Primary osteoarthritis of the ankle with no history of trauma is rare. We report the use of a low tibial osteotomy on 18 ankles in 18 patients, two men and 16 women. The osteotomy is designed to correct the varus tilt and anterior opening of the distal tibial joint surface where it has been shown by weight-bearing radiographs and arthroscopy that there is healthy articular cartilage on the lateral side of the ankle. An opening-wedge osteotomy was used to achieve slight overcorrection. Follow-up of the 18 ankles at an average of 6 years 11 months (2.7 to 12.10) showed the results by our own scoring system to be excellent in six ankles, good in nine, and fair in three with no poor results. Of the three patients with fair results, two had been undercorrected and the third had little residual articular cartilage. Arthroscopic examination of ten ankles showed repair by fibrocartilage in seven. We conclude that slight overcorrection of deformity by low tibial osteotomy is effective in treating intermediate-stage primary osteoarthritis of the ankle

Fourteen patients with ankylosing spondylitis had an extension osteotomy for severe flexion deformity of the spine. The Smith-Petersen technique was modified by using a compression device which allows a slow, finely controlled closure of the osteotomy, and provides rigid internal fixation. There were no serious neurological complications. All the patients were able to see straight ahead after operation, and all had solid fusion at nine months, having maintained good correction

We report 12 consecutive cases of vertical scapular osteotomy to correct Sprengel’s deformity, performed during a 16-year period, with a mean follow-up of 10.4 years. The mean increase in abduction of the shoulder was 53°. The cosmetic appearance improved by a mean of 1.5 levels on the Cavendish scale. Neither function nor cosmesis deteriorated with time. We recommend the procedure for correction of moderate deformities with a functional deficit

We have treated 11 patients aged three days to 15 years with bladder exstrophy by horizontal osteotomies of the innominate bones. The operation was originally used for older patients with severe deformity or failed previous surgery but is now applied as a primary procedure in the first week of life. The osteotomies enable the complex malformations to be corrected in a single operation without turning the patient: the pubic bones can be brought together, the abdominal wall repaired and the bladder closed with reconstruction of the urethra and external genitalia. The early results have been very satisfactory in all cases with only minor complications; we felt that a preliminary report should be made, despite a mean follow-up of only seven months

We report a case in which the popliteal artery was divided during upper tibial osteotomy performed with the knee in 90 degrees of flexion. This position is believed to allow it to fall safely back from the tibia, but we could find no published confirmation. We used duplex ultrasonography in ten healthy volunteers to measure the distance from the popliteal artery to the posterior surface of the tibia at various degrees of flexion of the knee. Our results showed that in 12 of 20 knees the popliteal artery was closer to the tibia in 90 degrees of knee flexion than in full extension. Surgeons performing upper tibial osteotomy should be aware that flexing the knee does not protect the popliteal artery from injury

Intertrochanteric osteotomy gives compensatory correction for the severely slipped upper femoral epiphysis without endangering its blood supply. The results of thirty-five such osteotomies carried out over an eighteen-year period are reviewed. The indication for operation was a chronic slip of a third or more of the growth plate in the lateral radiograph. The mean age at operation was fourteen years and the mean follow-up period seven and a half years. The results showed that even a moderate correction of deformity as shown by the radiograph could produce a hip with a functionally satisfactory range of movement. Chondrolysis was the most serious complication and occurred in four hips. The radiological results are discussed in relation to details of operative technique and also to long-term prognosis

Seventeen patients, with an average age of nine years 11 months, underwent 18 Chiari osteotomies for the treatment of painful subluxation of the hips following Perthes' disease. The average follow-up period was four years three months. The 13 patients reviewed clinically all did well and none complained of pain or instability. The radiographs were examined in all 17 cases. The average centre-edge angle and percentage femoral head cover were definitely improved by the operation. No significant medical displacement of the femoral head was achieved. The clinical success may result from improved femoral head coverage and diminished eccentricity. Chiari's osteotomy is recommended for adolescent patients with painful subluxation of the hip as a consequence of Perthes' disease

