The transiliac method of leg lengthening uses a modification of Salter's innominate osteotomy. The bone graft increases the length of the hemipelvis distal to the sacro-iliac joint. Leg-length inequality in 23 patients was treated by this method with an average gain in length of 2.8 cm (2.0 to 3.5). Apart from one residual femoral nerve palsy there were no notable complications. The facility to redirect the acetabulum allowed by the technique, may be useful in cases of potential hip instability or acetabular dysplasia

Subluxation of the hip presenting for the first time in a child over the age of four years is rare. We report ten cases treated over nearly 11 years by the senior author (JAF). We describe the surgical procedures and the results, at maturity, of nine of the ten patients. At a mean follow-up of nearly nine years, the clinical outcome was good in all ten children by the criteria of Ponseti. Radiological assessment showed that three hips remained subluxed, and that four had avascular necrosis of the physis. We advise a one-stage procedure, correcting both the femur and acetabulum

Failure of an acetabular cup is uncommon and has been attributed to wear or creep, trauma or bony irregularities in the acetabulum. We report ten cases in which fracture of the cup occurred at the site of drill holes used to anchor the marker wire. The role of such indentations as stress raisers has not been previously reported; we suggest that deep indentations or grooves should not be placed in the most highly stressed areas and that the cup thickness should allow for predicted wear rates

We have studied the role of computerised axial tomography in the assessment of the acetabulum before an uncemented Mittelmeier arthroplasty was performed in 20 patients. In the absence of gross anatomical abnormality, computerised tomography did not provide additional information, but in eight patients it was useful in determining adequacy of acetabular depth, anterior acetabular cover, and thickness of the anterior and posterior walls. In these patients, the CT scans provided information which was not available from plain radiographs and greatly assisted in pre-operative planning

Ultrasound was used to observe the entire course of spontaneous reduction of CDH in the Pavlik harness in nine infants. In six infants with Suzuki type-A dislocations, the femoral head settled slowly into the bottom of the acetabulum by gliding on its posterior wall. In type-B dislocations, passive abduction of the legs during sleep caused it to approach the entrance to the socket and then suddenly to slip in. Reduction with the Pavlik harness is due to passive mechanical factors, and occurs only during muscle relaxation in deep sleep: no active movement is involved

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

The orientation of an acetabulum or an acetabular prosthesis may be described by its inclination and anteversion. Orientation can be assessed anatomically, radiographically, and by direct observation at operation. The angles of inclination and anteversion determined by these three methods differ because they have different spatial arrangements. There are therefore three distinct definitions of inclination and anteversion. This paper analyses the differences between the definitions and provides nomograms to convert from one to another. It is recommended that the operative definitions be used to describe the orientation of prostheses and that the anatomical definitions be used for dysplastic acetabula

The best treatment for a fractured neck of femur in an old person is considered by many to be replacement hemiarthroplasty which allows the patient to walk immediately on a stable, painless hip. The late results can be marred by acetabular erosion in which the metal head of the prosthesis erodes upwards into the acetabulum to give pain and disability. Here the trial of a new bipolar prosthesis with a dynamic self-aligning outer head is described in 161 fractured necks of femur. No acetabular erosion has been seen with its use over four years

A method for direct measurement of the local pressures in the acetabular cartilage is described. Pressure transducers were introduced into the subchondral bone and positioned there in contrast with the cartilage: the transducers were calibrated in situ. Twelve cadaveric hips were prepared in this way and the pressures were measured with the joint loaded in flexion, extension, abduction, adduction, and in lateral and medial rotation. The highest pressures were recorded in the anterior and posterior segments of the acetabulum; the lowest pressures were constantly found at the zenith of the joint. The relationship of these findings to the pathogenesis of osteoarthritis is considered

1. The long-term results in a consecutive series of 323 healed subcapital fractures of the femur show that, with few exceptions, the capital fragment maintains its integrity when the fragments are aligned within the narrow limits of good reduction, but undergoes superior segmental collapse when reduction is poor. 2. The effect of malreduction on the congruity of the hip joint is examined, and a remodelling response to malalignment of the aspherical femoral head in the imperfectly round acetabulum is proposed as an alternative interpretation of the radiological changes now considered to be the result of capital ischaemia

