Background:. Leg length discrepancy related to absence of the femoral head with proximal migration of the femur presents a treatment dilemma. Late sequelae of neonatal hip sepsis and chronic hip dislocation due to developmental dysplasia are the most common causes. Traditional teaching dictates that the hip is stabilised prior to limb lengthening. Reconstructive options alter the shape of the proximal femur which complicates future surgery. Methods:. We retrospectively reviewed 3 cases of femoral lengthening with an ‘unstable’ hip without prior stabilization. The aetiology was neonatal hip sepsis in 2 cases and chronic hip dislocation due to developmental dysplasia in 1 case. Lengthening was performed with the use of a retrograde Precice lengthening nail. Results and Discussion:. The desired length (range 5.5 to 6cm) was achieved in all patients without migration of the proximal femur. In all cases patient satisfaction was high with the lengthening and the ability to abort shoe raises. There was an improvement in gait pattern in all patients. Conclusion:. Femoral lengthening is possible without prior stabilisation of the hip in so called ‘unstable’ hip situations. The proximal femoral anatomy is not further altered and future salvage procedures such as a total hip replacement are not compromised

Introduction. Total Hip Arthroplasty (THA) in patients after proximal femoral osteotomy remains a major challenge. Inferior survival for both cementless and cemented THA has been reported in this subgroup of patients. Methods. We retrospectively evaluated the clinical and radiographic results of a consecutive series of 48 THAs (45 Patients) who had undergone conversion THA for failed intertrochanteric osteotomy after a mean of 12 years (2–33 years) using a cementless, grit-blasted, double-tapered femoral stem. Mean follow-up was 20 years (range, 15–25 years), mean age at surgery was 47 years (range, 13–55 years). Clinical results were evaluated using the Harris Hip Score. Kaplan-Meier survivorship analysis was performed to determine long-term outcomes for different end points. Results. At follow-up, 10 patients (11 hips) had died, and 1 patient (1 hip) was lost to follow-up. Five patients (5 hips) underwent femoral revision, 2 for infection and 3 for aseptic loosening of the stem. Overall stem survival was 91% at 20 years (95%-CI: 78%–97%); survival with femoral revision for aseptic loosening as end point was 93% (95%-CI: 80%–98%). Discussion and Conclusion. The long-term results with this type of cementless femoral component in young patients with failed intertrochanteric osteotomy are encouraging and compare well to those achieved in patients with regular femoral anatomy

Introduction. We compared standard NexGen Cruciate substituting-flex prosthesis with gender-specific NexGen Cruciate substituting flex prosthesis in patients undergoing bilateral total knee arthroplasty with regard to Coverage of the bone by femoral component, Clinical outcome, Radiographic outcome, Survival and complication rates, with special emphasis on patellofemoral complications. Material & Methods. 30 female patients with osteo-arthritis of the knees with similar deformity and preoperative range of motion were randomized to have one knee replaced with a gender non-specific Nexgen Cruciate substituting (Zimmer) prosthesis and the other with Gender Cruciate substituting (Zimmer) prosthesis. Follow-up clinical evaluation was done at 6, and 12 months postoperatively and then at yearly interval using “Knee Society” Recommendations. Clinical assessment of the patellofemoral joint of the replaced knees was done with the help of “Hospital for Special Surgery” patellar scoring system. The overall patient satisfaction after surgery was evaluated with use of the British Orthopaedic Association patient satisfaction score. Results. The mean age was 63.8 years (range 49–76 years). 14 patients had standard NexGen Cruciate substituting-flex gender knee prosthesis on right side and 16 patients had on left side. On the other sides, standard NexGen Cruciate substituting-flex prosthesis implant was used. Preop Clinical findings were similar in both groups. The average Preop range of motion was identical in both the groups. The average follow up was 2.5 years (2–3.8 years). The mean post-operative Knee Society knee scores were 88,90,94, (70 to 100) and 87,92, 93 (70 to 100) points and the function scores were 83,85,88 (60 to 100) and 84.86.88 (60 to 100) points for the standard implants and the gender-specific designs, respectively at 6 months, 1 year and 2 year follow up. Mean improvement in patella score was 65, 71.1 and 73.3 points in Gender group at the end of 6 month, 1 yr and 2 yr respectively as compared to 65.6, 71.1 and 72.2 in Nexgen group. No patient had malpositioning of components or radiolucencies at the end of 2 year follow up. Mean improvement in BOA functional score was 20.6, 22.6 and 24.1 points in Gender group at the end of 6 months, 1 year and 2 year respectively as compared to 20.7, 21.8 and 23.2 in Nexgen group. In those with a standard prosthesis, the femoral component was closely matched in 30 knees, overhung in 17 and undercovered the bone in 13. In those with a gender-specific prosthesis, it was closely matched in 45 knees and undercovered the bone in 15. Conclusion. Although gender specific knee matched the femoral anatomy of Indian female knees better than the standard nexgen Knee, we found no significant differences between the two groups with regard to the clinical and radiological results, patient satisfaction or complication rate