Background: Although needle tip position has been correlated with outcome with respect to pain relief, and to complication rate, to our knowledge, no previous study assesses the location of the needle tip with respect to its ability to isolate injectate around the exiting nerve root without blocking the traversing nerve root to the next caudal level.

Aim: To study the location of injectate when diagnostic selective nerve root blockade is performed.

Method: 87 consecutive selective nerve root blocks performed by a single surgeon were assessed. A consistent surgical technique was utilised. Antero-Posterior fluoroscopy films were analysed to determine the location of injectate in relation to the foraminal and pedicle anatomy. A pro-forma operation note ensured all necessary data was collected prospectively.

Results: Of needle tips positioned lateral to the middle third of the superior pedicle on the AP view, 45 of 51 flowed into the nerve sheath alone, and 6 flowed into both the nerve sheath, and spinal canal. Of these 6, 2 were due to a larger volume of contrast injected, and 2 were due to abnormal anatomy from marked lumbar degenerative scoliosis. Of tips located below the middle third of the pedicle, 2 of 29 flowed into the nerve sheath alone, 2 flowed into the canal alone, and 27 flowed into both. Of those placed medial to zone below the middle third of the pedicle, all seven flowed into the canal only. Analysis using Fisher’s Exact test yielded an extremely statistically significant result, with p < 0.001 comparing needle tip positions in the lateral position with the mid-zone and medial tip positions, and their relationship with injectate reaching the traversing nerve root.

Discussion: For a nerve root block to be truly selective, no injectate must flow past the exiting root to the traversing root. Low volumes of injectate must be placed predictably and accurately. This paper demonstrates the importance of needle tip location in preventing flow beyond the foramen. It is also recommended that contrast be used when significant deformity is present. In cases where there is a therapeutic rather than diagnostic intention, such accuracy is unnecessary. This study does not address the efficacy of the selective nerve root block as a non-operative intervention, nor does it assess the ability of the block to predict operative benefit. It does, however, provide a benchmark for accuracy achievable in patients without significant spinal deformity.

Conclusion: Care must be taken to ensure that the needle tip is positioned lateral to the zone below the middle third of the pedicle if a selective nerve root block is to be used for diagnostic purposes, particularly if there is significant deformity or no contrast is used. In the absence of deformity, however, selective nerve root block may be performed reliably, with a location accuracy of 96%.

Aim: Subtle intra-articular screw penetration of the distal radius during fracture fixation is difficult to determine using standard PA and lateral radiographs. The purpose of our study was to determine which radiographs most reliably identify penetration into the joint.

Methods: A distal volar locking plate was applied to an isolated cadaveric radius bone and a series of plain radiographs taken. The radius, fixed along its long axis, was allowed to rotate through 180 degrees and inclined, in increments, to 40 degrees. In the control group the distal screws did not breach the articular surface. In the study group the screws penetrated the articular surface by 1mm. In each group 65 plain radiographs were taken and the presence or absence of screw penetration scored by two blinded observers.

Results: Using Weighted Kappa analysis the overall inter-observer agreement for all views was 0.5 (CI 0.39 –0.63). However in 7 radiographs there was complete inter-observer agreement correctly identifying screw penetration of the articular surface. The articular surface was correctly identified as intact in 13 views. Only a 75 degrees pronated view, without inclination, was 100% sensitive and specific for identifying the absence or presence of screw penetration through the articular surface.

Conclusion: The intra-operative use of a 75 degrees pronated view may reduce the need for repeated use of the image intensifier and excessive irradiation during plate fixation of distal radius fractures.

Introduction: Avascular necrosis of the femoral head may play a role in failure of the femoral component in metal on metal hip resurfacing arthroplasty. The purpose of our study was to determine, prospectively, femoral head perfusion during hip resurfacing arthroplasty in the posterior and anterolateral approaches.

Methods: 20 hip resurfacing arthroplasties were performed in 19 patients between September 2005 and March 2006 by two different surgeons; one using the extended posterior approach and the other an anterolateral approach. There were an equal number of procedures for each approach. 1.5 gms of intravenous cefuroxime was administered following caspsulectomy and relocation of the femoral head. After 5 minutes the femoral head was dislocated and prepared as routine for the operation. Bone from the top of the femoral head and reamings were sent for assay to determine the concentration of cefuroxime. The average time taken to prepare the femur and take samples was 8.5 minutes.

