Abstract

Prophylactic stabilisation with internal fixation of the asymptomatic hip in unilateral slipped capital femoral epiphysis is controversial.

The incidence of bilaterality varies from 20–80% depending on the length of follow-up. The opposite hip has 2335 times higher incidence of developing a slip in cases of a unilateral slip at presentation and there is no chemical, anatomic or radiological feature which can predict a slip.

The arguments regarding prophylactic fixation are based on risks of AVN, chondrolysis, and problems with implant removal and joint penetration

We present a retrospective analysis of sixty-five patients who had prophylactic fixation of the uninvolved hip at the same time as their opposite slipped femoral physis. None had an underlying systemic or endocrine disorder and the average age was 12.5 years (range 11–15 years).A single 7.0 mm cannulated screw was used in all cases. The average time to fusion was 18 months (range 6 to 36 months) and duration of follow up ranged from 3–8 years (mean 4.5 years).

None of the patients had implant removal and at latest review did not show any evidence of chondrolysis, avascular necrosis, premature physeal arrest or secondary arthrosis in the prophylactically fixed hip. There were a couple of cases of inadvertent wire penetration into joint, which were recognised and rectified immediately, and a correct length screw inserted. Both these patients had an uneventful post-operative course with no problems of chondrolysis etc at latest follow-up (5 years). One patient (1.5%) developed a superficial wound infection, which cleared up with antibiotics.

Conclusion: This study demonstrates the safety of prophylactic fixation using a single cannulated cancellous screw and is recommended for prevention of delayed slip and hence secondary osteoarthrosis.

We made a randomised prospective comparison of the Dynamic Hip Screw and the Gamma locking nail for the internal fixation of 200 petrochanteric femoral fractures in elderly patients. There was less intraoperative blood loss and a lower rate of wound complications in the patients treated by the Gamma nail. They had, however, a high incidence of femoral shaft fracture which we relate in part to implant design. We do not recommend the use of the Gamma nail for these fractures.

Osteonecrosis of the femoral head is a severely disabling complication of steroid immunosuppression in renal transplant patients. We report 31 total hip arthroplasties in 21 renal transplant recipients with an average follow-up of six years. There were no problems with wound healing or infection despite full immunosuppression. Four hips developed symptomatic loosening but the other results were excellent, comparing well with other methods of treatment for osteonecrosis. Ten patients died during the follow-up period. Total hip replacement is a safe and effective treatment for transplant recipients and, in view of their limited life expectancy, should be considered at an early stage in their treatment.

Early mobilisation after arthroplasty of the knee sometimes results in wound breakdown. The two commonly used incisions, the anterior midline and the medial parapatellar incisions, were compared in order to determine which had the best potential for wound healing. Study of the cleavage lines around the knee demonstrated that the medial parapatellar incision lies parallel to the lines, whilst the anterior midline incision lies perpendicular to them. In addition, the medial parapatellar wound was found to be subjected to significantly less tension during flexion; after arthroplasty it can be expected to heal faster and to be less liable to disruption during early mobilisation.