We report the clinical and radiographic results of the Chiari pelvic osteotomy in 49 hips (45 patients) at an average of 14 years after operation. Of these hips, over half had minimal or no pain, had good or excellent results as assessed by the Harris hip score, and could walk at least three miles; three-quarters, however, had a positive Trendelenburg sign. A younger age at operation and a painless hip with no radiographic evidence of degeneration before operation were associated with a higher hip score at review. The percentage of hips without degenerative changes fell from 68% before operation to 15% at final review. There were no major complications and it was found that a Chiari osteotomy need not interfere with normal childbirth

From 1956 to 1965, congenital dislocation of the hip was treated in a standard manner in 191 cases. Reduction and plaster immobilisation was followed by a period in a Batchelor type plaster in full medial rotation. Femoral neck anteversion was then corrected by derotation osteotomy. In 95 children 117 hips were treated in this way and have been reviewed annually for 18 to 27 years. In 1983 they were assessed; there were 101 hips with good clinical results; radiologically, on a modified Severin scale, 62 were good, 39 were fair and 16 were poor. Derotation osteotomy proved to be the stimulus for growth of the acetabular roof in most cases; its safety, ease of performance and predictability suggest that it is superior to other methods of correcting the dysplasia

1. The results of Chiari pelvic osteotomy have been examined two to six years after operation in a group of eighteen patients with persisting acetabular dysplasia in the second and third decades. 2. The analysis suggests that for a good clinical result it is essential to create a relationship of the new outer acetabular lip to the original lip so that the CE angle is between 20 and 40 degrees and the roof angle is between 10 degrees below and 20 degrees above the horizontal. 3. This may be achieved by a pelvic osteotomy immediately above the joint capsule, angled 10 degrees upwards and inwards and displaced by 50 per cent of the pelvic thickness. 4. Details of the operative technique using a Smith-Petersen approach are presented

Subtrochanteric osteotomy has been reported to interrupt the destructive phase of coxa plana and speed up the rate of healing. The aim of this investigation was to test the validity of these statements. The material comprised twenty-five patients treated by osteotomy and thirty-three patients treated by support in a Thomas's splint. For every patient the extent of the radiological changes was estimated and plotted against time as a percentage of the normal epiphysial volume. The graph so obtained represents the rate of destruction and re-ossification, as well as the maximum involvement of the epiphysis. The curves for each group of patients were superimposed in a graph with all the minima coincident in time. The two patterns of curves are closely similar. It was confirmed statistically that the rates of destruction and re-ossification did not differ between the two groups. The results afford no evidence that osteotomy interrupts the disease or speeds up healing

We have investigated the effect of using tranexamic acid (TXA) during peri-acetabular osteotomy (PAO) on peri-operative blood loss and blood transfusion requirements. In addition we analysed whether the use of TXA was associated with an increased risk of venous thromboembolism (VTE) following this procedure. A consecutive series of 96 PAOs, performed by a single surgeon, were reviewed. A total of 48 patients received TXA and 48 did not. The TXA group received a continuous infusion of TXA at a rate of 10 mg/kg/h. The primary outcome measure was the requirement for blood transfusion. Secondary outcomes included total blood loss, the decrease in the level of haemoglobin in the blood, the length of hospital stay, and the complications of this treatment. The mean rate of transfusion was significantly lower in the TXA group (62.5% vs 12.5%, p < 0.001). The mean blood loss was also significantly reduced in the TXA group (1.9 L (standard deviation (. sd. ) 0.9) vs 1.5 L (. sd. 0.7), p < 0.01). No post-operative episodes of VTE were identified in either group. . The use of TXA reduced the blood loss and the rate of transfusion after PAO significantly, without adverse effects such as an increased rate of VTE. Cite this article: Bone Joint J 2015;97-B:1604–7

