Introduction

Two-stage reimplantation for prosthetic joint infection (PJI) of the hip is the standard of care with a 5–10% recurrence at a minimum two-year follow-up. Compiling outcomes data for this standard of care is necessary in order to characterize long-term reinfection risk and the culpable microbiology. The purpose of this study was to determine the long-term success of two-stage reimplantation and identify the factors that affected the success.

Congenital dislocation of the peroneal tendons is a rare and infrequently reported deformity of the foot in the neonate. Four cases of this deformity associated with a congenital calcaneovalgus deformity of the foot have been treated and followed to the resolution of both of the deformities. The calcaneovalgus foot proved more resistant to correction and required more prolonged and aggressive treatment than was usual when it was found as an isolated deformity. All four patients demonstrated other stigmata of intra-uterine malposition and oligohydramnios or both. Our anatomical studies suggested that the superior peroneal retinacular ligament was the critical stabilising structure for the peroneal tendons. A concept of the pathogenesis of this deformity is discussed and a proven regimen for its treatment presented.

We have reviewed the results of operations to stabilise the paralytic hip and to correct and stabilise the deformed spine of children with myelomeningocele. Despite a high complication rate the spinal operations were frequently successful. The hip operations were less satisfactory, with stabilisation of the hip eventually achieved in 69 per cent of the patients and improved walking in only 27 per cent. We do not recommend that such operations be undertaken on the hips of children with a level of paralysis at L3 or above. If stabilisation is indicated multiple combined procedures produce the best result.

Experience in the management of fourteen children with melorheostosis has been reviewed. The principal and presenting clinical features were unilateral soft-tissue contractures associated with inequality of limb length. In contrast to the disease in adults, pain occurred infrequently and was never intense. The average interval between the discovery of the clinical features and the correct diagnosis was six years. The distinctive radiographic feature in the child was an endosteal pattern of hyperostosis marked by streakiness of the long bones and spotting of the small. This differs from the usual subperiosteal or extracortical pattern of hyperostosis seen in adults. The surgical treatment of the contractures proved difficult and recurrence of the deformity was the rule. Distal ischaemia occurred when the chronically contracted and flexed joint was rapidly extended.

Sixty-six deformities of the foot and ankle in forty-two patients with arthrogryposis multiplex congenita were reviewd. Pes equinovarus proved particularly difficult to treat as there was a tendency for the deformity to recur because of the thick and rigid capsule. Intracapsular procedures were more successful than those done adjacent to the joint. Wide capsulotomy or talectomy were the best procedures under the age of three years and triple arthordesis was most successful for the older child.