Results: The concentration of cefuroxime in bone was significantly greater when using the anterolateral approach (mean 15.7mg/kg; CI 12.3 – 19.1) compared to the posterior approach (mean 5.6mg/kg; CI 3.5 – 7.8; p< 0.001). In one patient, who had the operation through a posterior approach, cefuroxime was undetectable.

Discussion: The posterior approach is associated with a significant reduction in the blood supply to the femoral head during hip resurfacing arthroplasty. This may be a cause for avascular necrosis and potential failure of the femoral component in this procedure.

Aim: To study the location of injectate when diagnostic selective nerve root blockade is performed.

Method: 87 consecutive selective nerve root blocks performed by a single surgeon were assessed. A consistent surgical technique was utilised for all patients. Antero-Posterior fluoroscopy films were analysed to determine the location of injectate in relation to the foraminal and pedicle anatomy.

Results: Of needle tips positioned lateral to the middle third of the superior pedicle on the AP view, 45 of 51 flowed into the nerve sheath alone, and 6 flowed into both the nerve sheath, and spinal canal. Of these 6, 2 were due to a larger volume of contrast injected, and 2 were due to abnormal anatomy from marked lumbar degenerative scoliosis. Of needle tips located below the middle third of the pedicle, 2 of 29 flowed into the nerve sheath alone, 2 flowed into the canal alone, and 27 flowed into both. Of those placed medial to zone below the middle third of the pedicle, all seven flowed into the canal only.

Conclusion: Care must be taken to ensure that the needle tip is positioned lateral to the zone below the middle third of the pedicle if a selective nerve root block is to be used for diagnostic purposes, particularly if there is significant deformity or no contrast is used. In the absence of deformity, however, selective nerve root block may be performed reliably, with a location accuracy of 96% providing the tip of the needle lies in the lateral position described.

There are no long-term published results on the survival of a third-generation cemented total shoulder replacement. We describe a clinical and radiological study of the Aequalis total shoulder replacement for a minimum of ten years. Between September 1996 and May 1998, 39 consecutive patients underwent a primary cemented total shoulder replacement using this prosthesis. Data were collected prospectively on all patients each year, for a minimum of ten years, or until death or failure of the prosthesis. At a follow-up of at least ten years, 12 patients had died with the prosthesis intact and two had emigrated, leaving 25 available for clinical review. Of these, 13 had rheumatoid arthritis and 12 osteoarthritis. One refused radiological review leaving 24 with fresh radiographs.

Survivorship at ten years was 100% for the humeral component and 92% for the glenoid component. The incidence of lucent lines was low. No humeral component was thought to be at risk and only two glenoid components. The osteoarthritic group gained a mean 65° in forward flexion and their Constant score improved by a mean 41.4 points (13 to 55). The rheumatoid group gained a mean of 24° in flexion and their Constant score improved by 29.4 points. This difference may have been due to failure of the rotator cuff in 75% of the patients with rheumatoid arthritis.

Thus a third-generation total shoulder replacement gives an excellent result in patients with osteoarthritis and an intact rotator cuff. Patients with rheumatoid arthritis have a 75% risk of failure of the rotator cuff at ten years.

Introduction: Dividing the short external rotators 2 cm from their insertion into the femur should preserve the deep branch of the medial femoral circumflex artery. Our aim was to determine, prospectively, femoral head perfusion during hip resurfacing arthroplasty comparing two posterior approaches.

Methods: 20 hip resurfacing arthroplasties were performed in 20 patients by two different surgeons between September 2005 and November 2006. Patients were divided into two equal groups according to approach. One surgeon used the extended posterior approach and the other a modified posterior approach. Intravenous cefuroxime was administered in every case following capsulectomy and relocation of the femoral head. After 5 minutes the femoral head was dislocated and prepared as routine for the operation. Bone from the top of the femoral head and reamings were sent for assay to determine the concentration of cefuroxime.

Results: There was no statistical difference between the concentration of cefuroxime in bone when using the modified posterior approach (mean 5.6mg/kg; CI 3.6 – 7.8) compared to the extended posterior approach (mean 5.6; CI 3.5 – 7.8; p=0.95). In one patient, who had the operation through the posterior approach, cefuroxime was undetectable.

Discussion: The similarity in femoral head perfusion between approaches suggests the blood supply is further impaired by capsulectomy rather than by damaging the MFCA alone.

Aim: Subtle intra-articular screw penetration of the distal radius during fracture fixation is difficult to determine using standard PA and lateral radiographs. The purpose of our study was to determine which radiographs most reliably identify penetration into the joint.

