The Author presents results 2–4 years following treatment of seven patients with complicated hip impingements with this new combination of operations.

Seven patients, aged 15–35yrs were treated by contemporaneous surgical dislocation and debridement of the hip with contemporaneous corrective subtrochanteric femoral osteotomy.. The dislocation and dedridement were performed in the usual way, but the seating chisel for a 95deg blade plate was introduced(to correct varus/valgus) before the trochanter was osteotomised. After debridement, the blade plate was used to transfix the trochanter in position. A separate subtrochanteric osteotomy was then performed at the upper end of the gluteus maximus insertion to provide correction of version and/or valgus/varus where indicated. The plate was removed six to twelve months later.

There were no perioperative complications. Weight-bearing was restricted until bone healing was complete [8–13wks]. Thereafter patients mobilised normally.. At review, all patients were pleased with the outcome. Pre-operative HHS was 62–70: at review it was 90– 96. There were no complications in the medium-term. All patients experienced an improvement in range of movement and exercise tolerance. Avascular necrosis has not occurred overtly and the six patients who had post-operative MRI scans showed no evidence of it.

This new combination of established operations combines the joint conserving benefits of debridement with realignment of the femur in patients with complicated impingements of the hip. The report is preliminary, but the combination of operations appears to be safe in terms of the absence of AVN and effective in its relief of symptoms.

In the period 1991 to 1993, twenty-five patients had Tonnis Triple Pelvis Osteotomy (TPO) performed. The presenting condition was primary or residual acetabular dysplasia. The age range was 24 to 54. Fifteen operations were on the left and two patients had bilateral operations at intervals of more than one year.

The anterior approach (Salter incision) was limited to an internal dissection, with the most limited possible abductor elevation of 2cm at the level of the iliac osteotomy. An Orthofix leg-lengthener was used intraoperatively to manoeuvre the central acetabular fragment, to accurately correct the presenting deformity as determined by CT scans. Two or three 6. 5mm screws were used to fix the osteotomy. No immobilisation was used. Mean blood loss was 580mis (range 375–1050mis).

All patients presented with pain, and only two patients had (mild) pain at review. The adult acetabular index was corrected from mean 31 deg to mean 4deg (max 1 Odeg). The CEA was corrected from mean 8 deg to 20–35 (mean 29) degrees. There was one temporary sciatic neuropraxia in the first patient. One patient has been converted to a resurfacing. Harris Hip Scores (HHS) have been measured yearly from three years post-op. Presenting HHS was mean 58 (range 44–72). At most recent follow-up it was mean 91 (range 79–1 00). Only two patients had HHS < 85. These patients had only 50% joint space at presentation. There was no reduction in HHS with longer follow-up. The operation shows durable and promising results in the medium-term, consistent with other series reported in Europe. The authors recommend that this type of operation be performed before any joint space narrowing develops, so that irretrievable deterioration occurs

The best method of femoral head containment in Legg-Calvé-Perthes’ disease (LCPD) is still controversial. Triple pelvic osteotomy allows desired rotation of acetabulum, reduces the relative stress, provides optimum femoral head cover and compensates for shortening. The iliac osteotomy was modified to interlock following acetabular rotation to provide extra stability and allow early mobilisation.

Material and methods: We reviewed 21 patients, who underwent interlocking triple pelvic osteotomy for severe Legg-Calvé-Perthes’ disease, to evaluate their clinical, radiological and functional results.

The mean patient age at presentation was 7 years and 7 months. Fourteen hips were in the fragmentation stage whereas 8 were in the early re-ossification stage. Seventeen hips were Herring group C and 5 were group B. Seventeen hips had 2 or more at risk radiological signs. The average period of follow-up was 51 months (range, 33 months to 80 months). The average gain in acetabular head index was 18% and that in centre-edge angle was 22 degrees, more than reported for any other single surgical procedure. According to the Harris hip rating system, there was an average gain of 35 points. Average gains in abduction, internal rotation and flexion were 17, 12 and 28 degrees respectively. The average gain in length of the limb was 6.4 mm.

Interlocking triple pelvic osteotomy in LCPD provides good cover of the femoral head, good symptom relief and markedly improved range of motion. Assessment of a few patients approaching maturity has shown a congruent hip joint with a spherical femoral head.