1. Congenital dislocation of the hip can be diagnosed clinically immediately after birth and the diagnosis confirmed radiologically by a special technique. 2. If the affected joint is reduced during the first two or three days after birth and held reduced for a period not exceeding three months, the joint will remain stable. 3. This treatment probably leads to normal development of the hip joint. 4. The cause of congenital dislocation of the hip may be laxity of the soft tissues of the joint and not a primary dysplasia of the acetabulum

Ten normal neonatal hips were examined in stillborn babies. At first, forcible Barlow manoeuvres did not produce subluxation or dislocation, but by repeated examination a previously stable joint could be rendered unstable. Dissection of the hips showed that the vacuum fit between the femur and the acetabulum was an important factor in neonatal hip stability. The posterior capsule was not a strong or, in itself, an important structure. It is postulated that the capsule and the labrum act together as 'O' rings to maintain the vacuum fit; it is possible that repeated examinations, by producing an effusion, could break the seal and allow instability

Aims

We investigated the long-term performance of the Tripolar Trident acetabular component used for recurrent dislocation in revision total hip arthroplasty. We assessed: 1) rate of re-dislocation; 2) incidence of complications requiring re-operation; and 3) Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain and functional scores.

Aims

The aims of this study were to review the surgical technique for a combined femoral head reduction osteotomy (FHRO) and periacetabular osteotomy (PAO), and to report the short-term clinical and radiological results of a combined FHRO/PAO for the treatment of selected severe femoral head deformities.

Aims

The aim of this study was to analyze the effect of a lateral rim mesh on the survival of primary total hip arthroplasty (THA) in young patients, aged 50 years or younger.

The study describes the topography, morphology and growth of osteophytes in forty femoral heads removed from patients presenting with advanced osteoarthritis of the hip. In addition to standard histological techniques, radiography of serial bone slices and in vivo bone labelling with tetracycline and . 32. P were used. The pattern of major osteophyte formation appeared to be influenced by the direction, degree and rate of displacement of the femoral head in relation to the acetabulum; four principal patterns of growth were noted. Osteophytes form part of extensive osteogenic processes that involve bone structure in the osteoarthritic joint

We carried out primary cemented total hip arthroplasty (THA) on 25 hips in 21 patients with developmental dysplasia of the hip, using autogenous acetabular bone grafts. The socket was placed at the level of the true acetabulum and bone from the femoral neck was used as graft. Five hips were excluded, leaving 20 which were followed up for a mean of 12.9 years (10 to 18). The mean modified Merle d’Aubigné and Postel functional scores were 5.6 for pain, 4.3 for mobility and 4.2 for range of movement. Radiological examination showed aseptic loosening in three sockets but not in the stems. The bone grafts had united and showed no evidence of late failure

We aimed to find out whether the Hastings bipolar prosthesis moved in a bipolar fashion after its use for displaced fractures of the femoral neck. In 65 patients non-weight-bearing movement was assessed radiographically and compared with an earlier study of the Monk prosthesis. In 70% of patients, the only movement was between the acetabulum and the prosthetic shell, the prosthesis behaving as if it were unipolar. This did not change with time, but there was a slight improvement in the range of movement, particularly in flexion. The absence of movement between the outer shell and the metal head is most probably due to the design of the prosthesis and makes this prosthesis unsuitable for use in osteoarthritic hips

Total hip replacement for adults with unreduced congenital dislocation presents a difficult problem because soft-tissue contractures usually prevent sitting at the normal anatomical level. Extensive soft-tissue division or a high-level acetabulum leads to reduced function and poor fixation of the components. We describe a new technique for hip replacement in such cases. The shortened abductors and flexors are released proximally and excision of the upper third of the ilium allows them to be repaired without tension, while providing bone graft to reconstruct the acetabular roof. We report 12 such replacements in 10 patients with good results and few early complications

We have reviewed 19 consecutive patients admitted to the Odense University Hospital after traumatic dislocation of the hip. We aimed to perform computerised tomography as soon as possible after closed reduction; this was accomplished in 15 patients. The CT scans revealed intra-articular fragments of bone in five hips, and fractures of the femoral head or acetabulum in six. In two cases the CT scans excluded fractures or intra-articular fragments which had been suspected on conventional radiography. CT scanning is a useful diagnostic tool in traumatic dislocation of the hip; we consider that it makes an important contribution to management