Originally used for correction of angular malalignment, 2 hole plate epiphyseodesis has recently gained popularity in paediatric orthopaedic practice for the correction of leg length discrepancy. In this study we aim to assess the efficiency of guided growth plates in correcting leg length discrepancy

Thirty-three children treated for leg length discrepancy with guided growth plates (“8-Plate”, Orthofix, Inc and “I-Plate”, Orthopediatrics) in a tertiary referral centre were retrospectively analysed. Medial and Lateral plates were inserted for symmetrical growth reduction and patients were followed up with clinical and radiological assessment. Thirty patients had distal femoral epiphyseodesis and three had proximal tibial epiphyseodesis. Leg lengths and individual bone lengths were measured from pre and post – operative radiographs. The angle between the screws was measured from radiographs taken intra operatively and at the time of final follow up to assess screw divergence with growth. Efficiency was calculated as the ratio of growth inhibition achieved to the projected discrepancy at maturity if left untreated.

At a mean follow up of 17 months (4–30 m) leg length discrepancy improved from a mean of 30 mm (50–15mm) to 13 mm (2.5–39mm) (p < 0.01). The angle between screws increased from 6 degrees to 26 degrees over the follow up period. Efficiency was found to be 66%. There were 5 patients with angular deformity who needed plate removal and 2 patients developed superficial infection that responded to oral antibiotics.

Epiphyseodesis using guided growth plates is an effective way to correct leg length discrepancy as it is a reversible procedure. Patients undergoing this treatment should be kept under close follow up to prevent development of angular malalignment. Inserting the screws in a divergent fashion at the outset may increase the effectiveness of this procedure.

We present our experience with a double-mobility acetabular component in 155 consecutive revision total hip replacements in 149 patients undertaken between 2005 and 2009, with particular emphasis on the incidence of further dislocation. The mean age of the patients was 77 years (42 to 89) with 59 males and 90 females. In all, five patients died and seven were lost to follow-up. Indications for revision were aseptic loosening in 113 hips, recurrent instability in 29, peri-prosthetic fracture in 11 and sepsis in two. The mean follow-up was 42 months (18 to 68). Three hips (2%) in three patients dislocated within six weeks of surgery; one of these dislocated again after one year. All three were managed successfully with closed reduction. Two of the three dislocations occurred in patients who had undergone revision for recurrent dislocation. All three were found at revision to have abductor deficiency. There were no dislocations in those revised for either aseptic loosening or sepsis.

These results demonstrate a good mid-term outcome for this component. In the 29 patients revised for instability, only two had a further dislocation, both of which were managed by closed reduction.