Introduction: A proposed benefit of hip resurfacing is straightforward revision. This study assesses the outcome of revision in a large series of failed resurfacings.

Methods: A consecutive series of 84 revisions of metal-on-metal hip resurfacings was analysed. The cohort consisted of 51 (61%) women and 33 (39%) men with a mean age of 48.0 years (range: 15.1–75.3 years) at primary resurfacing. The underlying diagnosis was primary osteoarthritis in 40 (48%) patients, developmental dysplasia of the hip in 13 (15%), avascular necrosis in 9 (11%) and slipped upper femoral epiphysis in 7 (8%).

Mean patient age at first revision was 50.8 years (range: 18.4–75.9 years), at a median of 1.8 years (25^th percentile 0.03 years, 75^th percentile 4.6 years) after the primary operation. 29 (35%) resurfacings were revised for aseptic loosening, 23 (27%) for periprosthetic fracture, 8 (10%) for component malalignment, 8 (10%) for pain alone, 4 (5%) for infection, 4 (5%) for avascular necrosis and 4 (5%) for instability.

Results: At a mean follow-up of 4.6 years (range: 1.0–8.2 years) after the first revision, 10 (12%) of the revised hips had undergone a second revision procedure. 6 men and 3 women required re-revision (data not available for 1 patient). The reasons for the first revision were acetabular malalignment (n=2), femoral neck fracture (n=2), aseptic loosening (n=2), avascular necrosis (n=1), instability (n=1) and pain alone (n=1). The second revision was required at a mean of 3.4 years (range: 0.4–6.3 years) after the first.

Discussion: This study suggests that revisions of hip resurfacing for acetabular malalignment may be at increased risk of subsequent re-revision (2 of 7 patients, 29%). Revision for other causes appears to have better survival in the short to medium term.

Treatment of severe Perthes disease remains a major challenge. Various surgical options exist for containment. We describe the Birmingham interlocking triple pelvic osteotomy (BITPO) and report the results at skeletal maturity.

We reviewed 22 hips in 21 consecutive patients with severe Perthes who had the BITPO. There were 16 males and 5 females. The mean age at presentation was 7 years 7 months. Seventeen hips were Herring group C and five were Herring group B. Six patients had four head-at-risk signs (HARS), 9 had three HARS, 4 had two HARS and 3 had a single HARS. The mean age at operation was 8 years 2 Months.

Clinical, radiological and functional evaluations were under taken on these patients who have since reached skeletal maturity. The minimum follow up was 6 years. Average age at review was 18 years 8 months (range 16–25). Two patients have since had hip resurfacing, and two patients a double femoral osteotomy and one patient a surgical dislocation of the hip and valgus osteotomy.

The average Harris Hip Score pre-operatively was 52, which improved to a mean score of 82. Eleven hips were classified as Stulberg I/II (50%), 9 hips Stulberg III/IV (41%) and 2 hips Stulberg V (9%). The average increase in Centre-Edge angle was 31 degrees and there was an average improvement of 24.6% in the head coverage. At follow up the average abduction was 31 degrees (improvement of 8.5 degrees), internal rotation 22 degrees (10.5 degree improvement) and flexion 106 degrees (11 degree improvement).

We conclude that the Birmingham interlocking triple pelvic osteotomy provides excellent coverage of the femoral head in severe Perthes disease, recaptures and remoulds the deformed head and avoids retroversion of socket. Good results in severe Perthes disease are maintained beyond skeletal maturity.

The purpose of the study was to assess the usefulness of this combination of operations in this challenging patient group.

18 patients (19 hips) with cerebral palsy and painful subluxed or dislocated hips underwent hip resurfacing with shortening and rotation osteotomy of the femur between 1999 and 2005. The mean age was 25 (range 14–59) and follow-up averaged 47 months. Eleven patients were quadriplegic, five were diplegic and two were hemiplegic.

There were no infections. There were two plate cut-outs and two dislocations. All stabilised following necessary treatment. Four plates were removed after about one year. All quadriplegic and four of the diplegic patients were chair-bound pre-operatively. Their carers all felt that their comfort sitting had improved. Seventeen patients (eighteen hips) were pain-free at latest follow-up. One patient, whose plate had not been removed had some lateral tenderness on transferring, but no apparent pain on sitting. Three of the previously chairbound diplegic patients were able to stand and one was able to walk.

As all eighteen of the carers were very satisfied with the outcome, this approach to the treatment of these challenging patients has proved promising

Introduction Growth of femoral neck can be stunted due to early fusion of capital femoral epiphysis and can occur in DDH, LCPD and Septic Arthritis of Hip, while the greater trochanter (GT) continues to grow normally. This results in a high riding greater trochanter with altered abductor function and shortening of the involved limb. Management of patients with such deformities in adolescence is challenging, more so in planning to conserve the hip joint.

Methods and Results We wish to present our experience in the management of such deformed proximal femur with double femoral osteotomy in 15 patients (6 male, 9 female), mean age 22 (11–36) years with an average follow-up of five years. Average distalisation of GT was 2.2 cms and limb-length gained was 2.8 cms. Fracture of GT with displacement was the only complication encountered that required further surgery.

