1. The indications for open reduction in congenital dislocation of the hip are discussed. 2. The technique of the operation and the post-operative treatment are briefly described. 3. The results of the operation in fifty hips are presented. 4. The function and the radiographic appearances of the hip were usually good in the early years after open reduction, but there was a marked tendency to deterioration ten to thirteen years afterwards. 5. The indications for the shelf operation and for rotation osteotomy after open reduction are discussed

In a survey of 6000 children between 9 and 10 years of age, 122 were found to have unilateral or bilateral hallux valgus. These children were randomly assigned to no treatment or to the use of a foot orthosis. About three years later 93 again had radiography. The metatarsophalangeal joint angle had increased in both groups but more so in the treated group. During the study, hallux valgus developed in the unaffected feet of children with unilateral deformity, despite the use of the orthosis

Ninety-seven revisions of total hip replacements are reviewed with a median time of observation of 47 months. Satisfactory pain relief was obtained in 86%. There were six complete failures which were reduced to three by further surgery. One hip became infected and was excised. In 12 cases the revisions were complicated by peroperative fractures and in five by dislocations. Radiographic analysis disclosed a high percentage of periarticular ossification and 25 cases of radiographic loosening of the femoral implant

Between 1965 and 1973 a total of 808 McKee-Farrar metal-on-metal cemented total hip arthroplasties were performed in the Norfolk and Norwich Hospital. Of these, 230 surviving arthroplasties have been reviewed at average follow-up of 13.9 years. There were good or excellent results in 49% of the arthroplasties as judged by the Harris hip score with 78% of these having little or no pain. A comprehensive radiographic analysis was undertaken and a survivorship study of 81% of the total number of prostheses is presented

Aims

Following the resection of an extensive amount of bone in the treatment of a tumour, the residual segment may be insufficient to accept a standard length intramedullary cemented stem. Short-stemmed endoprostheses conceivably have an increased risk of aseptic loosening. Extra-cortical plates have been added to minimise this risk by supplementing fixation. The aim of this study was to investigate the survivorship of short-stemmed endoprostheses and extra-cortical plates.

We describe six knees in five patients, referred to us after accidental irrigation with chlorhexidine 1% in aqueous solution during arthroscopy. All six knees developed persisting pain, swelling and crepitus with loss of range of movement. Radiographs showed loss of joint space in all three compartments due to extensive chondrolysis, with many loose bodies and synovitis. Histological examination showed partial necrosis of the cartilage, with slight non-specific inflammation and fibrosis of synovial specimens. Care is needed in checking irrigation fluids, and these should have a distinctive colour

Computerised tomography is useful in the diagnosis of abnormalities of the hip in children, particularly in assessing the size and shape of the acetabulum, the position and congruity of the femoral head relative to the acetabulum, and the degree of femoral anteversion or retroversion. It is most useful when limited hip movement and previous operations preclude adequate clinical examination and assessment by routine radiographic techniques. It is not recommended for routine use in screening congenital dislocation of the hip or in diagnosis or follow-up of Perthes' disease or slipped capital femoral epiphysis

1. The authors have found epiphysial stapling a satisfactory and helpful procedure for correction of limb length discrepancy and recommend its use as described. 2. The use of a spring caliper for absolute radiographic location of the epiphysial plates and the use of two Vitallium staples each side is recommended. 3. Suggestions for avoiding injury to the epiphyses are outlined. 4. The experience of stapling operations in seventy children is reported. Forty-four of these patients have completed growth

1. The true deformity of kyphoscoliosis has received little attention. Twenty-one deformities of congenital origin, ten idiopathic, and two secondary to neurofibromatosis, are discussed. The diagnosis is established and usually first suspected by radiography. 2. The deformity was severe and progressive except in three cases; paraplegia occurred in five congenital cases. 3. Early correction and fusion are advocated in the hope of preventing paraplegia and because correction of the old-established deformity is difficult or impossible

Aims

Primary (or spontaneous) and secondary osteonecrosis of the knee can lead to severe joint degeneration, for which either total or unicompartmental arthroplasty may be considered. However, there are limited studies analyzing outcomes of unicompartmental knee arthroplasties (UKAs) for osteonecrosis involving an isolated compartment of the knee. The aims of this study were to analyze outcomes of UKAs for osteonecrosis with specific focus on 1) survivorship free of any revision or reoperation, 2) risk factors for failure, 3) clinical outcomes, and 4) complications.

