two, while four patients had three previous reconstructions. IKDC score and KT evaluation were used at a mean 3.3 years follow-up (2–7 years). Results. The mean IKDC subjective score at follow-up was 81.3. The IKDC objective score rated A or B in 84% of the patients. Of the 20 good results, 17 patients resumed sport activity at the pre-injury level. KT side-to-side difference averaged 3.5 mm in the TPT, versus 3.2 mm in the AT group. No significant differences were noted between the AT and TPT group. Conclusions. Multiple ACL revision surgery is a salvage procedure, with average good results, but not equivalent to primary ACL reconstruction. Patients should be advised that a return to sports may not be feasible. OTTR+LP is an established technique that permits to overcome difficult anatomical situations, with cortical fixation providing good immediate stability and avoiding tunnel fixation and bone grafting. Long tendon grafts as AT and TPT are needed

Failed fusions are difficult to treat. This is an analysis of a subgroup of 19 patients who received lumbar disc prostheses in a segment adjacent to previous posterolateral instrumented fusions. Out of 142 patients who received 181 lumbar disc replacements of two different models, 19 patients (11 men and eight women) had previously undergone posterolateral fusions of one or two lumbar segments. Seven of these patients had junctional replacement using a Charité disc prosthesis and 12 using a Centurion disc prosthesis. The mean age was 46 years (33 to 63). All patients had a significant flat back deformity of their lumbar spine before the index operation. All presented with sacro-iliac joint pain and 17 had spinal stenosis symptoms. The mean postoperative hospital stay was 3.4 days (2 to 8). All patients returned to their previous occupations at a mean of 29 days (21 to 42). Follow up ranges from 6 to 32 months. At the latest follow-up, 10 patients were very satisfied and nine were satisfied. The Oswestry score in the last 12 (Centurion) patients decreased from 49 ± 12 preoperatively to 16 ±22 at the latest follow-up. There are no published data on this particular subgroup of patients. They are difficult to treat and would otherwise require combined front and back procedures with extension of the fusion in order to correct the sagittal imbalance. Disc replacement seems to be a good salvage procedure for junctional failure after previous fusions

Introduction. Ankle fusion presents a difficult problem in the presence of infection, inadequate soft tissue, poor bone stock and deformity. Nonunion and infection remains a problem even with internal fixation. Ilizarov frame provides an elegant solution to the problem with stable remote fixation while allowing lengthening, deformity correction and weight bearing. Patients and methods. Twenty-one consecutive patients were studied. The mean age at onset of disease was 52 years (range 4-70). Mean duration of the problem was 59.9 months (6-372). Aetiology included traumatic arthritis in 5, traumatic arthritis with osteomyelitis in 1, failed ankle fusion in 8, septic arthritis in 1, infected ankle fracture nonunion in 1, avascular necrosis of talus in 1, congenital deformity in 3 and failed ankle arthroplasty in 1. 15 patients had deformity of the ankle at the time of presentation. 15 of the 21 patients had either clinical or radiological evidence of infection. Treatment principles involved local excision, deformity correction with good alignment and soft tissue management. Static Compression was achieved with an Ilizarov frame while dynamic fixation was performed in 3 cases for lengthening. Antibiotics treatment was continued until union in the infected cases. On achieving union the frame was removed and a below knee cast was applied for 4 weeks. Results. Fusion was achieved in all cases at an average time of 5 months. One patient had below knee amputation for chronic pain. There was no recurrence of infection. Complications included pin site infection, lateral impingement, drug reaction and hind-foot pain. The results were assessed in terms of SF36 and Modified foot and ankle score. Conclusion. The Ilizarov ankle fusion is a reliable salvage procedure in difficult ankle problems

A subgroup of nine patients, five women and four men, who received lumbar disc prostheses in a segment adjacent to previous posterolateral instrumented fusions (one or two levels) is reviewed. Two patients underwent double-level disc replacement. The mean age was 46.1 years (33 to 62). All patients had marked flattening of the lumbar spine before the operation. One patient developed subsidence within two weeks of the procedure but went on to a satisfactory result. One patient with a double-level disc replacement needed another operation because of a missed far out lateral disc. On day five after the procedure, the top-level disc was removed, the level properly decompressed and the disc reinserted, with good results. The mean postoperative hospital stay was 3.9 days (3 to 8). Within a mean time of 32 days (21 to 42), all patients returned to their previous occupations. Follow-up ranged from 3 to 19 months. At the latest follow-up, four of the patients were satisfied and five were very satisfied. Disc replacement seems an ideal salvage procedure for junctional failure after previous fusions. The short-term clinical results are good