Methods: A distal volar locking plate was applied to an isolated radius bone and a series of plain radiographs taken. The radius, fixed along its long axis, was allowed to rotate through 180 degrees and inclined, in increments, to 40 degrees. In the control group the distal screws did not breach the articular surface. In the study group the screws penetrated the articular surface by 2mm. In each group 65 plain radiographs were taken and the presence or absence of screw penetration scored by two blinded observers.

Results: Using Weighted Kappa analysis the overall inter-observer agreement for all views was 0.5 (CI 0.39–0.63). However in 7 radiographs there was complete inter-observer agreement correctly identifying screw penetration of the articular surface. The articular surface was correctly identified as intact in 13 views. Only a 75 degrees pronated view, without inclination, was 100 % sensitive and specific for identifying the absence or presence of screw penetration through the articular surface.

Conclusion: The intra-operative use of a 75 degrees pronated view may reduce the need for repeated use of the image intensifier and excessive irradiation during plate fixation of distal radius fractures.

Aim: We present a new trunk asymmetry index for topographic measurement of patients with thoracolumbar scoliosis, which does not require full 3-dimensional reconstruction of the back shape and can be performed with a digital camera and a laptop.

Material and methods: To date, 27 patients were assessed preoperatively, and 14 of these also had post operative assessments. The midline was identified between the two lateral edges of the trunk visible on a digital photograph. This was compared with a straight line. We derived an asymmetry index for each image and compared this with the cobb angle on x-rays pre- and postoperatively.

Results: The new asymmetry index correlated well with the cobb angle up to about 50°. Curves beyond this tended to have compensatory curves. This made interpretation more complex, however, if the compensatory cobb angle was subtracted from the major cobb angle, the asymmetry index fell at the expected points. It clearly distinguishes pre-operative and post-operative images. With POTSI, (posterior trunk symmetry index) there is a significant difference between the pre- and post-operative groups and significant overlap of the two distributions.

Conclusions: Surface topography of scoliotic patients is a useful tool to assess the progression of scoliosis without X-rays, reducing radiation exposure. The proposed new index is a promising measurement for monitoring the progress of a thoracolumbar curve with much better sensitivity and specificity than existing topographic indices, without requiring the capital outlay for surface topography equipment as it can be obtained from a simple digtal photograph and laptop.

Aim: Avascular necrosis of the femoral head is believed to play a role in failure of the femoral component in metal on metal hip resurfacing arthroplasty. The purpose of our study was to determine, prospectively, femoral head perfusion during hip resurfacing arthroplasty in the posterior and anterolateral approaches.

Methods: 20 hip resurfacing arthroplasties were performed in 19 patients between September 2005 and April 2006. Patients were divided into two groups according to approach. An equal number of operations were performed by two different surgeons; one using the extended posterior approach and the other an anterolateral approach. Intravenous cefuroxime was administered in every case following capsulectomy and relocation of the femoral head. After 5 minutes the femoral head was dislocated and prepared as routine for the operation. Bone from the top of the femoral head and reamings were sent for assay to determine the concentration of cefuroxime.

Results: The concentration of cefuroxime in bone was significantly greater when using the anterolateral approach (mean 15.7mg/kg; CI 12.3 to 19.1) compared to the posterior approach (mean 5.6mg/kg, CI 3.5 to 7.8; p< 0.001). In one patient, who had the operation through a posterior approach, cefuroxime was undetectable.

Conclusion: The posterior approach is associated with a significant reduction in the blood supply to the femoral head during hip resurfacing arthroplasty. This may be a cause for avascular necrosis and potential failure of the femoral component in this procedure.

This is a prospective study to determine if we could identify patients who may benefit from preoperative catheterisation in lower limb arthroplasty.

211 consecutive patients undergoing total hip and knee arthroplasty were recruited. There were 131 female (62%) and 80 male (32%), the mean age (+−1 S.D.) was 68+−12 years old. Patients’ demographic details and pre-operative urinary symptoms were recorded. Previous urological surgery and past history of urinary catherisation were also documented. The anaesthetist who was blinded from the study selected the type of anaesthesia and the post-operative analgesia regime. All patients were required to produce mid-stream urine sample before surgery and at post-operation. Urine tract infection was confirmed on a positive microbiological culture. Regression analysis was used to assess various co-variables to identify the high-risk groups.

