The painful subluxed or dislocated hip in adults with cerebral palsy presents a challenging problem. Prosthetic dislocation and heterotopic ossification are particular concerns. We present the first reported series of 19 such patients (20 hips) treated with hip resurfacing and proximal femoral osteotomy. The pre-operative Gross Motor Function Classification System (GMFCS) was level V in 13 (68%) patients, level IV in three (16%), level III in one (5%) and level II in two (11%). The mean age at operation was 37 years (13 to 57).

The mean follow-up was 8.0 years (2.7 to 11.6), and 16 of the 18 (89%) contactable patients or their carers felt that the surgery had been worthwhile. Pain was relieved in 16 of the 18 surviving hips (89%) at the last follow-up, and the GMFCS level had improved in seven (37%) patients. There were two (10%) early dislocations; three hips (15%) required revision of femoral fixation, and two hips (10%) required revision, for late traumatic fracture of the femoral neck and extra-articular impingement, respectively. Hence there were significant surgical complications in a total of seven hips (35%). No hips required revision for instability, and there were no cases of heterotopic ossification.

We recommend hip resurfacing with proximal femoral osteotomy for the treatment of the painful subluxed or dislocated hip in patients with cerebral palsy.

Objective: We present our recent experience in the management of tumours of the cervical spine and in particular comparing patterns of presentation of benign and malignant tumours and highlighting any delays of treatment.

Design: A retrospective study of 40 patients treated operatively at a regional spinal centre between 1995 and 2001.

Results: Twenty-five patients had metastastic disease and fifteen had primary tumours, five of which were malignant. Patients with malignant disease were older at diagnosis (55 vs 40) and had a shorter duration of symptoms (3m vs 19m). All patients with metastases reported good pain relief and improvement in neurological function where myelopathy or radiculopathy was present. Eight of these twenty-five patients have died at a mean of eleven months postoperatively. The longest survivor is now 31 months surgery. There were some excessive delays in treatment in benign and malignant cases. There were five cases of missed or wrong diagnosis and three patients waited more than six months for investigations.

Conclusions: Surgery for metastatic disease in the cervical spine has been successful in improving the quality of life in all of the patients although it should be stressed that each case must be dealt with on an individual basis with a multidisciplinary approach. It was noteworthy that some patients were subjected to extraordinary delays in diagnosis.