Childhood septic hip should usually be treated immediately by arthrotomy and antibiotic. Even if treated correctly, the affected hip may become osteoarthritic and functionally disabling. Usually the literature is not in favor of total hip arthroplasty in young patients, and the reports are on patients older than 32 years of age. We present here a unique group of very young patients with early coxarthrosis caused by septic hip in childhood, with an average age of 19.14 years (range, 14-25) at the time of the arthroplasty. The Harris hip score improved from a preoperative mean of 58.43 to a postoperative mean of 94.14. The follow-up period ranged between 2 and 24 years, with an average of 8.14 years. We conclude that total hip arthroplasty in young people with early coxarthrosis caused by septic hip in childhood provides good functional results.

Adolescent↗

PubMedDate not supplied

Subluxation of the hip joint during femoral lengthening.

Three cases of subluxation of the hip joint occurred during femoral lengthening using the Wagner technique. This infrequent complication, which may result from a conflict of force vectors at the hip joint during lengthening, can, when left untreated, nullify the benefits of such a procedure. We suggest that increased awareness and closer monitoring can improve the prognosis for patients undergoing this course of therapy, especially where a previous hip operation has been performed.

Bone Lengthening↗

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Distal transfer of the greater trochanter revisited: long-term follow-up of nine hips.

Seven female patients (nine hip joints) with avascular necrosis and functional coxa vara secondary to developmental dysplasia of the hip joint (DDH) were treated by distal transfer of the greater trochanter (DTT). A 5-year follow-up showed good results in 89% of the hip joints. We reviewed the patients again 12 years later using the Mayo Clinic hip score. Improvement of gait was maintained in the majority of the patients (71%), but the hip score was low in 67% of the patients because of the development of osteoarthritis. Two patients underwent a total hip arthroplasty, and a third is awaiting this operation. Distal transfer of the trochanter is beneficial in improvement of gait but may enhance the development of osteoarthritis.

Adolescent↗

PubMedDate not supplied

Hemichondrodiastasis for the treatment of genu varum deformity associated with bone dysplasias.

Hemichondrodiastasis has been reported for treatment of angular deformities in children close to skeletal maturity. The use of distraction through the physis in younger children was not recommended. The authors report three children 3 to 7 years of age who underwent bilateral proximal tibial hemichondrodiastasis for correction of genu varum due to bone dysplasia. Ilizarov external fixators were applied in all cases. The patients underwent gradual angular correction at a rate of 0.5 mm/d. Distraction was continued until a normal mechanical axis was achieved. Normal alignment was achieved in two patients and slight overcorrection in the third. The patients were followed for 3 to 11 years, and no adverse affects on the physis were identified. This is the first report of physeal distraction in patients this young. Our results are good, and we believe that hemichondrodiastasis can be safely used for correction of angular deformities in young children.

Bone Diseases, Developmental↗

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Chevron osteotomy in the treatment of hallux valgus.

Fifty patients who underwent 80 chevron osteotomies for symptomatic hallux valgus were re-examined and assessed 4 years and 7 months (average) after surgery. Forty-five of the patients were satisfied with the result of their surgery, three patients suffered recurrence of their deformity and two had continuance of their symptomatology. The major complications noted were intraoperative intra-articular fracture of the metatarsal head in five feet, loss of initial repair in three feet, and tilt of the distal fragment (metatarsal head) in two feet. The Chevron osteotomy is a relatively simple procedure that corrects the varus deformity of the first metatarsal, realigns the valgus orientation of the metatarsal head, corrects the hallux valgus deformity, and improves symptomatology.

Adult↗

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Histopathology of failed osteoarticular shell allografts.

Fresh cadaveric osteochondral fragment allografts were used to replace damaged articular surfaces of knee joints. Of the original 100 patients, 22 experienced graft failure necessitating graft removal. From these patients, a total of 44 osteochondral allografts were extirpated between 12 and 84 months after insertion. These were examined radiologically, histologically, and ultrastructurally. The bone and bone marrow were necrotic and had undergone variable replacement by host bone, which appeared to be independent of the duration of the graft. The articular cartilage showed degenerative changes ranging from fibrillation to erosion. Viable donor cartilage was present as late as seven years, proving that fresh graft cartilage can survive transplantation. Host bone interfaced with the cartilage, but in 14 grafts there was focal invasion of the cartilage. In some grafts, pannus formation with resorption of cartilage was evident. There was no histologic evidence of transplant rejection. This study is encouraging because hyaline cartilage has been shown to survive for as long as seven years and because bone can be replaced in a homogeneous fashion if the correct biomechanical conditions are met.

Adolescent↗

PubMedDate not supplied

Usefulness of the F-wave conduction time in the localization of median nerve lesions in the post mastectomy patient.

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Adult↗

PubMedDate not supplied

Residual bone cysts after correction of severe foot deformities with the Ilizarov technique.

Fourteen patients with severe foot deformity treated by application of the Ilizarov device were evaluated for residual bone changes in the foot. Cyst formation was noted in all patients, most commonly in the base of the fifth metatarsal. These cysts did not develop in the area of bone penetrated by the wires. In an average follow-up of 3.4 years after device removal, the cysts did not resolve. Histologic examination of one resected cyst demonstrated an empty lacuna with no cell lining, as seen in the "cysts" associated with osteoarthrosis.

Bone Cysts↗