Impingement-free hip range of motion after osteochondroplasty and relative neck lengthening in adults with healed Perthes disease.

OBJECTIVE: Our main objective is to assess the efficiency of the osteochondroplasty with relative neck lengthening in adults with healed Perthes clinically (through assessment of impingement-free hip ROM, functional scores) and radiographically. PATIENTS AND METHODS: This was a prospective case series study included 30 hips of 30 patients who underwent osteochondroplasty and RNL due to symptomatic healed LCPD. This study included 16 males (53.3%) and 14 females (46.7%). The age of patients ranged from 19 to 40 years with mean age 26.4 years at the date of surgery (SD 6.4). RESULTS: Median time of follow-up was 27.7 months after surgery (range 12-60 months). Two patients (6.6%) developed avascular necrosis (AVN) and needing total hip replacement; none of our patients developed nerve injury, detachment of the trochanteric fragment, and wound infection needing treatment. Preoperative Stulberg classes II and III improved more than preoperative Stulberg classes IV and V, although not statistically significant (P = 0.1104, n = 30). The mean HHS and WOMAC score values for each patient were higher in the Stulberg II and III groups compared to the Stulberg IV and V groups CONCLUSION: Head and neck osteochondroplasty performed through the surgical dislocation approach, combined with RFNL, relieved pain and restored function in most of the patients with reasonable complications. LEVEL OF EVIDENCE: IV.

Is subtalar extra articular screw arthroereisis (SESA) reducing pain and restoring medial longitudinal arch in children with flexible flat foot?

Subtalar arthroereisis has been accounted for as a minimally invasive, successful and generally safe technique in the treatment of flatfoot in children. The primary aim of our study was to evaluate the subtalar extra-articular screw arthroereisis (SESA) in children with flexible flatfoot clinically and radiologically. This prospective case series study included 84 feet of 42 patients who underwent Subtalar Extra-articular Screw Arthroereisis (SESA) due to symptomatic flexible flatfoot. This study included 26 males (62 ℅) and 16 females (38℅). The mean age at surgery was (9.92 years); range from (7-15 years).The average follow up period was 29.1 months (ranged from 2 to 48 months). The values of the pre- and post-SESA weight bearing X-ray angles were 149 ± 6 and 127° ± 8° respectively for the Costa-Bartani angle, 43° ± 8° and 25° ± 6° respectively for the lateral T-1stMT angle and 26° ± 7° and 8° ± 3° respectively for calcaneal pitch angle 6° ± 4° and 15° ± 5°. The average AOFAS preoperative score was 68.7 ± 5.7 (Range, 58 to 78) whereas post operative AOFAS score was 97.4 ± 2.3 (range, 94 to 100). All data were analyzed statistically with graph instat. With final conclusion that SESA is an optimal technique for the correction of flexible flatfoot (FFF) as it is simple and can be performed rapidly and is effective procedure in reducing pain and restoring medial longitudinal arch in children with flexible flat foot. Level of clinical evidence (LOCE): Level 4.

Surgical hip dislocation in treatment of slipped capital femoral epiphysis.

BACKGROUND: Most surgeons advocate in situ fixation of the slipped epiphysis with acceptance of any persistent deformity in the proximal femur [Aronsson DD, Loder RT, Breur GJ, Weinstein SL (2006) Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg 14, 666-679]. This residual deformity can lead to osteoarthritis due to femoroacetabular cam impingement (FAI) [Leunig M, Slongo T, Ganz R (2008) Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect 57, 499-507]. OBJECTIVE: The primary aim of our study was to report the results of the technique of capital realignment with Ganz surgical hip dislocation and its reproducibility to restore hip anatomy and function. PATIENTS AND METHODS: This prospective case series study included 30 patients (32 hips, 13 left (Lt) hips, 19 right (Rt) hips) with stable chronic slipped capital femoral epiphysis (SCFE) after surgical correction with a modified Dunn procedure. This study included 22 males and eight females. The mean age of our patients was 14 years (10-18 years). The mean follow-up period was 14.5 months (6-36 months). RESULTS: Thirty hips had excellent and good clinical and radiographic outcomes with respect to hip function and radiographic parameters. Two patients had fair to poor clinical outcome including three patients who developed Avascular Necrosis (AVN). The difference between those who developed AVN and those who did not develop AVN was statistically significant in postoperative clinical scores (p = 0.0000). The mean slip angle of the femoral head was 52.5° ± 14.6 preoperatively and was corrected to a mean value of 5.6° ± 8.2° with mean correction of 46.85° ± 14.9° (p = 0.0000). The mean postoperative alpha angle was 51.15° ± 4.2° with mean correction of 46.70 ± 14.20 (p = 0.0000). In our series, the mean postoperative Harris hip score (HHS) was (96.16 ± 9.7) and the mean improvement was (29.6 ± 9.6) (p = 0.0000). CONCLUSIONS: The modified Dunn procedure allows to restore the normal proximal femoral anatomy by complete correction of the slip angle. This technique may reduce the probability of secondary osteoarthritis and femoroacetabular cam impingement.