Objective: To assess the efficacy of split Tibialis Posterior tendon transfers for the treatment of spastic equino-varus feet.

Materials and Methods: Fourteen patients with 14 spastic equino-varus feet underwent split Tibialis Posterior tendon transfers. The spasticity was due to cerebral palsy, ataxia telangiectasia and traumatic brain injury. All the patients had Ashworth 1–3 spasticity, and the forefoot was correctible in equinus. Evaluation of the results was by grading of the shape of the feet, ambulation, pain and brace tolerance.

Results: One patient was lost to follow-up after an excellent primary result. Twelve patients had good or excellent results, and one patient had a fair result due to partial recurrence of the deformity. No complications were encountered.

Conclusions: Split Tibialis Posterior tendon transfer is a safe and efficacious procedure for the treatment of spastic equino-varus feet. Good alignment of the treated feet allows comfortable brace and shoe wear. Patient selection is important in order to avoid over-correction or recurrence of the deformity.

Objective: To review our results with hip joint reconstruction in severe spastic hip disease.

Design: Descriptive case series.

Setting: A tertiary referral medical center.

Subjects: All the patients who underwent a hip reconstruction procedure because of SHD were retrospectively evaluated. Twenty-five patients with 32 involved femoral necks were treated between 1997 and 2003. All of the patients had a migration index greater than 40% with 8 of them having a migration index of over 65%. 15 patients had total involvement type CP and 10 patients had diplegic type CP.

Intervention: Hip joint reconstruction comprised of varus derotation osteotomy and a periacetabular osteotomy such as the Dega osteotomy, and when necessary an open reposition of the hip joint was performed.

Results: Good coverage of the femoral head was achieved in 23 of the patients and in 30 of the femoral heads. There was no difference between the high migration index group and the low migration index group. In two cases progressive posterior dislocation continued following the operation, attributed to incomplete correction of the posterior acetabulum. One patient had an intra-operative fracture of the femoral neck. The results were similar in the more severe and less severe groups.

Conclusions: Hip reconstruction has favorable results in all types of CP. We found no difference between the group with high migration index and the low migration index concerning complications and outcome. A high migration index should not be considered as reason not to reconstruct the hip joint. The only contraindication for this procedure is osteoarthritic changes of the hip joint.

Introduction: Septic arthritis of the hip joint in the pediatric age group is considered as an indication for surgical drainage of the joint. The commonly accepted treatment is arthrotomy of the hip joint, and continuous lavage and drainage. The child is treated with intravenous antibiotic therapy and is sometimes placed in a cast.

Because of repeated technical problems with the drains, the senior author developed a method of treatment by repeated aspirations of the hip joint under ultra-sound guidance. We report the results of the first group of these patients, followed up for at least 2 years.

Methods: Hip aspiration is performed when a child is suspected to have septic arthritis of the hip joint based on clinical, radiographic, ultrasonic and laboratory examinations. When hip effusion is found, aspiration is performed under ultrasound guidance, using topical anesthesia and strict sterile technique. If the aspirated fluid is visibly purulent, the joins is irrigated with sterile saline until clear fluid is aspirated. The patient is admitted to the hospital and intravenous antibiotic therapy is initiated. Repeated ultrasound examinations are performed daily, and the joint is decompressed and irrigated again. The procedure is continued until no effusion is demonstrated.

Results: Twenty-four patients were treated for septic arthritis of the hip joint at our institution between January 1st 1990 and December 31st 1998. The first 3 patients were operated and then aspirated when the drains were clogged during the first post operative day. Twenty-one patients were treated by repeated aspirations. Four of those patients were operated when the aspiration failed or when the clinical course did not improve, all of them during the first 4 years of the study. Seventeen patients were treated by repeated aspirations only. The mean number of aspirations was 4, and the children tolerated them well. No complications were seen on follow-up, and all patients went back to full activities. No cases of avascular necrosis of the femoral head were identified.

Discussion and Conclusions: Arthrotomy and drainage of hip joint is an emergency procedure for the treatment of septic arthritis of the hip joint. Possible complications of the procedure are dislocation of the hip joint, avascu-lar necrosis of the hip joint and technical problems with drains. We describe a reliable and safe procedure, that does not necessitate general anesthesia and surgery. The 4 patients who did have to undergo surgery represent a learning curve, and were all treated during the first four years. No complications or late sequelae were seen in our patients.