Background and Aim: Developmental dysplasia of the hips covers a wide spectrum of hips scenario ranging from mild subluxation to frank dislocation. Sonographic examination has been a widely accepted method of screening and monitoring treatment. Graf IIa+ hips are believed to indicate physiological immaturity with alpha angles appropriate for age and are expected to develop normally without any treatment. The aim of this study was to assess the final outcome of sonographically proven Graf IIa+ hips and to identify any factors which may influence the progression of dysplasia in this group of children.

Materials and methods: Over a six year period, 19,170 new born babies were assessed for DDH. 393 infants with high risk factors and clinical abnormality of the hips underwent ultrasound examination. The scans were performed and reported according to Graf Technique. Pavlik harness treatment was instituted as indicated. Seventy four hips in 44 children were classified as Graf IIa+. Patients who had the hips scans before four weeks and those with incomplete medical records were excluded. All children had regular follow-up with a pelvic x-ray. Acetabular Index (AI), Reimers Index (RI) and Centre edge (CE) angle was measured. All children were followed up until their hips were clinically or radiologically satisfactory. The results were analysed using SPSS software.

Results: Thirty six children with 60 Graf IIa+ hips were eligible for this study. There were 28 girls with 46 hips and eight boys with 14 hips (Girls: Boys = 3.5:1). 29 Left hip and 31 right hip were involved. At a mean follow up of 13 months (range 6 – 41months), the AI was normal in 62%, mildly dysplastic in 30% and severly dysplastic in 8% of the hips. The Reimers Index was normal in 73%, sub-optimal in 24% and subluxated in 3% of the hips. The CE angle was normal in 65%, mildly pathological in 23% and moderately pathological in 12% of the hips. Limitation of abduction after 48hrs of birth appeared to have a direct effect on the development of dysplasia (p=0.02)

Conclusion: From our study, we believe that hips with Graf IIa+ scans are not as benign as they were thought to be. When associated with limited abduction after 48 hours of birth, a high index of suspicion and a long term follow up may be prudent.

The aetiology of Panner’s disease is unknown. Thrombophilic states have been implicated in Perthes’ disease but remain controversial. The relationship, if any, between thrombophilia and Panner’s disease is not known.

A 7 year old boy presented with pain and restriction of motion in one elbow with no history of trauma. Radiographs confirmed Panner’s disease. A thrombophilia screen showed an abnormal activated protein C resistance test consistent with the presence of Factor V Leiden in the heterozygous state. Thrombophilia may predispose to thrombotic venous occlusion in bone leading to intramedullary hypertension, anoxia and avascular necrosis. This may explain the aetiology of some cases of Panner’s disease. Resistance to activated protein C is a common heritable thrombophilia. The incidence in the UK is around 1.75%. It is caused by a CGA to CAA substitution at position 1691 of the Factor V Leiden gene. This blocks the binding of activated protein C to prothrombotic Factor V producing thrombophilia. Factor V Leiden carriers are three times more likely to experience clinical venous thrombosis than non-carriers. Whilst this risk does not warrant lifelong anticoagulation, thromboembolic events are more likely to cause problems than Panner’s disease which is essentially self-limiting. Affected patients should avoid other risk factors such as smoking or the combined contraceptive pill.

As Factor V Leiden is common in our population, its presence in this patient may be incidental. Thrombophilia screening should be considered for patients with Panner’s disease. This enables appropriate counselling if a thrombophilic condition is found.

We followed up 82 patients who under went 92 Furlong Hydroxyapatite coated uncemented femoral stem, and threaded acetabular component. All hips had a 28mm ceramic heads.

These hips were inserted between the periods 1989–1992. The mean age of the patients at the time of surgery was 54(31–67).

At the ten year follow up there were 64 patients with 70 hips. 5 hips were revised. 3 for acetabular component loosening, 2 for infection. 8 patients died from unrelated causes, 3 refused to attend but filled in the Oxford hip score by mail, 2 were lost to follow up.

At 10 years follow-up the mean age was 64(41–77) years. The Oxford, and the Harris hip scores were used to Asses the patients clinically, and a standard AP pelvis X-Ray showing both hips was performed

Clinically we found that the mean Harris hip score was 90 (51 – 100), the mean Oxford hip score 20 (12 – 45).

Radiographic assessment showed good component fixation with uniform bone growth around the components. The average angle of the Acetabular component was 52 (40– 60). 21 hips showed polyethylene wear in the acetabular component, 5 had more than 2mm wear, and 1 had more than 3mm of poly wear.

36 (52%) of the hips showed proximal calcar remodelling.

We conclude that the Furlong HA coated THR is an excellent THR for the young patient who has a higher activity demand with a cumulative survival rate of 94.29% (CI ±5.2).