The Birmingham Interlocking Pelvic Osteotomy for acetabular dysplasia: 13- to 21-year survival outcomes.

AIMS: The aim of this study was to evaluate the long-term clinical and radiographic outcomes of the Birmingham Interlocking Pelvic Osteotomy (BIPO). PATIENTS AND METHODS: In this prospective study, we report the mid- to long-term clinical outcomes of the first 100 consecutive patients (116 hips; 88 in women, 28 in men) undergoing BIPO, reflecting the surgeon's learning curve. Failure was defined as conversion to hip arthroplasty. The mean age at operation was 31 years (7 to 57). Three patients (three hips) were lost to follow-up. RESULTS: Survivorship was 76% at ten years and 57% at a mean of 17 years. Younger patients (< 20 years) had the best survivorship (20 hips at risk; 90% at 17 years; 95% confidence interval 65 to 97). Post-operative complications occurred after 12 operations (10.4%) over the duration of the study. Increasing patient age and hip arthritis grade were primary determinants of surgical failure. CONCLUSION: BIPO provides good to excellent survivorship in appropriately selected patients, with a relatively low rate of complications. Our results are comparable with other established methods of periacetabular osteotomy (PAO), such as the Bernese PAO, even during the surgeon's initial learning curve. Cite this article: Bone Joint J 2017;99-B:724-31.

Hip resurfacing with femoral osteotomy for painful subluxed or dislocated hips in patients with cerebral palsy.

The painful subluxed or dislocated hip in adults with cerebral palsy presents a challenging problem. Prosthetic dislocation and heterotopic ossification are particular concerns. We present the first reported series of 19 such patients (20 hips) treated with hip resurfacing and proximal femoral osteotomy. The pre-operative Gross Motor Function Classification System (GMFCS) was level V in 13 (68%) patients, level IV in three (16%), level III in one (5%) and level II in two (11%). The mean age at operation was 37 years (13 to 57). The mean follow-up was 8.0 years (2.7 to 11.6), and 16 of the 18 (89%) contactable patients or their carers felt that the surgery had been worthwhile. Pain was relieved in 16 of the 18 surviving hips (89%) at the last follow-up, and the GMFCS level had improved in seven (37%) patients. There were two (10%) early dislocations; three hips (15%) required revision of femoral fixation, and two hips (10%) required revision, for late traumatic fracture of the femoral neck and extra-articular impingement, respectively. Hence there were significant surgical complications in a total of seven hips (35%). No hips required revision for instability, and there were no cases of heterotopic ossification. We recommend hip resurfacing with proximal femoral osteotomy for the treatment of the painful subluxed or dislocated hip in patients with cerebral palsy.

The role of ultrasound in the assessment of post-operative complications following hip arthroplasty.

Hip arthroplasty is one of the most commonly performed orthopedic procedures. Clinicians can be faced with the diagnostic dilemma of the patient presenting with a painful hip following arthroplasty and satisfactory post-operative radiographs. Identifying the cause of symptoms can be challenging and ultrasound is increasingly being utilized in the evaluation of potential soft tissue complications following hip surgery. In this article, we describe the common surgical approaches used during hip arthroplasty as this can influence the nature and location of subsequent complications. A review of the literature is presented along with the imaging appearances frequently encountered when imaging this patient population.

Profunda femoris pseudoaneurysm following Birmingham hip resurfacing: an important differential diagnosis for a periarticular cystic mass.

Vascular injury following hip resurfacing arthroplasty is rare: we present a case of profunda femoris pseudoaneurysm complicating hip resurfacing arthroplasty performed via an anterolateral approach. Over recent years, it has been recognized that an adverse reaction to metal debris from metal-on-metal arthroplasties can also result in the development of cystic masses around the hip. This case highlights a potential rare differential diagnosis that needs to be considered when imaging cystic mass lesions around the postoperative hip. Imaging can provide a definitive diagnosis if this entity is considered and its appearances recognized, resulting in appropriate management of this potentially limb- and life-threatening complication.

Metal-on-metal hip resurfacing in developmental dysplasia: a case-control study.

Metal-on-metal hip resurfacing was performed for developmental dysplasia in 96 hips in 85 patients, 78 in women and 18 in men, with a mean age at the time of surgery of 43 years (14 to 65). These cases were matched for age, gender, operating surgeon and date of operation with a group of patients with primary osteoarthritis who had been treated by resurfacing, to provide a control group of 96 hips (93 patients). A clinical and radiological follow-up study was performed. The dysplasia group were followed for a mean of 4.4 years (2.0 to 8.5) and the osteoarthritis group for a mean of 4.5 years (2.2 to 9.4). Of the dysplasia cases, 17 (18%) were classified as Crowe grade III or IV. There were five (5.2%) revisions in the dysplasia group and none in the osteoarthritic patients. Four of the failures were due to acetabular loosening and the other sustained a fracture of the neck of femur. There was a significant difference in survival between the two groups (p = 0.02). The five-year survival was 96.7% (95% confidence interval 90.0 to 100) for the dysplasia group and 100% (95% confidence interval 100 to 100) for the osteoarthritic group. There was no significant difference in the median Oxford hip score between the two groups at any time during the study. The medium-term results of metal-on-metal hip resurfacing in all grades of developmental dysplasia are encouraging, although they are significantly worse than in a group of matched patients with osteoarthritis treated in the same manner.