Discussion Primarily the procedure was performed to distalise the greater trochanter thereby improving abduction function, increasing the offset at the hip joint, and creating a more anatomical neck; so facilitating any subsequent joint-sacrificing procedure. Although the secondary benefit of the procedure was to gain limb length, this was what the patients appreciated was the greatest benefit. The technique demands detailed preoperative planning, detailed execution of the plan but produces consistently good results.

Introduction: Difficulties posed in managing late diagnosed CDH are 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 now well-established practice. Femoral shortening prevents excessive pressures on the enlocated femoral head which can predispose to avascular necrosis. Instability due to a co-existing dysplastic shallow acetabulum is frequent and so a pelvic osteotomy is performed to achieve stable and concentric hip reduction.

Theoretical advantages of a one stage open reduction includes shortened hospital stay, avoidance of prolonged repeated immobilization and decreased joint stiffness. This study reports the results of single stage combined procedure for late presenting congenital dislocation of the hip in children aged 4 years and above.

Methods: We retrospectively reviewed 15 patients (total 18 hips) presenting with CDH age 4 years and above who were treated by one stage combined procedure performed by the senior most author. The average age at surgery was 5 years and 9 months (range 4 years to 11 years). The average follow up was 6 years 2 months (range 2 years to 8 years 6 months). All patients were followed up clinically and radiologically in accordance with McKay criteria and modified Severin classification.

Results: According to the McKay criteria12 hips performed excellently whilst 6 did good. All patients had full range of movement except for one. There was an average 1 cm limb length discrepancy in 8 patients. All were Trendlenburg negative. Modified Severin classification demonstrated 4 hips of grade1a, 6 were 1b, 8 were grade 2. 1 patient had AVN and 1 had subluxation requiring revision surgery.

Conclusions: In conclusion, one stage correction of congenital dislocation of the hip in an older child is a safe and effective treatment with good results in short to medium term follow.

This study reports the early results of Birmingham Hip Resurfacing in a group of patients less than 25 years of age. We assessed over a period of 5 years all patients who underwent hip resurfacing who were under the age of 25. Thirty-eight patients underwent 43 hip resurfacing procedures for a variety of diagnoses. This included 15 with Developmental Dysplasia of the Hip (DDH), 13 with Osteonecrosis (ON) of the femoral head, and 7 with End-stage Spastic Hip Disease (ESSHD). We assessed complications, failure and revision rates. Patients completed co-op and oxford hip scores and both clinical and radiographic assessments. At a follow-up of a maximum of 5 years the survival rate was 93% with a further 7% showing radiographic features of failure. Thirteen hips (30%) had a femoral osteotomy at the time of resurfacing allowing correction of length and rotation with no apparent increase in complications. Those who required revision were successfully converted to metal- metal total hip replacement. Our results report the first use of this type of prosthesis in a group of patients under the age of 25 and demonstrate comparable results to standard treatments at this early stage. This study supports the use of hip resurfacing as alternative to conventional treatments for this complex group of patients.

Introduction and Aims: The authors present their results following treatment of 15 patients with complex hip deformities by this new combination of operations.

Method: Fifteen patients aged 14 to 36 years (one male) were treated by contemporaneous metal-on-metal hip resurfacing and rotation osteotomy of the femur to nor-malise anteversion over a five-year period (1996–2001). The resufacing was performed in the usual way; anteversion was corrected at the end of the operation where limited internal or external rotation (< 20deg) was felt likely to interfere with the foot progression angle. The plate was removed about one year later.

Results: There were no peri-operative complications. Weightbearing was restricted until bone healing was complete (8–13 weeks). Thereafter patients mobilised normally. One patient had her plate removed at six months, as there was sleep disturbance due to local tenderness. At review, all patients were pleased with the outcome. Pre-operative HHS was 65–72: at review it was 89–96. There were no complications in the medium term. All patients had an abnormal foot progression angle pre-operatively (14 had fixed internal rotation, one external rotation). At review, in extension all fell within the physiological range IR50/ER50.

Conclusion: This new combination of established operations facilitates the bone conserving benefits of the metal-on-metal resurfacing with corrective rotational osteotomy in patients with complex hip deformity. We have avoided the use of expensive custom protheses and have allowed patients the benefits of a prosthesis minimising bone resection and retaining the physiological modulus of elasticity

We report a case of a 20-year-old microcephalic patient who suffered from symptomatic patellar dislocation since his early days. His patella was laterally dislocated from full extension to 40° of flexion and would remain subluxated thereafter. His CT-scan revealed excessive ipsilateral femoral neck anteversion (45°) that resulted in substantial internal femoral torsion and subsequently led to patella dislocation.

He was treated in one stage with a stepwise procedure, that involved arthroscopic assessment of patellar tracking followed by derotational femoral shaft osteotomy. Tracking was reassessed arthroscopically and although improved was still suboptimal. Therefore an arthroscopic lateral release and an Elmslie-Trillat tibial tubercle transfer were undertaken. This led to very satisfactory patellar tracking.

One year postoperatively he had significant functional improvement, no further episodes of patellar dislocation and a ROM of 0–110°. His Lysholm score improved from 45 to 88, his Tegner activity scale from 2 to 4 and his Knee Outcome Score from 38/80 to 70/80.

This complex case highlights excessive femoral neck anteversion as a causative factor for patella dislocation. A combination of proximal and distal bony realignment procedures is proposed and the role of arthroscopy is emphasised.