Introduction: Femoroacetabular Impingement (FAI) with more or less subtle abnormality of the hip anatomy and function may contribute to the early development of osteoarthritis (OA). Surgical dislocation as well as arthroscopy of the hip joint are effective and save tools to correct these anatomic deformities. Good clinical results could be achieved predominantly in patients not exceeding grade I OA. The aim of the presented study was to evaluate the clinical and radiological outcome of patients that were treated by open surgical hip dislocation for more advanced OA of the hip joint (> grade I). Patients and Methods: This is a prospective clinical trial on the outcome of patients after surgical hip dislocation. We report on 45 hip joints (41 patients, 16 m, 25 f) that were treated in our institution by offset-correction (removal of osseous bumps at the femoral head-neck junction) and/or labral surgery for FAI. All patients were evaluated prospectively before and after surgery (Harris Hip Score, radiographic parameters, arthro-MRI). Results: The mean follow up (FU) was 45 months (range: 12–102 months). 9 hips underwent total hip replacement in the further course of FU for persisting pain. In the remaining hips a significant pain reduction but no amelioration of hip range of motion could be accomplished. In 90% of the cases, a good correlation between preop-erative arthro-MRT findings and intraoperative labrum and cartilage assessment could be demonstrated. Concerning the outcome, no patient or radiographic factors could be identified that were strongly associated with failure after surgical dislocation. Discussion and Conclusion: Our data suggests that even patients with more advanced osteoarthritis of the hip may benefit from the surgical dislocation approach as a hip salvage procedure. However, the high number of conversion to total hip arthroplasty indicates, that the indication for hip salvage should stay restricted. Patient or radiographic factors indicative of failure could not be identified. In the future and with more sophisticated molecular MRI techniques such as delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) concrete prediction models could be implemented to preoperatively assess hip cartilage in order to sort out patients who will not profit from salvage surgery for advanced OA due to FAI

The treatment of large bony defects following osteomyelitis and trauma with skin damage is challenging. This paper reports the results of fibular transplant for tibial defects. Between 1990 and 2000, five children aged four to nine years were treated. Four had pyogenic osteomyelitis and one a compound fracture with bone loss. All had large wounds on the medial aspect of the tibia. Before reconstruction, conservative treatment lasted five to six months. Sequestrectomy and debridement were performed before fibular transfer. At surgery the fibula was divided below the physis and transferred to the remaining tibia, deep to the tibialis anterior muscle belly. In two cases the fibula was fixed to the lateral aspect of the tibia with screws, and in three into the metaphysis with K-wires. Bone graft was packed around the transfer. Immobilised in a cast for four to six months, the leg was later protected with a calliper. Follow-up ranged from 9 months to 10 years. All children are ambulant, four with callipers and one independently. The latter shows evidence of tibialisation of the fibula. Follow-up continues and the remaining four transfers show solid union and signs of fibular hypertrophy. Osteomyelitis remains a crippling condition that results in bone defects. Fibular transfer is a salvage procedure and an alternative to ablation in cases of severe bone loss with infection and scarring. It should be reserved for difficult cases with extensive defects where conventional bone grafting is not possible

Failed internal fixation of hip fracture is a problem with varied aetiology. This becomes more complex when associated with infection. Total hip arthroplasty (THA) remains the only option to restore hip biomechanics when there is partial/complete head destruction associated with it. A retrospective review was performed for 22 consecutive patients of THA following failed infected internal fixation between Sept. 2001 and Nov. 2007. There were 11 dynamic hip screw failures for intertrochanteric fractures, 6 failed osteotomies following proximal femoral fractures, and 5 failed screw fixations for transcervical fractures. The average age of the patients were 48.5years and average follow up period was 3.5 years (5months – 7.5years). All the patients have undergone two stage revision surgeries. The average Harris Hip Score improved from 35.5 to 82.8 at the latest follow up. None of the patients had recurrence of infection. One patient developed sciatic nerve palsy, recovered partially at 1 year following surgery. The results were comparable to primary arthroplasty in femoral neck fractures. THA is a useful salvage procedure for failed infected internal fixation of hip fractures. Extreme care must be taken to avoid fracture and penetration of femoral shaft in such cases. Auto graft, allograft and special components like multihole cup, narrow stem should be available for reconstruction in difficult cases

