Introduction: One of the most important factors, to improve the primary prosthesis stability is the bearing surface between the femoral head and the cup. The connection metal-metal and ceramic-ceramic seems to be one of the best to reduce the loosening rate. The purpose of the study is to evaluate the long-term results of uncemented total hip replacement using the ceramic Mittelmeier enoprosthesis (ceramic cup – ceramic head).

Material and Methods: In the last twenty years, 258 primary ceramic, Mittelmeier type hip endoprosthesis were implanted in our Institution. This surgery was performed in 222 patients (116 women and 106 men), at the average age at the surgery of 45,6 years (range from 18 years to 70 years). In 36 patients the surgery was performed on both hips. The means follow-up was 10,2 years ( range from 4 years to 18,6 years). The most frequent indication for surgery was: in 105 cases idiopathic, in 81 dyspalstic and in 25 posttraumatic coxarthrosis. All patients were evaluated clinically and radiological. For clinical evaluation the classification system proposed by Merle d’Aubigne and Postel with Charnley modification was used. For radiological evaluation the classification system proposed by De Lee and Charnley ( steam) and system by Gruen and Moreland (cup) was used.

Results: Based on above mentioned criteria in 87 hips (33,7%) the final result was graded as very good, in 96 cases (37,3%) as good, in 47 hips (18,2%) as satisfactory and in the remaining 28 cases (10,9%) the final result was poor. The very good and good results were noted in patients older than 50 years with idiopathic coxarthrosis. The poor results were observed in young patients with dysplastic coxarthrosis, especially in cases with poor developed hip joint after the previous hip surgery in the childhood, because of DDH (type III and IV according to Crowe at all. classification system). Only 13 hips (5%) required revision procedures. In 2 cases (0,8%) revision was directed only to the cup, in 6 hips (2,3%) to the steam and in 5 cases (1,9%) it was necessary to exchange both elements.

Conclusion: The long term results and our experience with ceramic uncemented hip endoprosthesis type Mittelmeier are promising. This type of hip prosthesis should be indicated in young patients with idiopathic or posttraumatic coxarthrosis. This indication could give long lasting good clinical and functional results.

Ischemic necrosis of the femoral head occurring after the treatment of congenital dysplasia of the hip can negatively affect the long-term prognosis of the involved hip.

The purpose of the study was to evaluate a number of clinical and radiological risk factors for AVN after non-operative treatment of DDH.

Clinical data and radiographs of 77 patients with103 abnormal hips treated because of developmental dysplasia of the hip by closed reduction followed by cast immobilization were reviewed retrospectively. The average age of patients at the time of reduction was 16 months (ranged, 4 to 28) and the average final follow up was 22,4 years (ranged from 13 to 47 years). Kalamchi and MacEwen classification system was used for evaluation of the AVN. Avascular necrosis was found in 35,9% of the treated hips. We established the influence of several radiological and clinical data on the incidence and severity of AVN.

Conclusion: In our analysis the degree of initial dislocation according to Tönnis classification is an important risk factor for AVN. Age at the onset of treatment, presence and size of ossific nucleus, the use and period of preliminary traction, previous treatment with Frejka pillow or Pavlik splint, sex and side were not associated with the incidence and severity of ischemic necrosis. The results have been analysed statistically.

The purpose of this study is to determine how the lateral shape of the acetabulum changes during Perthes disease and if there is any correlation between the lateral acetabulum shape and final result and type of treatment.

The study population consisted of 243 patients with unilateral involvement who had reached skeletal maturity at last follow up. There were 35 (14.4%) female and 208 (85.6%) male patients. The mean age at the onset of symptoms was 7 years and 1 month. AP X-ray films were estimated during fragmentation, reossification and last follow up. Group A consisted of 56 hips, 126 hips were classified as group B and 61 hips as group C according to the Herring classification. For the lateral acetabular shape we proposed a classification: group A – a normal concave acetabular roof, group B – a horizontal flat roof and group C – a roof convexly rounded and up going. All hips were treated by containment methods (bed rest and traction in abduction-78 hips, Petri cast-31 hips, brace-94 hips, varus osteotomy-20 hips, Salter oste-otomy-12 hips and shelf arthroplasty-8 hips). The outcomes of treatment were evaluated according to the Stulberg classification.

During fragmentation stage we found 78 (32.1%) hips with normal lateral acetabular shape-type A. Horizontal roof-type B was noted in 136 (56%) hips and in 29 (11.9%) type C was observed. We observed improvement in the shape of lateral acetabulum after treatment. At the last follow up there were 124 (51%) hips with type A, 81 (33.3%) with type B and 38 (15.7%) with type C. Statistical analysis revealed significant correlation between lateral acetabular shape and Stulberg classification. A normal concave acetabular roof at the fragmentation stage leaded mainly to Stulberg group 1and 2 whereas a roof convexly rounded and up going leaded to Stulberg group 3, 4 or 5 (p< 0.0001). Analysis showed no statistical significant correlation between treatment by using bed rest and traction in abduction, Petri cast, braces and development the lateral acetab-ular shape (p=0.09). Only treatment by using surgical methods improved the lateral acetabular shape at the last follow up (p=0.0015).

The acetabulum is a mould for remodeling of the deformed femoral head in Perthes disease and the lateral acetabulum plays the most important role. We can expect that normal shape of the acetabulum gives good result at final follow up whereas a roof convexly rounded usually follows to Stulberg group 3, 4 or 5. Only surgical treatment improves the shape of the acetabulum.

Introduction: Thanks to early ultrasound diagnosis of DDH the number of late diagnosed cases decreased in the last ten years. The surgical intervention because of dislocated hip is also reduced to the few cases a year. We still however have in our practice patients after operative treatment of DDH. One of the methods used for proper hip reduction is transiliacal pelvic osteotomy described by Dega.

The aim of this study is to evaluate the late results of one stage procedure with Dega transiliacal pelvic osteotomy in the treatment of DDH with dislocation.

Material and Methods: In our Institution 256 dislocated hips were treated surgically by means of open hip reduction, femoral directional osteotomy and Dega’s transiliacal osteotomy. From this group 102 patients (91 female and 11 male), presented 144 operated hips were seen for the final follow-up. The left hip was affected in 45 cases, right in 17, and bilateral in 41 patients. The mean age at the surgery was 23,5 months. Mean follow-up was 19.8 years (minimum 15 years after surgery). Patients were evaluated clinically (Barrett modification of McKay classification) and radiologically using Severin classification. All radiograms from whole period of treatment were collected and evaluated.

Results: In 90 hips the final result was classify as very good (57%), good in 36 hips (23%), satisfactory in 10 hips and poor in 8 hips. Radiologically very good result (group IA) was seen in 51 hips, good in 65 hips (group IB, IIA, IIB), satisfactory in 24 hips and poor in 4 hips. It was a good correlation between clinical and radiographic classification.

Conclusions : The late results after one stage hip reconstruction with Dega’s transiliacal osteotomy gives a long lasting good results and is recommended for operative treatment of DDH with dislocation.