35 female (56%) and 27 male (44%) were catheterised, the mean age (+−1 S.D.) was 72+/−14 years old. The frequency of catheterisation was unrelated to the surgical procedure, the type of anaesthesia or the postoperative pain control regime. Age over 65 years old and nocturia were significant indicators for urinary catheterisation (p< 0.05). Patients with urinary incontinence and nocturia were strong determinant for urinary catheterisation (p< 0.03). Males over the age 65 years with a past history of urinary catheterisation (p=0.037) were more likely to be catheterised than females of the same group (p=0.947). This has become more evidential if patients have coexisting urinary incontinence and nocturia (p=0.005). Females over the age of 65 years with urinary incontinence were also significant (p=0.013).

The sensitivity for urinary catheterisation in patients over the age of 65 years with previous history of catheterisation, urinary incontinence or nocturia was 89.7%. This group of patients would benefit from pre-operative urinary catheterisation.

While the early period of distraction osteogenesis has been extensively investigated, there are very few data describing the long-term morphology of the regenerate. We performed magnetic resonance scans in ten adults (men age 35+− 11 yr), seven of whom had bone transport for an iatrogenic osseous defect while further three had tibial lengthening for limb length discrepancy. Follow-up ranged between 14 and 43 months (mean : 28 + − 10 months) following the removal of the external fixator. The perimeter, cross- sectional area, volume and the mean signal intensity was calculated from the obtained T1 weighted axial images. Values were compared with the contralateral tibia that acted as control. All cases that had bone transport increased the volume of the tibia from 15.3% up to 50.8%. The regenerated segment was noted to have expanded significantly (p< 0.0001) in all cases. Mean signal intensity in the regenerate decreased in seven cases significantly (p< 0.0001) suggesting increase content of unhydrated tissue such as bone and collagen. The cross-sectional surface of the transported segment was increased in all cases (p< 0.008). Finally in cases that underwent bone transport, the docking site was noted to be obstructed by unhydrated tissue. Contrary to previous claims, the post-distraction osteogenesis tibia is far from normal, consisting of areas with potentially different biomechanical properties. Recognition of these changes is essential not only for appropriate pre-operative counselling but also for considering treatment modalities in case of a fracture.

We present our technique for arthrodesis of the failed Keller’s excisional arthroplasty and the results of postoperative follow-up in a series of eight patients [nine feet].

Arthrodesis of the first metatarsophalangeal joint was performed with a tricortical interposition bone graft stabilised between the first metatarsal and proximal phalanx with a mini dental plate. In all cases the indication for the procedure was for chronic pain at the first meta-tarsophalangeal joint and transfer metatarsalgia of the lateral rays. Post-operative follow-up ranged from 13– 70 months and patients were evaluated using a custom-made satisfaction questionnaire, clinical examination and evaluation of pre-and post-operative x-rays.

All patients were female. The mean age of the patients was 53.2 years [range 32–69]. The post- operative questionnaire revealed that five patients [six cases] were highly satisfied with the surgery. However, we do report complications associated with the procedure including one case of deep infection and four cases in total of radiological non-union of the graft.

The majority of patients were highly satisfied with the surgery, but this technique for the revision of failed Keller’s procedures has a significant risk of complications, so patients should receive appropriate counselling pre-operatively. Although the mini dental plate was low profile, its decreased rigidity may have been responsible for the four cases of non-union.

We determined the effect of the surgical approach on perfusion of the femoral head during hip resurfacing arthroplasty by measuring the concentration of cefuroxime in bone samples from the femoral head. A total of 20 operations were performed through either a transgluteal or an extended posterolateral approach.

The concentration of cefuroxime in bone was significantly greater when using the transgluteal approach (mean 15.7 mg/kg; 95% confidence interval 12.3 to 19.1) compared with that using the posterolateral approach (mean 5.6 mg/kg; 95% confidence interval 3.5 to 7.8; p < 0.001). In one patient, who had the operation through a posterolateral approach, cefuroxime was undetectable.

Using cefuroxime as an indirect measure of blood flow, the posterolateral approach was found to be associated with a significant reduction in the blood supply to the femoral head during resurfacing arthroplasty compared with the transgluteal approach.

Introduction: The anterior drawer test for anterior cruciate ligament (ACL) deficiency, requires a subjective assessment of joint movement, as the tibia is pulled forward. The aim of this study was to objectively quantify this movement using a magnetic tracking device.

