The benefit of dual mobility cup (DMC) for primary total hip arthroplasties (THA) is still controversial. This study aimed to compare 1) the complications rate, 2) the revisions rate, 3) the survival rate after monobloc DMC compared to large femoral heads (LFH) in primary THA.

Between 2010 and 2019, 2,075 primary THA using cementless DMC or LFH were included. Indications for DMC were patients older than 70 years old or with high risk of dislocation. Every other patient received a LFH. Exclusion criteria were cemented implants, femoral neck fracture, a follow-up of less than one year. 1,940 THA were analyzed: 1,149 DMC (59.2%), 791 LFH (40.8%). The mean age was 73 ±9.2 years old in DMC group and 57 ±12 in LFH group. The complications and the revisions have been assessed retrospectively.

The mean follow-up was 41.9 months ±14 [12–134]. There were significantly fewer dislocations in DMC group (n=2; 0.17%) compared to LFH group (n=8; 1%) (p=0.019). The femoral head size had no impact on the dislocations rate in LFH group (p=0.70). The overall complication rate in DMC (n=59; 5.1%) and LFH (n=53; 6.7%) were not statistically different (p=0.21). No specific complication was attributed to the DMC. In DMC group, 18 THA (1.6%) were revised versus 15 THA in LFH group (1.9%) (p= 0.71). There was no statistical difference for any cause of revisions in both groups. The cup aseptic revision-free survival rates at 5 years were 98% in DMC group and 97.3% in LFH group (p=0.78).

Monobloc DMC had a lower risk of dislocation in a high-risk population than LFH in a low-risk population at the mid-term follow-up. There was no significant risk of specific complications or revisions for DMC in a large cohort. Monobloc DMC can be safely used in a selected high-risk population.

Twenty-five Regnauld’s procedures were performed in 20 patients with painful hallux valgus. This procedure involves the removal of proximal one-third of the proximal phalanx which is fashioned into a ‘hat-shaped graft’ and replaced as an osteochondral autogenous graft. The average age at operation was 56 years (range 39–76). After a mean follow-up of 3 years, 4 months (range 2.5–5.7 years), all the patients were assessed clinically and radiologically. The mean hallux valgus angle preoperatively was 29.3° (range 20–50°). At follow-up, a mean correction of 16.9° was obtained. In our study, 92% of patients were satisfied with the operation, but 8 patients (40%) showed progression of osteoarthritis of the first metatarsophalangeal joint. At 10 year follow up all these patient are satisfied with procedure and doing well. In view of the high incidence of degenerative changes in the first metatarsophalangeal joint, this procedure should be reserved for those patients over the age of 65 years or those with early osteoarthritic changes in the first metatarsophalangeal joint.

Background and Aim: Developmental dysplasia of the hips covers a wide spectrum of hips scenario ranging from mild subluxation to frank dislocation. Sonographic examination has been a widely accepted method of screening and monitoring treatment. Graf IIa+ hips are believed to indicate physiological immaturity with alpha angles appropriate for age and are expected to develop normally without any treatment. The aim of this study was to assess the final outcome of sonographically proven Graf IIa+ hips and to identify any factors which may influence the progression of dysplasia in this group of children.

Materials and methods: Over a six year period, 19,170 new born babies were assessed for DDH. 393 infants with high risk factors and clinical abnormality of the hips underwent ultrasound examination. The scans were performed and reported according to Graf Technique. Pavlik harness treatment was instituted as indicated. Seventy four hips in 44 children were classified as Graf IIa+. Patients who had the hips scans before four weeks and those with incomplete medical records were excluded. All children had regular follow-up with a pelvic x-ray. Acetabular Index (AI), Reimers Index (RI) and Centre edge (CE) angle was measured. All children were followed up until their hips were clinically or radiologically satisfactory. The results were analysed using SPSS software.

Results: Thirty six children with 60 Graf IIa+ hips were eligible for this study. There were 28 girls with 46 hips and eight boys with 14 hips (Girls: Boys = 3.5:1). 29 Left hip and 31 right hip were involved. At a mean follow up of 13 months (range 6 – 41months), the AI was normal in 62%, mildly dysplastic in 30% and severly dysplastic in 8% of the hips. The Reimers Index was normal in 73%, sub-optimal in 24% and subluxated in 3% of the hips. The CE angle was normal in 65%, mildly pathological in 23% and moderately pathological in 12% of the hips. Limitation of abduction after 48hrs of birth appeared to have a direct effect on the development of dysplasia (p=0.02)

Conclusion: From our study, we believe that hips with Graf IIa+ scans are not as benign as they were thought to be. When associated with limited abduction after 48 hours of birth, a high index of suspicion and a long term follow up may be prudent.