The early diagnosis of aseptic loosening of a total hip replacement by plain radiography, scintigraphy and arthrography has been shown to be unreliable. It has been suggested that it may be possible to distinguish between a secure and a loose prosthesis using a vibration technique. We have assessed the use of this technique in vitro using models of early and late loosening. Late loosening with an unstable prosthesis can be reliably detected by vibration analysis, but this method was shown to have a very poor diagnostic sensitivity in early loosening when there is no obvious prosthetic instability

We have reviewed the results of treating 75 fractures of the proximal femoral shaft in the presence of a cemented femoral prosthesis. A simple radiographic classification into four types is proposed, and suggestions are made on the appropriate management of each. Comminuted fractures around the implant need early revision, whilst spiral fractures in this region may be treated conservatively or by operation. Transverse fractures at the level of the tip of the prosthesis are difficult to manage, and may require open reduction and internal fixation

Of 693 elderly patients admitted with suspected hip fractures, 43 had normal radiographs and were investigated by isotope bone scan. The 30 patients (70%) with normal scans were mobilised and none developed a fracture. All 13 of the patients with specific bone scan abnormalities were subsequently proved to have fractures, five of which became displaced. Clearly conventional radiography does not exclude fracture of the femoral neck in elderly patients; bone scanning is advisable in doubtful cases

Unstable degenerative spondylolisthesis of the cervical spine is very rare. Slip usually occurs at the C3 on C4 or C4 on C5 levels, immediately above a stiff lower cervical spine. There are two clinical patterns: that with neurological involvement causing cervicobrachial pain or myelopathy and that with neck pain alone. The diagnosis can be made by flexion/extension radiography. All of our eight patients had localised fusion, three anterior and five posterior, and all had satisfactory results one to seven years after operation

Congenital vertical talus was diagnosed in 15 feet of 10 children, and was treated by operative reduction. Forefoot deformity was corrected first, using anterolateral soft-tissue release on 11 feet, and manipulation alone in four feet. After prolonged immobilisation in plaster the affected feet had posterior release at the ankle and elongation of the calcaneal tendon. Clinical and radiographic examination at follow-up 15 months to 21 years later showed that a satisfactory outcome had been achieved in 12 of the 15 feet

1. Sixteen patients with articular cartilage erosions after slight injury have been described, as have the results of their treatment. 2. The clinical features of this rarely diagnosed condition are discussed. Attention is drawn to "articular crepitus" and "synovial crepitus" as useful physical signs in establishing the diagnosis. 3. A radiographic sign of localised subarticular osteoporosis is reported and discussed. 4. The surgical treatment used was either shaving of the affected area of cartilage or a combination of shaving with drilling of the subchondral bone plate

1. A child with so-called ischio-pubic osteochondritis is reported from whom the affected ramus was resected. The features observed in the resected specimen were those of a normal closing epiphysis. 2. The literature is reviewed with emphasis on other children who had biopsies and on large scale radiographic surveys of normal children. 3. The conclusions are that the changes in the ischio-pubic synchondrosis cannot justifiably be called osteochondritis, and that they require further investigation, which can most profitably be done at necropsy

1. In a survey of 107 cases of Erb's paralysis, twenty-seven instances of incipient or actual posterior dislocation of the upper end of the radius were discovered. 2. The type of case in which the dislocation occurs is defined and the early clinical and radiographic signs of the displacement are described and illustrated. 3. The probable causes—muscle imbalance and rigid splinting over a long period—are adumbrated and the prevention and remedies are suggested. 4. The occurrence of anterior dislocation—six cases—and its significance are discussed

Objectives

The determination of the volumetric polyethylene wear on explanted material requires complicated equipment, which is not available in many research institutions. Our aim in this study was to present and validate a method that only requires a set of polyetheretherketone balls and a laboratory balance to determine wear.