In late presenting developmental Dysplasia of hip there is controversy as to the most appropriate method of treatment. The purpose of study was to determine the outcome following the non-operative and operative treatment for late presenting developmental dysplasia of hip.

Retrospective study. Inclusion criteria – (1) Unilateral DH (2) Diagnosed 6 months or more after birth (3) Minimum follow up of 2 years after treatment. 41 patients matched the inclusion criteria. 32 patients attended the follow-up clinic. Patients were divided into non-operative and operative group. Outcome instruments used include activities scale for kids (ASK), physical component of SF36 v2, centre edge angle and severin classification system, all validated scoring systems.

32 patients with mean follow-up of 7 (2–12_ years. Mean age at the time of follow-up was 9 (range 2.7 – 15) years. In our series, 15 patients received non-operative and 17 patients received operative treatment. On ASK, conservatively treated hips scored 72% and surgically treated hips scored 69%. (P-Value = > 0.05). On SF36 v2, mean value of physical function score (PFS) for both non-operative and operative group were 57.58 respectively (P Value > 0.05). Centre edge angle (CEA) of non-operative and operative group were compared with their contra-lateral normal sides (P Value > 0.05). According to Severin classification system, 7 hips were grade I, 8 were grade II in the non operative group and in operative group, 10 were grade II, 5 were grade III and 2 were grade IV. There were no major complications and only one (3%) hip developed avascular necrosis of hip.

On a medium term follow-up, despite some radiological abnormalities, most of the patients achieved good functional results following both non-operative treatments for late presenting DDH. There was no statistically significant difference in the development of hips either treated conservatively or surgically. Long term follow up studies are required in order to establish the true outcome of late presenting DDH treated either conservatively or surgically.

The role of nucleus pulposus (NP) biology in the genesis of sciatica is being increasingly investigated.

The aim of this study was to examine the ability of control and degenerate human nucleus pulposus to respond to an exogenous pro-inflammatory stimulus.

Control disc material was obtained from surgical procedures for scoliosis and degenerate disc tissue from surgical procedures for sciatica and low back pain. Disc specimens were cultured using a serumless technique under basal and lipopolysaccharride (LPS) stimulated conditions and the media harvested, aliquoted and stored at –80°C for subsequent analysis. Levels of IL-1β,TNFα, LTB4, GM-CSF, IL-6, IL-8, MCP-1, PGE2, bFGF and TGFβ-1 in the media were estimated using commercially available enzyme linked immunoabsorbent assay kits.

Neither basal nor LPS stimulated control or degenerate NP produced detectable levels of IL-1β, TNFα, LTB4 or GM-CSF. Control disc IL-8 secretion increased significantly with LPS stimulation, p< .018. Degenerate disc IL-6, IL-8 and PGE2 production increased significantly with LPS stimulation, p< .01, p< .001 and p< .005 respectively. LPS stimulated degenerate NP secreted significantly more IL-6, IL-8 and PGE2 than LPS stimulated control NP, p < 0.05, 0.02 and 0.003 respectively.

LPS induces an increase in both control and degenerate NP mediator production demonstrating the ability of human NP to react to a noxious stimulus by producing pro-inflammatory mediators. The difference in levels of basal and LPS stimulated mediator production between control and degenerate discs show that as a disc degenerates it increases both its level of inflammatory mediator production and its ability to react to a pro-inflammatory stimulus. The increased sensitivity of degenerating human NP to noxious stimuli and increased ability to respond with inflammatory mediator production support the role of NP as an active participant in the genesis of lumbar radiculopathy and discogenic back pain.

Background: We have noticed while performing total hip arthroplasty, that during skin closure, the anterior edge of the wound tends to migrate proximally in relation to the posterior edge. This result is an inaccurate approximation of the wound, the so-called ‘dogs ear’. The aims of the study were to assess and quantify the degree of migration of the anterior edge relative to the posterior one using an invisible marker and to see whether marking the incision site prior to surgery improved skin closure.

Material and methods: We included forty patients undergoing primary hip arthroplasty in the study. Prior to surgery, the skin was marked with five lines perpendicular to the incision line with an invisible skin marker using the greater trochanter as reference point. The skin was then routinely prepared with betadine and a proprietary adhesive incision drape (Ioban 2) was applied to the incision site. The surgeon performed the operation routinely and intra-operatively, the subcutaneous fat content was measured at three set points and averaged. After the wound had been closed, an ultraviolet light source was used to highlight the invisible lines. The gap between the anterior and posterior edge was measured for each line. One set of patients had their incision site marked with a visible marker on the incision drape while the other set did not.

Results: There was a persistent proximal migration of the anterior edge in relation to the posterior edge. The proximal part of the incision site had a more marked skin migration compared to the distal wound. In the unmarked group, the proximal part of the anterior edge tended to migrate on average by 9.5 mm (from 30 mm to 5 mm) in respect to the posterior edge. In the marked group, this migration was reduced to an average of 1.6 mm (from 2 mm to 0 mm) and there was a statistical difference between the 2 groups with p< 0.0001 using the independent t-test as illustrated by the table. Of note, the degree of migration did not vary with the thickness of the fat content. Also, all the wounds healed with no signs of infection.

Conclusion: From this study, we have been able to quantify objectively the extent of migration of the anterior edge of the wound in a hip incision in relation to the posterior edge. Improved hip closure following total hip replacement was achieved after marking the skin prior to surgery. We therefore recommend marking the skin pre-operatively prior to hip incision in order to achieve accurate skin closure as part of the general principle of proper wound closure.