To assess the reliability of the pre-operative measurement methods used in the management of the hallux valgus deformity, five observers assessed 50 pre-operative standing foot radiographs on two occasions in order to assess the reliability of radiological hallux valgus assessment using the inter-metatarsal angle (IMA), hallux valgus angle (HVA) and joint congruency. Five published methods of angle measurements described by Hawkins, Venning and Hardy, Mitchell, Miller and Nestor were used.

Kappa statistics were used to assess the reliability of the diagnosis of congruency. Regarding IMA and HVA, mean values between the methods were assessed by one-way ANOVA. The differences between the methods and observers were assessed by two-way ANOVA.

Results: Diagnosis of congruency showed good agreement (k=0.608) over two occasions, although this did vary by observer.

The mean IMA and HVA measurements varied significantly between methods on both occasions (p< 0.0001). Mitchell’s method had the lowest and Miller’s the highest mean values.

Analysis of variance showed both method and observer variations were significant for IMA. But HVA measurements differed significantly only by observers.

Conclusion: The reliability of IMA and HVA measurements is poor whichever measuring method is used and these methods are not interchangeable. Study papers should state the measurement method used. For the pre- and post-operative assessment the same method should be used.

Aims: To assess the reliability and repeatability of the þve described methods of measuring hallux valgus (HVA) and intermetatarsal angles (IMA). The diagnosis of congruency of þrst MTP joint was also assessed. Methods: Five Orthopaedic staff analysed 50 pre-operative standing foot radiographs on two occasions. ANOVA was used to examine the difference between the þve methods and between the þve observers, for both IMA and HVA. Kappa test was used to measure agreement in diagnosing congruency between two occasions. Results: The mean IMA and HVA varied signiþcantly between some of the methods (p< 0.00001). The ANOVA model showed that both method and observer variations (p=0.0264 and p< 0.001 respectively) were signiþcant for IMA and there was no signiþcant difference between measurement methods (p=0.7882) for HVA. The intraobserver reliability of congruency was good (k=0.608) but the interobserver reliability was only fair (k=0.261). A second IMA measurement will lie between 4.2û less and 4.6û more than the þrst IMA measurement 95% of the time. A second HVA measurement will lie between 6û less and 5.6û more than the þrst HVA measurement 95% of the time. Conclusions: This study shows that the different methods give signiþcantly different results. The methods are, therefore, not interchangeable. There was no advantage to any of the method in terms of reliability. All methods had considerable inter- and intra- observer variability that makes these measurements unreliable.

The five different methods of measuring hallux valgus (HVA) and intermetatarsal angles (IMA) and the diagnosis of congruency of first MTP joint were studied on 50 pre-operative standing foot radiographs, to test if these methods were reliable and the results reproducible enough to be used in a treatment algorithm for hallux valgus.

Analysis of variance (ANOVA) was used to examine the difference between the five methods and between the five observers. Kappa test was used to measure agreement in diagnosing congruency between two occasions.

The mean IMA and HVA varied significantly (p< 0.00001). The ANOVA model showed that method and observer variations were both significant for IMA; there was no significant difference between measurement methods for HVA. Congruency had good (k=0.608) intraobserver and fair (k=0.261) interobserver reliability. A second IMA measurement will lie between 4.2° less and 4.6° more than the first IMA measurement 95% of the time. A second HVA measurement will lie between 6° less and 5.6° more than the first HVA measurement 95% of the time.

Overall, there was no advantage to any of the measurement methods, although some observers were better than others. All methods had considerable inter- and intra-observer variability that makes these measurements unreliable.

We reviewed retrospectively 94 patients who had undergone soft-tissue release to correct flexion contracture of the knee to determine the incidence of postoperative hypertension. The cause of contracture in most patients was cerebral palsy (45) or old poliomyelitis (39). Twenty patients developed persistent hypertension. Two of them were symptomatic, one developing hypertensive encephalopathy. Patients who had had poliomyelitis were at a higher risk than those with cerebral palsy; the risk increased with bilateral procedures. The amount of correction achieved had no influence on the incidence of hypertension.

After severe poliomyelitis, which is still relatively common in some developing countries, lateral rotation deformity of the tibia may occur. We have reviewed 51 patients treated by O'Donoghue's rotation osteotomy of the tibia. An average lateral rotation deformity of 57 degrees was fully corrected in all the patients, and in 38 of them the graft obtained during the osteotomy was used for a simultaneous Grice-Green subtalar arthrodesis in one or both feet. All the osteotomies united in an average of 11 weeks, some with relatively minor and unintentional posterior angulation. There was no posterior angulation when the length of the step cut osteotomy was 4.5 cm or more. O'Donoghue's osteotomy is a simple and safe operation, being particularly advantageous if a Grice-Green procedure is also required.