Congenital dislocation of the hip. A re-appraisal of the upper age limit for treatment.

Difficulties posed in managing developmental dysplasia of the hip diagnosed late include a high-placed femoral head, contracted soft tissues and a dysplastic acetabulum. A combination of open reduction with femoral shortening of untreated congenital dislocations is a well-established practice. Femoral shortening prevents excessive pressure on the located femoral head which can cause avascular necrosis. Instability due to a coexisting dysplastic shallow acetabulum is common, and so a pelvic osteotomy is performed to achieve a stable and concentric hip reduction. We retrospectively reviewed 15 patients (18 hips) presenting with developmental dysplasia of the hip aged four years and above who were treated by a one-stage combined procedure performed by the senior author. The mean age at operation was five years and nine months (4 years to 11 years). The mean follow-up was six years ten months (2 years and 8 months to 8 years and 8 months). All patients were followed up clinically and radiologically in accordance with McKay's criteria and the modified Severin classification. According to the McKay criteria, 12 hips were rated excellent and six were good. All but one had a full range of movement. Eight had a limb-length discrepancy of about 1 cm. All were Trendelenburg negative. The modified Severin classification demonstrated four hips of grade IA, six of grade IB, and eight of grade II. One patient had avascular necrosis and one an early subluxation requiring revision. One-stage correction of congenital dislocation of the hip in an older child is a safe and effective treatment with good results in the short to medium term.

Interlocking triple pelvic osteotomy in severe Legg-Calvé-Perthes disease.

The authors reviewed 21 patients who underwent triple pelvic osteotomy for severe Legg-Calvé-Perthes disease to evaluate their clinical, functional, and radiologic results. The mean age at presentation was 7 years 7 months (range 5-11 years). Seventeen hips were Herring group C and 5 were group B. All of them had "at risk" radiologic signs. A new technique of interlocking iliac osteotomy was used to provide extra stability, allow early weight bearing, and prevent inadvertent retroversion. The average period of follow-up was 30 months (range 1-5 years). The average gain in Harris score was 34.3 (range 4-55). The average gain in acetabular head index was 18% and that in center-edge angle was 22 degrees, more than reported for any other single surgical procedure for containment of the subluxed femoral head. Average gains in abduction, internal rotation, and flexion were 17 degrees, 12 degrees, and 28 degrees respectively. Longer follow-up is required to see the results at maturity, but the early results are promising.

Calcar resorption beneath a well-fitting flanged femoral prosthesis.

Forty-three of 51 Link SP hip prostheses inserted 4 years previous to this study were clinically and radiographically reviewed. All demonstrated bone resorption in excess of 2 mm under the collar, but this resorption was not progressive. No prosthesis had loosened. The collar of a prosthesis, even when securely cemented into the femur with a carefully matched neck cut, was decoupled from its functional position in all the reviewed cases at 4 years. Its only remaining function was to prevent subsidence within the cement mantle, should it ever become necessary to provide stability.

A simple and effective method of sterilizing Esmarch bandages.

The authors evaluated three methods of sterilizing Esmarch bandages. A commercially available autoclave tape laid along the whole length of the midpoint of the width of the bandage was used to determine sterility. Satisfactory sterility was achieved by rolling the Esmarch loosely, with a standard crepe bandage interposed between layers. Tightly rolled bandages and folded bandages without the crepe bandage interposition could not be reliably sterilized.

Congenital dislocation of the hip: acetabular deficiency in adolescence (absence of the lateral acetabular epiphysis) after limbectomy in infancy.

Acetabular development in adolescence was assessed in 61 patients with congenital dislocation of the hip (CDH). Limbectomy was performed in 31; in these, the lateral acetabular (iliac) epiphysis failed to appear by age 13 years. This failure was associated with loss of cover of the femoral head in patients followed up until the third decade. The lateral acetabular epiphysis appeared in all remaining patients in whom reduction was achieved without limbectomy. Acetabular development in adolescence is affected adversely by limbectomy; this is due at least in part to absence of the lateral acetabular epiphysis.

Early results of medial approach open reduction in congenital dislocation of the hip: use before walking age.

The operative findings and results in our first 40 consecutive open reductions of the congenitally dislocated hip by the medial approach are presented. These were all performed by one surgeon before walking age and, with one exception, all patients were aged less than 11 months at operation. Follow-up was from 2 to 7 years (mean 4.6 years). A vascular necrosis did not occur, but coxa magna and significant acetabular dysplasia were each present in one case. We have not performed any secondary operations.

An improved screening system for the early detection of congenital dislocation of the hip.

A screening programme for congenital dislocation of the hip in which physiotherapists examine all neonates is described, together with the results over a 7-year period. All easily reducible dislocated and dislocatable hips are splinted within 2-5 days of birth. Subluxable or "slidey" hips are identified and followed up but not splinted. Risk groups are also identified and followed up. There was a progressive decrease in the number of late diagnosed cases, a result suggesting that even late-presenting acetabular dysplasia can be eliminated by neonatal screening.