Materials and Methods: Ten patients aged 24 to 44 years were assessed as having unilateral ACL deficiency with conventional clinical tests. These patients were then re-assessed using a magnetic tracking device (Polhemus Fastrak). Patients had magnetic sensors attached around their femurs and tibias using elasticated Velcro straps. The Anterior Drawer test was then performed with the patient lying within range of the system’s magnetic source. The test was performed three times on the normal and injured knees of each patient, using a spring balance to apply a standard 20 lb (=89 N) force. During the tests, sensor position and orientation data was collected with an accuracy better than 1 mm and 1 degree, respectively. The data was sampled at 10Hz and stored on a computer for post-test analysis. This analysis deduced the tibial displacement resulting from each anterior drawer.

Results: During the anterior drawer test the supine patient’s knee is in 90 degrees flexion, with the foot planted on the examination couch. As the tibia is pulled anteriorly, it rotates upwards from the foot and the femur experiences a corresponding rotation from the hip. These complex coupled movements are best quantified in terms of absolute displacement of the tibia from the femur. In the normal knees, the mean displacement of the tibia from the femur was 4.2 mm (SD=1.6). In comparison the ACL deficient knees had a mean displacement of 6.3 mm (SD=2.9). This is 50 % more. A paired t test of this data showed a highly significant difference, with P = 0.005.

Conclusion: This study has quantified the movement produced during the Anterior Draw test for ACL deficiency. The tracker’s lightweight sensors caused minimal disturbance to the established clinical test. The system therefore provides objective measurement data to augment the clinicians subjective assessment.

Aim of study: To establish whether there was a correlation between the degree of bony spinal canal encroachment and initial neurological deficit and subsequent neurological recovery.

Methodology and Results: Twenty-six Patients with Thoraco-lumbar Burst fractures presenting with Frankel Grades C, D and E were studied retrospectively. All the Patients were admitted to the spinal injury centre within seven days of injury and were managed conservatively with bed rest for six weeks (mean) followed by brace or a POP jacket for a further period of approximately six weeks. Neurological progress was assessed by Frankel Grade and American Spinal Injury Association (ASIA) motor score.

The degree of spinal canal encroachment was determined from coronal sections of the CT scan by measuring the antero- posterior diameter (APD) and the surface area (Area). (APD 18.84% – 80.62%, Area 9.5% – 81.29%).

Average period of follow up was 24.8 months. All Frankel Group C improved to Frankel D and six out of the 13 Frankel D patients improved to Frankel E. The other seven Frankel D patients out of the 13 patients also had improvement in motor scores but did not change Frankel grade.

Conclusion: There appeared to be no statistically significant correlation between the degree of canal encroachment, the degree of initialneurological impairment or the degree of neurological recovery in patients who had motor sparing within one week of injury.

Purpose: To evaluate the clinical results after meniscal repair using Bionx arrows.

Methods: The study reports the clinical results of 50 patients who had meniscal repair.

The meniscal repairs were carried out by a single surgeon over a period of 4 years.

30 patients ( 1st set) had isolated meniscal repairs. 9 patients ( 2nd set) had meniscal repairs and ACL reconstruction at the same time. 11 patients (3rd set) had meniscal repair followed by ACL reconstruction few months later. The patients were seen in the clinic at 2, 6, 24 weeks post surgery and then kept under surveillance.

Results: In the 1st set , there were only 2 failures who needed partial menisectomy at 7 months and 2 years respectively after the initial repair. So, the failure rate is only 6.6%.

There was only 1 failure in the 2nd set who needed partial menisectomy 19 months post repair. This gives it a failure rate of 11.1%. In the 3rd set, there were 2 failures out of whom one needed partial menisectomy and other needed re-repair using the arrows at 3 and 7 months respectively post repair at the time of ACL reconstruction, a failure rate of 18.8%.

Repair of distal biceps tendon rupture is a subject that has received increasing attention in the past decade. In the active individual who desires as close to normal function as possible, repair of biceps tendon is recommended.

The author describes a tehnique with a single anterior incision and fixation with superanchors. This method was successfully used in 25 patients with excellent functional results. There were no failures and no complications of neurological injury. The single anterior incision approach in which superanchors are used is recommended as an alternative to the traditional two-incision method.

The Biceps brachii is an important flexor of the elbow and is the main supinator of the forearm. Avulsion of its distal tendon insertion is rare injury that mostly affects middle-aged men. It represents only 3% of all biceps tendon ruptures. There is an average of 1.24 spontaneous complete distal biceps ruptures per 100,000 people per year.

