Aim: This study was carried out in order to clarify the causes that are mainly responsible for the necessity of reoperation after the initial correction of the deformity in congenital talipes equinovarus. The cases, which had been treated surgically with the same method and recurred later, were studied retrospectively in order to be ascertained epidemiological data related to the disease, to be isolated operative findings related to its pathology and to be estimated the surgical results based on clinical and radiological criteria.

Material-Methods: During the 15-year-period from 1990 to 2004, 123 infants (196 feet) with congenital talipes equinovarus have been treated operatively. There were 88 males and 35 females. Seventy three patients (59.3%) had the deformity bilaterally, 20 patients in right foot and 30 in left. Family history was positive in 5 infants. Other congenital anomalies coexisted in 12 infants (9.7%). Preoperative application of successive plasters was started into the first week for 93 infants (75.6%) and its duration was 3 months for 83.7% of cases. All the patients have been operated on with posteromedial approach, extensive ligament division and generous release of soft tissues during the first year of age. Two thirds of cases (67.4%) were treated surgically into the first 6 months of age.

Results: Anatomical variations were revealed during the operation in 14 feet (7.1% of the cases). The clinical results as well as the radiological signs into the first 6 postoperative months were satisfactory, but a reoperation was necessary in 21 feet (in 14 infants) for correction of part of the initial deformity into the following 2–5 years. The clinical criteria were related to the manner of standing and walking, the range of motion of the foot joints and block test. The radiological criteria were related to anteroposterior and lateral talocalcaneal angles and the angle between the longitudinal axis of the talus and that of the first metatarsal in the anteroposterior view as well as the position of the calcaneus in the lateral view. The causes that led to recurrence were related to imperfect correction with the plasters, to incomplete release of soft tissues during the initial operation and to some likely predisposing congenital and environmental factors.

Conclusions: The prevention of recurrence of the initial deformity, in the operative correction of congenital talipes equinovarus, is mainly related to the attentive pre-operative application of plasters, the careful lege artis surgical technique and the early diagnosis and treatment of the predisposing factors.

We reviewed retrospectively the results of total hip arthroplasties that were performed at one institution in young patients who had different types of sickle-cell Haemoglobinopathies to ascertain whether this form of therapy for Osteonecrosis of the hip was appropriate.

MATERIAL-METHOD. Between 1991–2005, 40 patients (24 females-16 males) who have sickle-cell anaemia (12 pts) and microdrepanocytic disease (28 pts), underwent a THR (4 pts bilaterally).The average age at the time of the primary operation was 42.5 yrs (range 18–57 yrs). Cemented, hybrid or uncemented prostheses were used in all cases.

Usually 4–5 blood units are needed perioperatively. Prophylatic antibiotic therapy and anticoagulation treatment always is used.

RESULTS. At the follow-up one patient had died because of haematological complications while was in the hospital. Three others have died of unknown to us reasons. The mean follow-up was 6 yrs-7 mo.

Thirty-six hips re-evaluated and according the Harris Hip Score in 17 the result was excellent, in 15 good and in 4 fair.

The main problem, during the operation, was the difficulty to open the femoral canal, which was very narrow and in some cases completely closed and the bone cortex very dense.

One patient had a revision procedure in two stages for septic loosening seven years after the primary THR. Four patients had a revision procedure for aseptic loosening between one and ten years after the primary operation.

The more serious complications during the surgical intervention were fracture of the greater trochanter in four cases and fracture of the diaphysis of the femur in four, also, cases.

CONCLUSIONS. In this cohort of patients with the multiple medical problems and the frequent admissions, total hip arthroplasty offers a satisfactory solution to the hip problem. However accurate patient selection and carefull multidisciplinary pre-, intra-and post-operative approache is mandatory, including detailed pre-operative examination, close collaboration with the haematologist, pre-operative red blood cell exchange, perioperative use of antibiotics, intra-operative care for preventions of crises of sickling and finaly antibiotic therapy in cases of dental interventions or catheterisms