Purpose of the study: Progressive excentration of the femoral head is fequent in the paralytic hip. The result can be dislocation with considerable functional impact even if the subject cannot walk. Once the dislocation becomes permanent,, treatment is difficult. Soft tissue surgery is insufficient. We present our experience with Chiari osteotomy in a series of 28 paralytic hips.

Material and methods: This retrospective analysis included 28 paralytic hips which were operated on from 1974 to 2003. Fourteen patients had cerebral palsy and 14 a cord lesion. Mean age was 18.5 years (range 9–48) at the time of hip surgery. Mean postoperative follow-up was ten years. Prior hip surgery was noted in eleven cases and association with other bone and joint deformities was frequent: scoliosis, oblique pelvis. The Buly classification was noted for patient independence and was ≤ 2 preoperatively for seven patients. Flexion was greater than 80°. Preopeartive excentration was scored according to Reimers: luxation for ten hips and subluxation for 18. Acetabular dysplasia was present in all patients and 19 presented coxa valga. The femoral head was deformed in 14. The objective of the operation was to relieve hip pain and improve hip motion with a good acetabular cover. A chisel was used in all cases for the osteotomy: average 12° ascending cut medially. Associated procedures were: release (n=7), posterior block (n=2), femoral varus osteotomy (n=6), derotation osteotomy (n=6).

Results and discussion: The effect was clearly beneficial in terms of pain relief. There were no stiff hips. No functional degradation was noted and there were no major complications. The Median Reimers index improved from 66% to 19%. Centering was perfect for nine patients and presented residual excentration > 30% for six. There were two cases of femoral head necrosis (on dislocated hips). Seven hips progressed to osteoarthritic degradation and one patient underwent a revision procedure at 14 years for a total hip arthroplasty.

Conclusion: Chiari osteotomy enabled pain relief and improved function in most patients. It stabilized the hip even after dislocation if appropriate procedures are associated. At present however, for dislocated hips, total hip arthroplasty is often proposed. An associated oblique pelvis and scoliosis should be corrected for before surgical treatment of the hip.

Purpose: First described in 1699, hydatid cyst in a muscle is extremely rare today, even in endemic areas.

Material and methods: We report a retrospective series of nine cases of primary hydatid cyst observed between 1985 and 1998. The patients were predominantly women living in a rural area (mean age 37 years), who consulted for an isolated tumefaction of the thigh (left side in 7/9 cases) which had evolved for twelve months on the average without affecting the general health status. Ultrasonography was highly contributive, suggesting the diagnosis in all cases. Hydatic serology was positive in five cases. Computed tomography (n=3) and magnetic resonance imaging (n=2) provided supplementary information. Hydatid cysts were identified in the adductors (n=4), the quadriceops (n==3) and the three compartments (n=1).

Results: Surgical treatment was performed in eight patients; en bloc resection of the hydatid cyst with peripheral muscle tissue in six cases and subtotal pericystectomy in two. Clinical and anatomic results are presented at mean six years follow-up.

Discussion: We discuss the role of each radiographic examination for the diagnosis and search for extension of hydatid cysts as well as the therapeutic options depending on the clinical course and soft tissue involvement.

Purpose: Patellar tendinopathy is a frequent pathology which generally heals well after functional treatment if managed early.

Material and methods: We report a retrospective analysis of thirteen high-level athletes who underwent surgery for chronic patellar tendinopathy. The disease was demonstrated by ultrasound, MRI, and plain radiographs. Four patients had insertion tendiopathies and nine had tendinopathies involving the tendon body. Six patients also presented a femoropatellar impingement demonstrated by arthroscan. The indication for surgery was total sports disability (Blazina stage III-b) after failure of functional treatment. Surgery consisted in systematic combing of the tendon after resection of degenerative tissue. Resection of the patellar apex was performed in the four patients with insertion tendinopathy. Lateral release was performed in patients with femoropatellar impingement and one patient with severe impingement required advancement of the anterior tibial tuberosity.

Results: Outcome was very good in eight patients and good in five at 36 months (mean follow-up).

Discussion: Ultrasonography was often the only exploration performed for chronic patellar tendinopathy. It is essential for diagnosis and postoperative surveillance. MRI should be reserved for surgical cases or if the diagnosis is doubtful. The beneficial effect of surgical treatment is undeniable if the indication is well founded. For us it is logical and necessary to treat any femoropatellar impingement during the same operation.