Aims. In cases of severe periprosthetic joint infection (PJI) of the knee, salvage procedures such as knee arthrodesis (KA) or above-knee amputation (AKA) must be considered. As both treatments result in limitations in quality of life (QoL), we aimed to compare outcomes and factors influencing complication rates, mortality, and mobility. Methods. Patients with PJI of the knee and subsequent KA or AKA between June 2011 and May 2021 were included. Demographic data, comorbidities, and patient history were analyzed. Functional outcomes and QoL were prospectively assessed in both groups with additional treatment-specific scores after AKA. Outcomes, complications, and mortality were evaluated. Results. A total of 98 patients were included, 52 treated with arthrodesis and 47 with AKA. The mean number of revision surgeries between primary arthroplasty and arthrodesis or AKA was 7.85 (SD 5.39). Mean follow-up was 77.7 months (SD 30.9), with a minimum follow-up of two years. Complications requiring further revision surgery occurred in 11.5% of patients after arthrodesis and in 37.0% of AKA patients. Positive intraoperative tissue cultures obtained during AKA was significantly associated with the risk of further surgical revision. Two-year mortality rate of arthrodesis was significantly lower compared to AKA (3.8% vs 28.3%), with age as an independent risk factor in the AKA group. Functional outcomes and QoL were better after arthrodesis compared to AKA. Neuropathic pain was reported by 19 patients after AKA, and only 45.7% of patients were fitted or were intended to be fitted with a prosthesis. One-year infection-free survival after arthrodesis was 88.5%, compared to 78.5% after AKA. Conclusion. Above-knee amputation in PJI results in high complication and mortality rates and poorer functional outcome compared to arthrodesis. Mortality rates after AKA depend on patient age and mobility, with most patients not able to be fitted with a prosthesis. Therefore, arthrodesis should be preferred whenever possible if salvage procedures are indicated. Cite this article: Bone Joint J 2024;106-B(7):669–679

Introduction and Aims: We present the preliminary results of patellar tendon shortening (PTS), for severe crouch gait in children with spastic cerebral palsy who were household ambulators. Method: We performed bilateral patellar tendon shortening in 15 patients with severe spastic diplegia between May 1996 and January 2002. The majority had acquired crouch gait because of isolated lengthening of the Achilles tendons in childhood and presented with anterior knee pain and rapidly deteriorating gait and function. The PTS procedure included dividing the patellar tendon in its mid portion, and performing an overlapping repair by suturing the distal tendon to the distal pole of the patella and the proximal segment to the tibial tubercle. The corrected position of the patella was maintained by a K-wire passed transversely through the patella and incorporated into a cylinder plaster, with the knee in extension, for a period of six weeks. Correction of knee flexion deformity was achieved by transfer of semitendonosis to the distal femur or extension osteotomy of the distal femur. Results: Rehabilitation was predictably slow but all patients regained their pre-operative mobility status within one year and the majority surpassed their pre-operative functional level by two years after surgery. There were no tendon ruptures or growth disturbance in the proximal tibia. Average age at the time of surgery was 14.2 years (10–19 years). Mean follow-up was 27 months (12–48 months). Pre- and post-operative Insall index in 17 knees was 0.68cm (0.46 to 1.07cm, SD=0.16cm) and 0.85cm (0.56 to 1.08cm, SD=0.20) respectively (p< 0.001 Students-t test). Pre-operatively, only three sides had a normal index, but post-operatively 14 sides had a normal index. Crouch gait improved in all patients who were reclassified as community ambulators. Thirteen patients still needed crutches. One patient continued to complain of bilateral knee pain 12 months after surgery, had insufficient correction according to the Insall index (0.58cm on the left 0.56cm on the right). Conclusion: Severe crouch gait after appropriate surgical and orthotic management, maybe due to patella alta, quadriceps and ankle plantarflexors insufficiency. We present preliminary results of a salvage procedure, patellar tendon shortening, which seems a reasonable option to treat complex crouch gait in selected patients with cerebral palsy

Background. Salvage procedures on the 1st MTPJ following failed arthroplasty, arthrodesis or hallux valgus surgery are difficult and complicated by bone loss. This results in shortened first ray and transfer metatarsalgia. We present our experience of using tri-cortical interposition grafts to manage this challenging problem. Methods. Between 2002 and 2009 our department performed 21, 1st MTPJ arthrodeses using a tri-cortical iliac crest interposition graft. Surgical fixation was achieved with a compact foot plate. We performed a retrospective review from the medical notes and radiographs along with American Foot and Ankle scores which were collected prospectively. We analysed the following parameters: time to radiological, requirement for further surgery, lengthening of 1st ray and any post operative complications. Results. Patient Demographics – Male: Female = 4:16. Mean age – 58 years (38-78 years). Mean follow up – 35 months (4-94 months). Indication for surgery –. Failed arthroplasty 8. Failed fusion 9. Previous Keller's 1. Failed Scarfe Osteotomy 1. Avascular Necrosis 2. Total 21. Arthrodesis achieved – 18 patients (90%) at 4 months post surgery (2-12 months). Mean AOFAS – 45 pre op, 75 post op. Lengthening of 1st Ray achieved – 6 mm average (5mm – 10mm). Complications – 7 (35%). Major – 3 (15%) – 2 non s, 1 varus overcorrection. Minor – 4 (20%) – 2 superficial infection, 2 painful hardware. Conclusions. Using interposition arthrodesis for the salvage of 1st MTPJ surgery we can achieve in 90% of patients. However, the rate of complications is not low and hardware often causes irritation, requiring removal

