A variety of materials were used for early hip prostheses. The introduction of Vitallium by Smith-Petersen represented a further advance in this surgical field. We present the longest known follow-up of a Smith-Petersen Vitallium mould arthroplasty

Aims

Periacetabular osteotomy is an effective way of treating symptomatic hip dysplasia. We describe a new minimally invasive technique using a modification of the Smith-Peterson approach.

We performed a prospective, longitudinal cohort study to assess for any compromise in acetabular correction when using this approach, and to see if the procedure would have a higher complication rate than that quoted in the literature for other approaches. We also assessed for any improvement in functional outcome.

Aims

The most effective surgical approach for total hip arthroplasty (THA) remains controversial. The direct anterior approach may be associated with a reduced risk of dislocation, faster recovery, reduced pain and fewer surgical complications. This systematic review aims to evaluate the current evidence for the use of this approach in THA.

This is the first time that the principle of the mould—the principle of guiding the repair of nature for the purpose of recreating a destroyed or damaged structure, has been applied to surgery. The evolution of the method to its present encouraging stage is the result of the co-operative, professional family spirit of the Massachusetts General Hospital. We all share in it. We share it with the general surgeon because of his contributions to surgical technique. We share it with the "medical man" because of his pre-operative and post-operative care of the patient; because of his guidance as to when, and when not, to operate; and because of the many friendly arguments which are productive of so much good. We share it with the anaesthetist because of his clinical judgment of the patient, his selection of anaesthetic agent, and his continuous, conscientious administration of the anaesthetic throughout the operation.

I am going to change from "we" to "I." I owe so much to my assistants, from the first to the last: Bill Rogers, Eddie Cave, George Van Gorder, Paul Norton, Milton Thompson, Otto Aufranc, and Carroll Larson. I want to thank them all for helping to carry the load, for remembering the things that I forgot, and for making helpful suggestions which often led to improvement in surgical technique or to the construction of a useful instrument. I want to pay tribute to the staff of the Orthopaedic Service of the Massachusetts General Hospital and to thank its members for kindly scepticism, constructive criticism, and neverfailing loyal support.

The subject of this lecture, "Evolution of Mould Arthroplasty of the Hip Joint," is appropriate for a Moynihan lecture. It is not the work of one man alone. It is the work of one man, supported by a co-operative, helpful, and friendly hospital staff. This is what Lord Moynihan strove so hard to bring about at a time when surgeons viewed one another as rivals. To quote Dr William Mayo: "It is to Lord Moynihan's everlasting credit that, largely as a result of his unceasing efforts, surgeons came to consider themselves as fellow-workers in a cause."

Khan OH, Malviya A, Subramanian P, Agolley D, Witt JD Minimally invasive periacetabular osteotomy using a modified Smith-Petersen approach. Bone Joint J 2017;99-B:22-28

Aims

We aimed to assess the cumulative risk of total hip arthroplasty (THA) from in situ fixation for slipped capital femoral epiphysis (SCFE) after a follow-up of almost 50 years.

Aims

Lateral femoral cutaneous nerve (LFCN) injury is a complication after periacetabular osteo-tomy (PAO) using an anterior approach, which might adversely affect the outcome. However, no prospective study has assessed the incidence and severity of this injury and its effect on the clinical outcomes over a period of time for longer than one year after PAO. The aim of this study was to assess the incidence and severity of the symptoms of LFCN injury for ≥ three years after PAO and report its effect on clinical outcomes.

Slipped upper femoral epiphysis (SUFE) is the most common hip disorder to affect adolescents. Controversy exists over the optimal treatment of severe slips, with a continuing debate between in situ fixation versus corrective surgery. We present our experience in a series of 57 patients presenting with severe unilateral SUFE (defined > 50°) managed with a subcapital cuneiform osteotomy. Between 2001 and 2011, 57 patients (35 male, 22 female) with a mean age of 13.1 years (9.6 to 20.3, SD 2.3) were referred to our tertiary referral institution with a severe slip. The affected limb was rested in slings and springs before corrective surgery which was performed via an anterior Smith-Petersen approach. Radiographic analysis confirmed an improvement in mean head–shaft slip angle from 53.8. o. (standard deviation (. sd) 3.2). pre-operatively to 9.1. o. (. sd. 3.1) post-operatively, with minimal associated femoral neck shortening. In total 50 (88%) patients were complication free at a mean follow-up of seven years (2.8 to 13.9 years, . sd. 3). Their mean Oxford hip score was 44 (37 to 48) and median visual analogue pain score was 0 out of 10 (interquartile range 0 to 4). A total of six patients (10.5%) developed avascular necrosis requiring further surgery and one (1.8%) patient developed chondrolysis but declined further intervention. . This is a technically demanding operation with variable outcomes reported in the literature. We have demonstrated good results in our tertiary centre. Cite this article: Bone Joint J 2015;97-B:1718–25

Aims

This study reports mid-term outcomes after periacetabular osteotomy (PAO) exclusively in a borderline hip dysplasia (BHD) population to provide a contrast to published outcomes for arthroscopic surgery of the hip in BHD.

Fourteen patients with ankylosing spondylitis had an extension osteotomy for severe flexion deformity of the spine. The Smith-Petersen technique was modified by using a compression device which allows a slow, finely controlled closure of the osteotomy, and provides rigid internal fixation. There were no serious neurological complications. All the patients were able to see straight ahead after operation, and all had solid fusion at nine months, having maintained good correction

A patient is reported who developed a fistula between the hip and the caecum 39 years after arthrodesis of her hip. She presented with a painful right hip and radiographs showed that the Smith-Petersen nail used for arthrodesis had moved up through the acetabulum and into the pelvic cavity. The nail was removed but within a week a fistula which discharged alimentary contents had developed between the hip and the caecum. The patient was treated conservatively, and three weeks later the fistula had closed

1. Aching pain in the thigh, hip or buttock in an elderly person should lead to radiological examination of the hip region. In patients who have been subjected to irradiation for pelvic neoplasms a spontaneous fracture should be strongly suspected and the patient kept under close review, even if the first radiograph is negative. 2. Patients with spontaneous fractures of the femoral neck can be satisfactorily treated by Smith-Petersen nailing even when symptoms have been present for as long as sixteen weeks and displacement for eight weeks. Osteotomy is unnecessary if adequate reduction can be obtained

1. The results of Chiari pelvic osteotomy have been examined two to six years after operation in a group of eighteen patients with persisting acetabular dysplasia in the second and third decades. 2. The analysis suggests that for a good clinical result it is essential to create a relationship of the new outer acetabular lip to the original lip so that the CE angle is between 20 and 40 degrees and the roof angle is between 10 degrees below and 20 degrees above the horizontal. 3. This may be achieved by a pelvic osteotomy immediately above the joint capsule, angled 10 degrees upwards and inwards and displaced by 50 per cent of the pelvic thickness. 4. Details of the operative technique using a Smith-Petersen approach are presented