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The Bone & Joint Journal
Vol. 103-B, Issue 3 | Pages 589 - 596
1 Mar 2021
Amin N Kraft J Fishlock A White A Holton C Kinsey S Feltbower R James B

Aims

Osteonecrosis (ON) can cause considerable morbidity in young people who undergo treatment for acute lymphoblastic leukaemia (ALL). The aims of this study were to determine the operations undertaken for ON in this population in the UK, along with the timing of these operations and any sequential procedures that are used in different joints. We also explored the outcomes of those patients treated by core decompression (CD), and compared this with conservative management, in both the pre- or post-collapse stages of ON.

Methods

UK treatment centres were contacted to obtain details regarding surgical interventions and long-term outcomes for patients who were treated for ALL and who developed ON in UKALL 2003 (the national leukaemia study which recruited patients aged 1 to 24 years at diagnosis of ALL between 2003 and 2011). Imaging of patients with ON affecting the femoral head was requested and was used to score all lesions, with subsequent imaging used to determine the final grade. Kaplan-Meier failure time plots were used to compare the use of CD with non surgical management.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXV | Pages 5 - 5
1 Jul 2012
Jewell D McBryde C O'Hara J
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Purpose of study. This study is to determine the survival and outcomes of the Birmingham Interlocking Triple Pelvic Osteotomy. A dysplastic hip predisposes to early arthritis. The Triple Pelvic Osteotomy (TPO) is a joint-preserving option for the treatment of young adults with hip dysplasia. The long term success of the procedure is not known. Patients and methods. The senior author has been performing Birmingham Interlocking Triple Pelvic Osteotomies for 18 years. The outcomes of the first 100 patients (117 TPOs) were reviewed using postal questionnaires, telephone interviews and radiograph review. The primary outcome measure of the study was the Kaplan—Meier survival curve for the TPO. Hip replacement or resurfacing were taken as failure points. The Oxford Hip Score (OHS) and University of California, Los Angeles (UCLA) score were used as secondary outcome measures for the surviving osteotomies. The pre-and post-operative acetabular index and centre-edge angles were measured from surviving radiographs. Results. Follow-up was 93% for survivorship. The mean age at operation was 31 years (range of 7 to 57 years). The mean pre- and post-operative centre-edge angles were 19°and 50° and acetabular indices were 23° and 2°. The Kaplan-Meier survival curve demonstrates that the 10, 15 and 18-year survival rates are 76%, 57% and 50% respectively. Survival was 89% if the osteotomy was performed before 20 years of age. The median UCLA score was five (inter-quartile range three to seven). Median OHS was 41 (inter-quartile range 24 to 46). The UCLA and OHSs show that those with surviving osteotomies tend to have good hip function. Conclusions. The Birmingham Interlocking Pelvic Osteotomy provides a valuable tool to preserve dysplastic hip function and delay arthroplasty surgery, particularly in the younger patient. It is best performed early before arthritis sets in