Introduction: Hip instability is a complex and challenging problem. In experienced units, up to 4% of patients undergoing total hip arthroplasty will require revision surgery to treat hip instability, with only 60% of these treatments being successful. Many authors reporting results with various constrained systems available have described dislocation rates post implantation of the constrained component of 4% to 29%.

Method: The thirteen patients who underwent placement of a constrained component as a revision procedure in our unit from 1989 to 2000 were reviewed.

Results: The indications for revision surgery included recurrent dislocation in eight and intraoperative instability in five revision hip arthroplasties. No patients were lost to follow up. The average follow-up was 43 months(range 14 to 121). The average age at time of surgery was 73 years(range: 52 to 84 years). No component has been revised. The average hip score after revision surgery was 72(range: 52 to 89). There have been no episodes of dislocation of the constrained arthroplasty. In seven cases the constrained arthroplasty was implanted into a previously placed well fixed shell.

Conclusion: Constrained acetabular components were a highly effective tool in the treatment of hip instability.

As there are many reports describing avascular reactions to metal debris (ARMD) after Metal-on-Metal Hip Arthroplasty (MoMHA), the use of MoMHA, especially hip resurfacing, is decreasing worldwide. In cases of ARMD or a rise of metal ion blood levels, revision is commended even in pain free patients with a well integrated implant. The revision of a well integrated implant will cause bone loss. As most of the patients with a hip resurfacing are young and a good bone stock is desirable for further revision surgeries, the purpose of this study was to evaluate the stability of a cemented polyethylene cup in a metal hip resurfacing cup. Two different hip resurfacing systems were investigated in this study (ASR™, DePuy Orthopaedics, Leatherhead, UK; Cormet™, Corin Group, Cirencester, UK).

Six different groups were formed according to the treatment and preparation of the cement-cup-interface (table 1). Before instilling cement in groups 1, 3, 5 the surface, which was contaminated with blood, was cleaned just using a gauze bandage. In groups 2, 4, 6 saline, polyhexanid and a gauze were used to clean the surface prior to the cement application. In group one and two the polyethylene cup (PE) was cemented either into Cormet™ or ASR™, just the ASR™ was further investigated in group three to six. A monoaxial load was applied while the cup was fixed with 45 degrees inclination (group 1–4) and 90 degrees inclination (group 5, 6: rotatory stability) and the failure torque was measured. In contrast to group 1 and 2, the cement penetrated the peripheral groove of the ASR™ in groups 3–6. The mean failure torque of five tests for each group was compared between the groups and the implants.

The ASR™ showed mean failure torque of 0.1 Nm in group one, of 0.14 Nm in group two, of 56.9 Nm in group three, of 61.5 Nm in group four, of 2.96 Nm in group five and of 3.04 Nm in group six. The mean failure torque of the Cormet™ was 0.14 Nm both in groups one and two (table 2). In groups 1–6 there were no significant differences between the different preparations of the interface. Furthermore, in groups 1 and 2 there were no significant differences between the Cormet™ and the ASR™. The mean failure torque of group 4 was significant increased compared to group 3 (p=0.008).

We saw an early failure of the cement fixation due to the smooth surface of the Cormet™ and the ASR™ components in groups 1, 2, 5, 6. In contrast to other hip resurfacing cups the ASR™ has a peripheral groove, which was not cemented except in groups 3 and 4 and therefore the lever-out failure torque was significant increased in these groups. Nevertheless, the groove did not provide stability of the cement-PE compound in case of rotatory movements. In conclusion we do not recommend the use of these methods in clinical routine. The complete removal of hip resurfacing components seems to be the most reasonable procedure.

We describe the technique of wedge resection for revision of an amputation stump, and report the results of this at below-knee level in 57 patients with peripheral vascular disease; healing occurred in 42 of these (74%).

We reviewed 13 patients with infected nonunion of the distal femur and bone loss, who had been treated by radical surgical debridement and the application of an Ilizarov external fixator. All had severely restricted movement of the knee and a mean of 3.1 previous operations. The mean length of the bony defect was 8.3 cm and no patient was able to bear weight.

