Purpose of the study: Data are scarce on the long-term outcome after anterior spinal fusion for idiopathic scoliosis in adolescents. The purpose of this study was to assess the clinical and radiological results obtained in a monocentric series using a single-phase fusion with pre-formed plates for the treatment of lumbar, thoracolum-bar and thoracic idiopathic scoliosis in adolescents.

Material and method: This procedure was performed in 111 patients from 1975 to 1993. Complete clinical and radiological evaluations were available for 35 patients, 7 male and 28 female. The SRS-30 questionnaire (translated into French by the authors) and the Oswestry score were used to assess functional outcome. Radiographic data were collected by an independent observer who read the pre-, post- and last follow-up images. Full spine images were available to assess correction of the curvature, frontal and sagittal balance, pelvic parameters, and degenerative changes in the subjacent discs. Functional outcome was assessed in relation to the radiographic findings.

Results: Mean follow-up was 22 years (range 16–31). Mean age at surgery was 14.5 years. At last follow-up, none of the patients were unemployed because of a spinal problem and 21 women had had one or more successful pregnancies. The mean SRS-30 score was 3.8/5 and correlated with the Oswestry score (13.8%). One patient underwent revision for disc herniation and one for posterolateral lumbosacral fusion because of persistent frontal imbalance. There as a fracture of the proximal screw in six patients with no sign of nonunion. At last follow-up, the mean Cobb angle was 14 (0–42). Frontal imbalance was noted in 18 patients, mean 12 mm. In the sagittal plane, three patients presented anterior imbalance. The pelvic parameters were within the range of the general population. Signs of L5-S1 disc degeneration were noted in ten patients, with no correlation with functional outcome.

Conclusion: Anterior fusion gives good long-term functional results in the treatment of idiopathic scoliosis in adolescents. Patients can pursue a normal occupational and familial life. This technique has provided satisfactory correction in the frontal and sagittal planes.

Aim: To evaluate the effectiveness of distal rectus femoris (RF) release versus transfer to treat gait abnormalities of the knee in ambulatory children with cerebral palsy.

Patients & Methods: Thirty-nine children were included in this study. Thirty patients (55 limbs) underwent RF transfer at a mean age of 11.8 years. and nine (16 limbs) underwent distal rectus release at a mean age of 12.5 years. Indications for surgery included RF contracture and abnormal activity during swing phase in dynamic electromyography (EMG), whether with the presence of kinematic characteristics of stiff-knee gait or not. All patients had pre- and postoperative gait analysis and EMG. To evaluate functional outcomes, patients were grouped by pre-operative knee kinematics (normal; swing-phase peak knee flexion (PKF) < 50°; and peak knee flexion > 50° happening later than 77% of the cycle). All data was analyzed statistically.

Results: For the group of patients with PNF< 50°, this value increased significantly after rectus transfer (p=.005). Children with PNF> 50° and later than 77% of the cycle, showed significant improvement in timing after both procedures (p=.001; p=.02). When kinematic parameters were normal before surgery, they did not improved, although patients experienced a significant decrease of muscle contractures.

Conclusions: According to the results of this study, RF transfer would be the preferred procedure for those patients with preoperative swing-phase knee flexion < 50°. For the rest of patients, both procedures brought similar results. We opt for distal RF release since is technically easier, particularly when one-stage multilevel procedures are being performed.

Purpose: The cause of Paget’s disease, osteitis deformans, defined by increased bone resorption followed by excessive attempts at repair, remains unclear. The current hypothesis is that bone is slowly infected by paramyxovirus in genetically predisposed patients. We report the case of a patient with monostotic Paget’s disease of the pelvis which was transferred to the homolateral distal femur after total hip arthroplasty.

Case report: A 66-year-old man with Paget’s disease of the hemi-pelvis developed pagetic hip deformation requiring a total hip arthroplasty performed in 1993. A Charnley-Kerboull cemented prosthesis was implanted. The medullary canal was plugged with fragments of cancellous bone harvested from the acetabulum (drill holes required to achieve rotatory stability of the acetabulum). One year later, an asymptomatic osteolytic lesion of the distal femur was identified at the level of the medullary plug. Hip function remained excellent despite extension to the distal and proximal femur. All inflammatory parameters were normal and the femoral component was not loosened. 99m-technetium scintigraphy revealed strong uptake in the pelvis but also in the distal femur under the femoral stem. Isolated femoral stem revision was performed in 1996 as a preventive measure against stress fracture. Pathology analysis of surgical specimens identified Paget’s disease (osteoclast hyperactivity, mosaic aspect of the osteoblasts. After femoral revision with a long stem and medical treatment with biphosphonates, the osteolytic lesion disappeared progressively, taking on the classical sclerous sequelar aspect of osteitis deformans. The disease remained quiescent six years after revision. Hip function remained excellent at last follow-up.

Discussion and conclusion: This is the first report of this type of complication after total hip arthroplasty. This observation that Paget’s disease can be transferred via a autologous cancellous bone graft is in favour of the viral hypothesis, suggesting osteoclastic infection by contiguity. This complication has never been observed with frozen or radiated allograft material although such material may have been harvested from pathological bone, notably with Paget’s disease