Aims

To examine the long-term outcome of arthrodesis of the hip undertaken in a paediatric population in treating painful arthritis of the hip. In our patient population, most of whom live rurally in hilly terrain and have limited healthcare access and resources, hip arthrodesis has been an important surgical option for the monoarticular painful hip in a child.

Introduction. Patients who are symptomatic with concurrent acetabular dysplasia and proximal femoral deformity may have Perthes disease. Osteotomies to correct both the acetabular and proximal femur deformities may optimise biomechanics and improve pain and function. In this study, we assessed the long-term results for such a combined procedure. Methods. We included patients who underwent concurrent pelvic and proximal femoral osteotomies by the senior surgeon (JNOH) with a minimum follow-up of 5 years. A modified triple pelvic interlocking osteotomy was performed to correct acetabular inclination and/or version with a concurrent proximal femoral osteotomy to correct valgus/varus and/or rotational alignment. We assessed functional scores, radiological paramenters, arthroplasty conversion rate, time interval before conversion to arthroplasty and other associated complications. Results. We identified 63 patients (64 hips) with a mean age of 29.2 years (range 14.3–51) at a mean follow-up of 10.1 years (range 5.1–18.5). The mean sourcil inclination postoperatively was 4.9. O. (range 1–12) compared to 24. O. (range 14.5–33) preoperatively. The mean Tonnis grade postoperatively was 2.2 (1–3) compared to 1.8 (range 1–2) preoperatively. At the last follow-up assessment, the mean Oxford Hip Score was 56 (range 60–47), Non-arthritic Hip Score was 71 (range 59–80) and UCLA activity score was 8 (range 5–10). There were 12 (18.8%) conversions to arthroplasty at a mean of 7.9 years (range 2.2–12.2) after surgery. Other associated complications include 1 sciatic nerve injury, 1 deep infection and 5 non-unions that required refixation. Discussion. Symptomatic acetabular dysplasia with concurrent proximal femoral deformity is difficult to treat. The use of combined pelvic and femoral osteotomies can optimise acetabular and femoral head alignment to improve pain and function with more than 4 out of 5 hips preserved at 10 years

Avascular necrosis is a serious complication of slipped capital femoral epiphysis and is difficult to treat. The reported incidence varies from 3% to 47% of patients. The aims of treatment are to maintain the range of movement of the hip and to prevent collapse of the femoral head. At present there are no clear guidelines for the management of this condition and treatment can be difficult and unrewarding.

We have used examination under anaesthesia and dynamic arthrography to investigate avascular necrosis and to determine the appropriate method of treatment. We present 20 consecutive cases of avascular necrosis in patients presenting with slipped capital femoral epiphysis and describe the results of treatment with a mean follow-up of over eight years (71 to 121 months). In patients who were suitable for joint preservation (14), we report a ten-year survivorship of the hip joint of 75% and a mean Harris hip score of 82 (44 to 98).