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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIV | Pages 31 - 31
1 Oct 2012
Hakki S Pedersen K Bui H Webster W Osman M Rodriguez H
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As much as there is interest in mini-invasive surgery (MIS) total hip arthroplasty (THA), there is controversy ranging from a more advantageous to a potentially dangerous alternative to classic THA. The purpose of this study is to compare the results of 130 cementless, standard stem navigated primary THA with data collected retrospectively from 2005 to 2010 (64 classic Hardinge approach (HAL) and 66 MIS intermuscular anterolateral approach by the senior surgeon). Data include: operative time, perioperative bleeding, length of surgery, hospital stay, patient's satisfaction and pain perception. The alignment values at six months to a maximum of 60 months provided necessary statistical information for clinical and radiological comparison of the two groups.

Significant differences were found between the two groups with MIS being superior with respect to less surgical time (p = 0.029) and achieving quicker rehab goals with shorter hospital stay (p <0.001). Pain perception was less in MIS group with a higher satisfaction score (p <0.001). Although both groups have the potential of nerve injury to tensor fascia muscle, it's only the classic HAL that jeopardises the glutei nerve supply.

MIS approach to navigated THA seems to be an acceptable alternative with some advantages to Classic HAL.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_VII | Pages 9 - 9
1 Mar 2012
Zgoda M Osman M Sherlock D
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Aim

To assess if Osteoset (CaSO4) improves graft incorporation after shelf procedure and whether spica immobilisation is necessary

Methods/results

49 patients with acetabular dysplasia treated by shelf procedure were reviewed retrospectively. Group 1 (19 children) and group 2 (12 adults) had shelf acetabuloplasty using autogenous bone graft and CaSO4. Group 3 (18 children) underwent shelf acetabuloplasty using autogenous bone graft alone. Group 2 was assessed separately to avoid age bias. Within group 3 we compared 10 patients managed in plaster for six weeks with 8 mobilized on crutches post operatively.

Total shelf and graft area, total shelf length, extra-osseous shelf length and speed of graft incorporation were measured radiologically.

There was no difference in shelf indices between patients treated in plaster and those mobilized on crutches.

Use of CaSO4 significantly enlarged shelf volume by 3 months post-operative with less resorption, which was maintained throughout follow-up. In contrast the non-CaSO4 group showed a steady decrease in shelf volume. The extra-osseous shelf length was initially similar in groups 1 & 3. By 6 weeks the group 1 extra-osseous shelf was significantly greater than for group 3 and was maintained throughout follow-up. Graft incorporation was faster in group 1.

Shelf area and extra-osseous shelf length improved significantly in group 2. However total shelf length decreased slightly by 6 months.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 370 - 370
1 Jul 2010
Osman M Martin D Sherlock D
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Aim: To assess the outcome for Perthes disease in children over eight treated by observation, varus osteotomy, abduction plasters and acetabular augmentation.

Methods and results: A retrospective case note review of prospectively collected data for 44 children (48) hips with Catterall grades 2, 3 or 4 Perthes’ disease with onset age eight or older and followed to maturity was performed. The groups were demographically similar. For all groups combined 60% had a satisfactory Stulberg grade I to III outcome. Poorer outcomes (as assessed by Stulberg, centre edge angle and Reimer’s migration index) were associated with increasing age, greater initial head deformity and greater head involvement. Initial head deformity did not remodel for any treatment group. Indeed, progressive head deformity occurred despite plaster treatment or varus osteotomy but not after acetabular augmentation. Hips managed by acetabular augmentation also had better outcomes than the other groups for Stulberg, Reimer’s index and centre-edge angle.

Conclusions: Whatever the treatment the outcome for Perthes’ disease in children over eight is poorer with increasing age. No treatment offers the prospect of a good result in the older child with significant head involvement or significant initial deformity but acetabular augmentation seems to improve Stulberg, Reimer’s migration and centre-edge angle outcomes and prevents progressive femoral head deformity compared with observation, varus osteotomy and plaster treatment.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 375 - 375
1 Jul 2010
Zgoda M Cheng K Osman M Wilson N
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Introduction: Early treatment with antibiotics is advocated in the management of septic arthritis. Whilst some argue for mandatory arthrotomy we have used arthrotomy selectively. The results of this approach over a ten year period were reported 20-years ago.

Aim: To review the outcome of joint aspiration and selective rather than mandatory arthrotomy for the management of septic arthritis in children.

Method: We compared the outcome for cases of septic arthritis in children reported from this centre in the decade 1982–1991 (Group I) with a contemporary cohort, from 1997–2006 (Group II) using the same criteria for diagnosis and the same treatment principles.

Results: Group I comprised 61 children, Group II 42. The mean incidence of septic arthritis in children (< 13 years old) was similar for Groups I and II (2.9/100,000 and 3.1/100,000). Infection caused by Haemophilus species declined from 10 of 56 (18%) in Group I to none in Group II. Staphylococcus Aureus reduced from 27/56(48%) in Group I to 13(31%) in Group II. As previously, infections particularly of the infant hip were at highest risk of causing permanent joint damage. There were eleven (18%) sequellae in Group I and two (5%) in group II.

Conclusions: These results continue to support joint aspiration for the management of early acute septic arthritis in children. However involvement of the hip in infants requires arthrotomy, as does late (≥4 days) diagnosis in older children.