Aims

The aim of the study was to compare two methods of calculating pelvic incidence (PI) and pelvic tilt (PT), either by using the femoral heads or acetabular domes to determine the bicoxofemoral axis, in patients with unilateral or bilateral primary hip osteoarthritis (OA).

Improvement in coverage achieved by double or triple osteotomies is limited by the size of the acetabular fragment and the ligaments connected with the sacrum. Correction is achieved with the notable asymmetry of the pelvis. In periacetabular Ganz osteotomy (PAO) the acetabular fragment has no connection with the sacrum, which creates enormous possibilities for correction, leaving the pelvic ring untouched.

The aim of the study is to present our experience and early results of using PAO in the treatment of hip dysplasia in adolescents and young adults who were previously treated operatively in childhood, and to find the technical and clinical impact of previous operations on our Results: In the years 1998–2005 262 periacetaubular osteotomies were performed in our hospital. All the patients were operated by one surgeon (JC). From this group 41 patients (43 hips) had previously been operated in childhood for the treatment of hip dysplasia. The previous treatment consisted of: open reduction in 10 hips, DVO in 14 hips, pelvic osteotomy (Salter, Dega, Chiari) in 8 hips, combined: open reduction+DVO+pelvic osteotomy in 10 hips, greater trochanter transfer in 3 hips, bone lengthening in 4 hips, acetabular cyst removal in 1 hip. The age at the primary operation ranged from 1–20.. The follow-up period ranged from 1–7,5 ys av. 2 ys.

In 31 hips the Smith-Petersen, and in 12 hips ilioinguinal approach were performed.

Methods. In clinical pre-op, and post-op examination the following factors were considered: pain, limping, Trendelenburg sign, range of motion, length discrepancy. Radiographic pre-op and post-op examination consisted of: AP view of the pelvis, false profile and AP view with the leg in abduction. Classic and anterior CE angle were measured. During the last examination Harris Hip Score was used.

Results. Flexion slightly decreased from pre-op. 90–140° (av. 118°) to 80–130° (av. 104°) post-op. abduction remained unchanged 15–60° (av. 40°) and 15–60° (av. 40°) respectively, adduction slightly increased 15–40° (av. 31) and 20–50° (av. 33°). The range of rotation did not change after the operation. The sign of Trendelenburg was found in 27 hips before operation and in 8 hips post-op. Pain (acetabular rim syndrome) was found in 40 hips before operation and in 4 hips after the surgery. Either classic or anterior CE angle increased after the surgery in all cases from −14° to 34° and from −10° to 35° respectively. We had a rather low complication rate. But in cases previously operated and in males we strongly recommend Smith-Petersen approach extended into the frontal part of the hip for a better exposure in the scarred and hardened tissues.

We find the technique of PAO as a safe, and effective tool for treating hip joint pathology increasing treatment possibilities for hip joint preservation.

The aim of the study was to assess the results of posterolateral fusion (PLF) of L5/S1 level spondylolisthesis.

Materials 19 children (5 girls, 14 boys) aged 10–18 years (average 14) were treated surgically PLF in years 1985–2002. 18 cases before surgery were classified as grade I and II, 1 as grade III according to Meyerding classification. Long lasted low back pain, progression of the slippage was the main indication for operative treatment.

In every case suspension in prone position were applied before surgery.

Methods The Denis clinical classification was used to evaluate results. On radiographs we evaluated the verticalisation of the sacrum, lordosis at lumbosacral area by drawing Whitman-Ferguson, Boxall, Fernand-Fox angles. The mobility of the fused segment was estimated on the functional radiographs.

Results In clinical evaluation improvement was achieved in 18 cases, in 1 no improvement was achieved. In radiological estimation the slippage decreased in 17 cases varying from 1 grade to 39 grades (average 10 grades). In 1 case no improvment was achieved and in 1 the slippage increased (8 grades). The value of Fernand-Fox angle increased from 1 grade to 35 grades in 16 cases; in 1 no improvement was achieved and in 2 cases the value decreased. In every patient the posterior segmental union was achieved.

On MRI scans disc degeneration was observed in 2 patients.

Conlusions Our results confirm the existence of the remodeling process in the lumbo-sacral area of the spine.

We think that PLF in painful grade I and II spondylolisthesis is adequate method of treatment.