Purpose of the study: In young adults, tibial wedge osteotomy performed for the best indications provides good results for about ten years. As these patients get older, knee arthroplasty may be necessary. The purpose of this work was to report operative difficulties and outcome after total knee arthroplasty performed in patients who had had a tibial osteotomy.

Material and methods: We reviewed 20 revision procedures where a posterior stabilised gliding total knee arthroplasty (TKA) was implanted after tibial osteotomy (closed wedge in general). There were 17 patients, mean age 71 years, sex-ratio 0.13; 82% of patients had cardiovascular histories and obesity was noted in 60%. The mean duration of the tibial osteotomy was 7 years. The mean IKS score was 31 and the mean function score 34. The patellofemoral joint presented signs of degeneration in all cases; the patella was low in 12 knees. Mean misalignment was 2 with > 10 varum in one knee and greater than 10 valgum in another. The anteromedial approach was used for 17 knees and the anterolateral approach for the other three. Osteotomy material was removed during the same procedure in five cases.

Results: There was one iatrogenic fracture of the tibial plateau with skin injury. At mean follow-up of 4 years (3–11 years), the mean IKS was 61 points and the mean function score 38. There was one aseptic loosening of the tibial plateau and one lat infection; there were 8 asymptomatic patellar subluxations and 14 low patellae.

Discussion: Tibial osteotomy with a closed lateral wedge for correction of major misalignment poses a difficult problem for subsequent prosthesis implantation. Difficulties include removal of the osteotomy material, the approach, ligament balance, and choice of the implant. Patellar complications can be avoiding by careful alignment of the height of the joint line and proper centring of the extensor system. The discordance between the function and joint score can be explained by the bilateral degenerative disease, by the cardiovascular history, and by the obesity noted in this series.

Conclusion: Tibial wedge osteotomy should be planned with the notion of possible future implantation of a total knee arthroplasty.

Purpose of the study: Echinococcosis is an anthropozoonosis with a predominantly muscular, more rarely osteoarticular, localisation. The purpose of this work was to describe the conditions of discovery, the diagnostic management, the serology and pathology findings, and the results of surgical treatment as well as potential complications.

Material and methods: We collected over a 16-year period, 14 cysts in eight women and six men. Mean age was 39 years (range 17–75) and delay to consultation was 36 months. The patients had an ultrasound (all 14 cases), computed tomography (n=7), MRI (n=7), hydatid serology (n=9) and pathology examination (n=10). All patients were treated surgically (7 complete resection); one patient was given associated medical treatment for a multiple localisation.

Results: Muscle hydatisosis occurred in all cases as a medium-sized tumour (mean 9 cm, range 5–16 cm) which was painful in half of the cases. One cyst was superinfected and one patient had a neurological complication. The most common site was the adductor compartment of the thigh (5 cases). Four patients had an associated visceral localization. At mean 4 years follow-up, one patient had a superinfection and two others recurrence at 7 and 10 months, with surgical revision and good outcome.

Discussion: The risk vascularisation of the thigh muscles explains these localisations. Ultrasound is a sensitive exploration which suggests the diagnosis in all cases. CT and MRI confirm the diagnosis and define the cyst relations. Pathology is needed for formal diagnosis. Total pericystectomy or wide resection is the best surgical technique, although not always readily achieved.

Conclusion: Muscle hydatidosis is rare. Treatment is surgical, different from the osteoarticular localisation, similar to the visceral foci. Recurrence is exceptional. Prevention remains the best treatment.

We report the management of two children and 11 adults with paraplegia secondary to vertebral hydatidosis. Destruction of pedicles, posterior vertebral elements and discs as well as the vertebral bodies was common and all six patients with thoracic disease had involvement of adjacent ribs. The 13 patients had a total of 42 major surgical procedures; two patients died from postoperative complications and four from complications of the disease and paraplegia. All eight patients initially treated by laminectomy or anterior decompression alone relapsed within two years and seven required further surgery. Circumferential decompression and grafting gave the best results, six of nine patients being in remission an average of three years and six months later. The prognosis for such patients is poor; remission is the aim, rather than cure. Anthelminthic drugs may improve the prognosis, but radical surgery is likely to remain the keystone of treatment in the foreseeable future.

The management of twenty-one children with a defect of the tibial shaft due to acute haematogenous osteomyelitis is described. Half the defects were due to removal of the sequestrum before the involucrum had formed. Only four patients, all under ten years of age, had spontaneous regeneration of the shaft. Eleven children had a posterior tibiofibular graft and six had a transfer of the ipsilateral fibular diaphysis. The results of operation were superior to those of spontaneous regeneration. All the grafts united and the children returned home to lead normal lives. Shortening was only a problem when growth plates or adjacent joints had been damaged. We now leave the sequestrum for up to one year after the onset of infection. If the involucrum fails to form we reconstruct the tibia as soon as possible after sequestrectomy.