The decline in the number of distal biceps tendon ruptures with increasing age correlates with a decrease in at-risk activities after the fourth decade of life. Decreased vascularity, tendon impingement, degenerative changes of the distal biceps tendon and the use of anabolic steroids have been postulated to predispose to tendon rupture.

Our study shows that repair of distal biceps tendon ruptures using superanchors is safe and gives clinically objective and functional results similar to bone tunnel fixation.

We had no major complications, no suture anchor failures and no occurrence of synostosis and neurological injuries. We recommend the use of superanchors for the treatment of distal biceps tendon ruptures.

Do patients’ recollections of disease severity following joint replacement surgery accurately reflect their pre-operative disability? Oxford Knee score questionnaires were sent to 100 patients who had undergone primary knee replacement surgery between January 1998 and July 2000.They were asked to complete these in a manner reflecting their pre-operative disability. The results were then compared with actual scores completed by the same group of patients prior to their surgery. The response rate was 78%.The mean pre-operative score was 45 compared to the recall score of 46.9. The difference was not significant (p=0.77).We believe that recall of disability using a simple knee score is a reliable method of assessing pre-operative disability.

There is a legal and ethical obligation to gain informed consent before treatment commences. A number of bodies have issued guidelines for obtaining consent and these include the Department of Health, the GMC, The Royal College Surgeons of England, and the B.O.A. For a patient to give their informed consent to surgery they must receive sufficient information about their illness, proposed treatment and its prognosis. There are no specific guidelines regarding joint replacement. With this in mind a retrospective case note study was undertaken involving 100 patients who had undergone a hip replacement. Noting the documented discussion at all stages of patient contact.Fifty percent of patients had been seen and listed in the Outpatients by a Consultant, 25% were discussed with the Consultant responsible and the remainder were listed without Consultant input. In only 33 % of cases were any specific risks recorded. This had fallen to 4% on their visit to pre operative assessment clinic. All the consent forms were completed at the time of admission for surgery. Forty percent of these on the day of surgery. The majority were completed by SHOs (58%), while only 4% were completed by consultants. None of the forms noted the lead surgeon. All the consent forms noted some frequently occurring risks. However there was a large variance in the details recorded. The study highlights that the majority of complications are only documented on the consent form, with little note of the dialogue leading up to it. It is also apparent that there is no agreement as to what represents a significant or frequent complication.

This review raises a number of important issues. There needs to be a national standardisation of the process of consent. We propose the introduction of a specific consent form for hip replacements that provide improved documentation of the standardised risks involved. This should also include guidelines regarding prosthesis choice, surgical approach and the extent of trainee involvement. In addition we would also suggest there is a need to improve sequential documented discussion up to the point of surgery and introduce specific training for juniors carrying out consent.

Introduction and aims: Numerous questionnaires are available to assess outcome of hip arthroplasty, but as yet there is no consensus as to which are the most appropriate to use following acetabular osteotomy. We have prospectively evaluated a quality of life measure validated for patients from the United Kingdom and self-administered disease and hip specific questionnaires in patients undergoing Bernese periacetabular osteotomy and compared these to outcome as measured by the Harris hip and Merle d’Aubigne and Postel hip scores.

Method: Since 1997, 24 Bernese periacetabular osteotomies have been performed at our institution. Only patients with a primary diagnosis of development dysplasia of the acetabulum, no evidence of degenerative disease and a minimum of 24 months of follow-up were included in this study. Any non life-threatening co-morbid conditions were documented and recorded. Harris hip (HHS), Merle d’Aubigne and Postel (MDP), Nottingham Health Profile (NHP) and Oxford Hip scores (OHS) were calculated pre-operatively and post-operatively at 6 weeks, 12 weeks, 6 months, one year and then yearly.

Results: Patients have been followed up for an average of 3.2 years (range: 1–5.5 years). The male: female ratio was 1: 8.5. The average age at time of operation was 32.3 years (range 18 – 48). No patient required further surgery or conversion to total hip arthroplasty. Mean postoperative HHS was 89.9. MDP 16.4 and OHS 16.3. All dimensions of the NHP demonstrated improvement of greater than 50 %. The MDP and OHS were most sensitive to time of assessment in the post-operative period. There was no significant difference in the order of magnitude of improvement between any of the scores.

Conclusion: This study has demonstrated that the Bernese periacetabular osteotomy, in a carefully selected group of patients, has a reproducibly good outcome as measured by a variety of scoring methods dependent upon both clinician and patient derived assessment.