Total hip replacement in patients with Gaucher’s disease with symptomatic osteonecrosis of the femoral head is controversial because of the high early failure rates. We describe four patients who had an uncemented total hip replacement following enzyme replacement therapy for a median of two years and one month (1 to 9.8 years) prior to surgery, and who remained on treatment. At operation, the bone had a normal appearance and consistency. Histopathological examination showed that, compared with previous biopsies of untreated Gaucher’s disease, the Gaucher cell infiltrate had decreased progressively with therapy, being replaced by normal adipose tissue. The surfaces of viable bone beyond the osteonecrotic areas showed osteoblasts, indicating remodelling. In one case acetabular revision was carried out after 11 years and eight months. The three remaining patients had a mean follow-up of six years and four months (3.3 to 12 years). We recommend initiating enzyme replacement therapy at least one to two years prior to total hip replacement to facilitate bone remodelling and to allow implantation of uncemented components in these young patients.

Aims: Reconstruction of bone continuity after wide resections for malignant tumours has always been a big problem in orthopaedic surgery. During the growing age the problem of reconstruction is harder because of the arrest of growing referring to the scheletal segment involved.

Authors present their experience with different surgical methods.

The choice of surgery depends on the age of the growing child and on the site of the neoplasm.

Methods: The personal series of the authors refer to nine osteogenic sarcomas (five of the distal femur, and four of the proximal tibia) and four Ewing’s sarcomas of the femoral diaphysis. The age of the patients was between nine and sixteen years.

Females were eight and males were five. After ten years only ten patients were disease free (seven osteogenic sarcomas and three Ewing’s sarcomas).

Results and conclusion: In four cases of osteogenic sarcoma the patients were under ten years of age and the surgical choice of Authors was dependent to the exention of the surgical resection including the growing cartilage and the normal growing of the controlateral scheletal segment. For this reason authors employed a conservative method using the association of the Ilizarov external fixator with a final arthrodesis employing a long intramedullary nail.

In five cases of o.s. the age of the patients was over fourteen years, the remaining growing period was limited and for this reason a mechanical growing prosthesis was employed.

In the four cases of diaphyseal Ewing’s sarcoma the reconstruction was performed in two cases employing an autologous graft taken from the iliac crest and in two cases a microvascularized fibular graft.

Functional results of the affected limb, in the surviving patients, depend on the sacrifice of the joint (arthro-dhesis) or in the use of a modular prosthesis that, in AA. experience have a follow-up of 12 years; in diaphyseal reconstruction an anatomical result was obtained either with the mcrovascularized fibular graft or with the autologous graft from the iliac crest, the only difference between these two methods depending on the time of bone healing.

Introduction and Aims: Treatment options for medial gonarthrosis include high tibial osteotomy (HTO). There has been a shift towards opening wedge techniques partially due a perceived higher complication rate with closing wedge techniques. This has not been our experience and we describe the outcome of a large series of closing wedge HTOs.

Method: We reviewed the case records of 313 patients who underwent a total of 374 closing wedge high tibial osteotomies by three surgeons for medial compartment gonarthrosis between 1989 and 2003. The mean outpatient follow-up was 16 months and the mean time post-surgery was 66 months. We identified any post-operative complications and the early clinical outcome including those known to have proceeded to joint replacement. The mean age of patient was 52 years (range 19–72). In all patients a laterally based wedge, mean size nine degrees (range 4–18), was excised and the osteotomy stabilised with one or two stepped staples.

Results: Outcome following closing wedge osteotomy was generally good, only six percent of patients complained of continuing knee pain, although not at a level that required further intervention. Symptoms in 3.5% of knees deteriorated and required total knee replacement at a mean of 63 months (range 16–112) following osteotomy. No intra-operative difficulties were encountered with these replacements. The complication rate was acceptable with an overall rate of 7.8%. One patient required revision shortly after surgery due to inadequate initial correction and one developed a transient peroneal nerve neuropraxia. There were no other neurovascular or intra-operative complications recorded. All the osteotomies united, although nine patients had delayed union, taking a mean of five months for their osteotomies to unite. Other complications included: five patients who had staples removed due to irritation, one who developed a stitch abscess and one who developed a deep wound infection. Two knees had a reduced ROM and required an MUA. In addition, six patients developed symptomatic DVTs, three with pulmonary emboli, but there were no deaths.

Conclusion: In our experience, closing wedge osteotomy for medial gonarthrosis is a safe and reliable procedure with a good early outcome and an acceptable complication rate of 7.8% in this series, with a low incidence of serious complications that compares favourably with the quoted complication rates for opening wedge techniques.