Aims

Periacetabular osteotomy (PAO) is an established treatment for acetabular dysplasia. It has also been proposed as a treatment for patients with acetabular retroversion. By reviewing a large cohort, we aimed to test whether outcome is equivalent for both types of morphology and identify factors that influenced outcome.

Introduction: We present the results of a prospective study of the blood transfusion requirements in patients undergoing a Bernese periacetabular osteotomy (PAO) with the use of an intra-operative cell-saver and without pre-donated blood. These data were compared with an earlier audit of patients who underwent this procedure without use of a cell saver.

Material and Methods: A cohort of 50 patients (56 hips) underwent a PAO for hip dysplasia between December 2006 and November 2008 performed by the senior author. The average age was 29 years (17–51) and there were 38 females and 12 males. The average weight was 69.96 kg (46–110) and the mean duration of operation was 136 minutes (100–240). A cell saver (Fresenius-Hemocare, Germany) was used intra-operatively for this cohort. Pre-operative Hb, post-operative Hb taken the day after surgery and any units transfused were documented. A post-operative transfusion policy was adopted where a haemoglobin (Hb) concentration of < 7.5 g/dl was an indication for transfusion or where a patient was sufficiently symptomatic

Results: The mean pre-operative Hb was 13.60 g/dl (10.8–15.9) and the mean post-operative Hb was 9.91 g/dl (6.4–11.8). Overall 4 patients received post-operative allogenic blood transfusion; 3 patients receiving one unit and one patient receiving 2 units. No patients received intra-operative allogenic blood.

Conclusion: Compared to our previous audit, the use of the cell saver resulted in an improvement in the mean post-operative Hb, (9.2 g/dl compared to 8.0 g/dl). The transfusion rate was also reduced (7.27% compared to 10.8%)..

Assessing femoral head coverage is a crucial element in acetabular surgery for hip dysplasia. Plain radiographic indices give rather limited information. We present a novel CT-based method that measures the fraction of the femoral head that is covered by the acetabulum. This method also produces a direct image of the femoral head with the covered part clearly represented, and it also measures acetabular inclination and anteversion. We used this method to determine normal coverage, and applied it to a prospective study of patients with hip dysplasia undergoing periacetabular osteotomy.

Twenty-five normal and 26 dysplastic hips were studied. On each CT scan points were assigned on the femoral head surface and the superior half of the acetabular rim. The anterior pelvic plane was then defined, and the pelvis was aligned in that plane. Using our custom software programme, the fraction of the head that was covered was measured, in addition to acetabular inclination and anteversion.

In the normal hips femoral head coverage averaged 73% (SD 4). In the same group, mean anteversion was 15.7° (SD 7°), whereas mean inclination was 44.4° (SD 4°). In the dysplastic group femoral head coverage averaged 50.3% (SD 6), whereas mean anteversion and inclination were 18.7° (SD 9°) and 53.2° (SD 5°) respectively.

This is the first study to our knowledge that has used a reliable measurement technique of femoral head coverage by the acetabulum in the normal hip. When this is applied to assessing coverage in surgery for hip dysplasia it allows a clearer understanding of where the corrected hip stands in relation to a normal hip. This would then allow for better determination of the likely outcome of this type of surgery. We are presently conducting a prospective study using this technique to study dysplastic hips pre- and post-periacetabular osteotomy.

Introduction: We report the results of activity and functional outcome of matched pair analysis comparing hip resurfacing with total hip replacement with a minimum follow up of 22 months

Materials and Methods: 14 matched pairs were selected in terms of age (within 4 years), sex and diagnosis, of which 10 pairs were females and 4 pairs were males The mean age was 49.7(19 – 63). The Birmingham hip resurfacing was used in all patients in the resurfacing group and the Furlong HAC stem in all cases in the THR group with the CSF cup in most cases. The mean follow up in BHR group was 5.2 years (1.7 – 9.2) and 2.4 years (1.8 – 3.6) in THR group. Functional outcome was measured using Harris Hip score, WOMAC, SF 36 and the UCLA and Tegner activity scores

Results: The mean Harris Hip score, SF 36, WOMAC, UCLA and Tegner activity scores in the BHR group were 86.8, 77.3,49.7, 6.1 and 3.6 respectively. In the Furlong group the Harris Hip score, SF36, WOMAC, UCLA and Tegner activity scores were 82.9, 79.0,29.5, 5.6 and 3.2 respectively. There was no statistical difference in the mean scores between the two groups.

With regard to functional activity, 21% of patients in both the groups scored 8 or more on the UCLA activity scale. 21% of patients in the BHR and 14% in the Furlong group scored 3 or more on the Tegner activity scale

Conclusion: In our study, hip resurfacing was not associated with a significant increase in activity level or functional outcome compared with total hip replacement.

Introduction: Assessing coverage of the femoral head is a crucial element in acetabular surgery for hip dysplasia. Radiographic indices give rather limited information. We present a novel ct-based method that gives an image of the head with the covered area precisely represented. We used this method to measure femoral head coverage in a series of normal hips and in a prospective study of patients with hip dysplasia undergoing peri-acetabular osteotomy.

Methods: Thirteen normal and ten dysplastic hips were studied. On each CT scan anatomical landmarks were assigned on the 3d reconstructed image and used to define the frame of reference. Points were assigned on the femoral head surface and the superior half of the acetabular rim after aligning the pelvis in the anterior pelvic plane. An image was produced representing the femoral head and its covered part. The fraction of the head that was covered was calculated.

Results: The average femoral head coverage in the normal hips was 73.9% (sd 3.2). The average coverage in the dysplastic group was 50.7% (sd 7.9) and after undergoing peri-acetabular osteotomy the average was 67% (sd 6.2).

Conclusion: This is the first study to our knowledge that has used a reliable measurement technique to give an indication of the percent coverage of the femoral head by the acetabulum in the “normal hip”. When this is applied to assessing coverage in surgery to address hip dysplasia it gives a clearer understanding of where the corrected hip stands in relation to a normal hip, and this should allow for better determination of the likely outcome of this type of surgery.

A prospective study on total knee replacement in patients with Juvenile Idiopathic Arthritis was carried out. There were 31 knee replacements in 17 patients; 12 were female. Bilateral procedures were performed in 11 patients; 10 staged during a single admission and 1 performed in a single procedure. The mean age was 19 years (range, 14–26), and the mean follow-up was 23 months (range, 6–44). The surgery was complicated in 9 cases by a previous distal femoral osteotomy. The results were assessed using the Hospital for Special Surgery (HSS) scoring system. A cruciate sacrificing implant was used in all cases, and the patella was resurfaced in 25/31.

The pre-operative mean arc of motion was 62° (range 10°–90° ) and this averaged 89° (range, 20° –115°) at latest follow-up. The pre-operative mean fixed flexion 17° (range, 0° –15° ). The mean pre-operative HSS score was 36 (range, 8–59), and the mean at latest follow-up was 81 (range, 67–95). There has been no sign of aseptic loosening on serial radiographs over the follow-up period. One patient developed a deep infection at 20 months requiring a 2-stage revision and one patient developed a perforated duodenal ulcer postoperatively.

The clinical results are very satisfactory, allowing patients to regain their mobility and independence. The early radiographic results are very encouraging despite the poor bone quality and severe deformities that require correction.