The mean external fixation time was 309.8 days. According to Paley’s grading system, eight patients had an excellent clinical and radiological result and seven excellent and good functional results. Bony union, the ability to bear weight fully, and resolution of the infection were achieved in all the patients. The external fixation time was increased when the definitive treatment started six months or more after the initial trauma, the patient had been subjected to more than four previous operations and the initial operation had been open reduction and internal fixation.

Purpose: To assess the outcome of customised hinged knee replacements when used to salvage catastrophically failed knee replacements in elderly patients.

Methods: Since 1993, 30 of the 280 (10.7%) revision knee replacements at the Avon Orthopaedic Centre, Bristol have used Endo customised hinged knee pros-theses (21 rotating, 9 fixed) for salvage of limb threatening situations in elderly patients. All were prospectively recorded and regularly reviewed. The average age was 75 years with a predominance of females. Surgical indications were 22 periprosthetic fractures (with or without aseptic loosening), 5 massive aseptic osteolyses, and 3 deep infections.

Results: The mean length of postoperative hospital stay was just 14.6 days and all patients were discharged walking with aids. At follow up (mean 3.0 years, range 0.5–9.3 years) 9 patients had died with their prostheses in situ and functioning. 2 had undergone amputation for recurrent sepsis and 2 had received further surgery for septic problems. 2 patients required further surgery for prosthetic disarticulation and one patient had successful on table vascular repair. 25 patients had mid or long term follow up. Their mean American Knee Scores (AKS) were 69.8 for knee and 35.6 for function (maximum 100), with a mean total knee flexion of 83 degrees. Mean Oxford knee scores (OKS) and WOMAC scores (both scored between 12 and 60 with low score indicating less difficulties) were 34.0 and 30.5 respectively.

Conclusions: Customised hinge revision knee replacements gave extremely rapid rehabilitation and hospital discharge which justified the high prosthetic cost. Complications were high but at mid and long-term review, no prostheses had failed from an aseptic cause and most of the knees of this challenging group were providing both stability and flex

Aim: To evaluate our results of articulated hip distraction in children with a painful, stiff hip.

Materials & Methods: Between 1988 & 2003, 10 children underwent hip distraction and 7 have completed treatment. The diagnoses were varied, though the presentations were those of pain & stiffness of the hip, poor posture and gait. The Orthofix articulated hip device was used in all patients. The outcome assessment was performed by clinical and radiological review.

Results: The mean age of the patients was 13.7 years (Range 12–17 years). The primary diagnosis was SUFE- 3, Perthes-4, trauma-1, septic arthritis -1, chemotherapy induced -1. The mean fixator time was 12 weeks (range 10–14 weeks). The follow-up period ranged from 4–183 months. Soft tissue releases and joint debridement were done in 6 and 2 patients respectively. Results were good in one, fair in five and poor in one patient. Patients with non-functional ankylosis gained functional position with some increase in range of motion. Grade 2 pin tract infections were noted in 4 patients.

Conclusion: Early results with hip distraction in this difficult, complicated group of patients are promising clinically and radiologically.

The purpose of this study is to present the surgical and functional results of a partial and total calcanectomy procedure as a foot salvage alternative in patients with extensive chronic osteomyelitis of the calcaneus.

Material: A retrospective review identified 19 calcanectomies in 16 patients: 5 partial, 11 total and 3 partial to total. The primary diagnosis was insulin-dependent diabetes mellitus (3 patients), neurophatic ulceration (2 patients), infected osteosynthesis (4 patients) and open fracture (7 patients). The average age of the patients was 42.36 years (range from 22 to 60). Prior procedures included removal of osteosynthesis, debridement, Gaenslen’s procedure and skin grafting. Operation was based in Martini’s technique. Most common bacteria were Staphylococcus aureus. Antibiotic treatment was based in cultures and has changed during this period of time.

Results: Four patients were lost (2 died) and the rest average follow-up was 9.8 years (range from 1 to 19 years). Recurrence of infection was present in 3/5 partial calcanectomies and in 1/14 of total calcanectomies. Talonavicular subluxation occurred as a late complication in the patient with recurrence after total calcanectomy and underwent a below-knee amputation. An assessment of functional ambulation was performed in all 16 patients according Volpicelli scale; the lost patients were recorded last time they were visited. All ambulatory patients needed a modified heel-containment orthosis.

Conclusions: Total calcanectomy is an alternative procedure to a bellow-knee amputation in patients with chronic osteomyelitis of the calcaneus. In our hands, partial calcanectomy has worse results in eradication of infection and we have left it.