We carried out the Bernese periacetabular osteotomy for the treatment of 13 dysplastic hips in 11 skeletally mature patients with an underlying neurological diagnosis. Seven hips had flaccid paralysis and six were spastic. The mean age at the time of surgery was 23 years and the mean length of follow-up was 6.4 years. Preoperatively, 11 hips had pain and two had progressive subluxation. Before operation the mean Tönnis angle was 33°, the mean centre-edge angle was −10°, and the mean extrusion index was 53%. Postoperatively, they were 8°, 25° and 15%, respectively. Pain was eliminated in 7 patients and reduced in four in those who had preoperative pain. One patient developed pain secondary to anterior impingement from excessive retroversion of the acetabulum. Four required a varus proximal femoral osteotomy at the time of the pelvic procedure and one a late varus proximal femoral osteotomy for progressive subluxation. Before operation no patient had arthritis. At the most recent follow-up one had early arthritis of the hip (Tönnis grade I) and one had advanced arthritis (Tönnis grade III). Our results suggest that the Bernese periacetabular osteotomy can be used successfully to treat neurogenic acetabular dysplasia in skeletally mature patients

Varus osteotomy of the distal femur is recommended for osteoarthritis of the knee with significant valgus deformity, but the operation is difficult to plan and perform. A simple technique involving a jig referenced to the line of the tibia is described. This allows accurate overcorrection by a few degrees, with impaction and secure fixation at the osteotomy. It has been successful, with no complications, in 12 consecutive knees

Aims. The influence of identifiable pre-operative factors on the outcome of eccentric rotational acetabular osteotomy (ERAO) is unknown. We aimed to determine the factors that might influence the outcome, in order to develop a scoring system for predicting the prognosis for patients undergoing this procedure. Patients and Methods. We reviewed 700 consecutive ERAOs in 54 men and 646 women with symptomatic acetabular dysplasia or early onset osteoarthritis (OA) of the hip, which were undertaken between September 1989 and March 2013. The patients’ pre-operative background, clinical and radiological findings were examined retrospectively. Multivariate Cox regression analysis was performed using the time from the day of surgery to a conversion to total hip arthroplasty (THA) as an endpoint. A risk score was calculated to predict the prognosis for conversion to THA, and its predictive capacity was investigated. Results. The congruity of the hip, age, the pre-operative minimum width of the joint space and range of abduction were identified as factors predicting conversion to THA. For three groups of patients (scoring 0 to 5, 6 to 7, and 8 to 9 points), the Kaplan-Meier event-free rates of survival at 15 years post-operatively for conversion to THA were 99.6%, 85.2% and 67.3%, respectively. Conclusion. These four pre-operative factors are easily measured and predict the prognosis for patients following ERAO. They may be used for decision making when offering surgical treatment to patients with acetabular dysplasia and early onset osteoarthritis. Cite this article: Bone Joint J 2016;98-B:1326–32

A prospective, randomised, controlled trial compared two different techniques of high tibial osteotomy with a lateral closing wedge or a medial opening wedge, stabilised by a Puddu plate. The clinical outcome and radiological results were examined at one year. The primary outcome measure was the achievement of an overcorrection of valgus of 4°. Secondary outcome measures were the severity of pain (visual analogue scale), knee function (Hospital for Special Surgery score), and walking distance. Between January 2001 and April 2004, 92 patients were randomised to one or other of the techniques. At follow-up at one year the post-operative hip-knee-ankle angle was 3.4° (± 3.6° . sd. ) valgus after a closing wedge and 1.3° (± 4.7° . sd. ) of valgus after an opening wedge. The adjusted mean difference of 2.1° was significant (p = 0.02). The deviation from 4° of valgus alignment was 2.7° (± 2.4° . sd. ) in the closing wedge and 4.0° (± 3.6° . sd. ) in the opening-wedge groups. The adjusted mean difference of 1.67° was also significant (p = 0.01). The severity of pain, knee score and walking ability improved in both groups, but the difference was not significant. Because of pain, the staples required removal in 11 (23%) patients in the closing-wedge group and a Puddu plate was removed in 27 (60%) patients in the opening-wedge group. This difference was significant (p < 0.001). We conclude that closing-wedge osteotomy achieves a more accurate correction with less morbidity, although both techniques had improved the function of the knee at one year after the procedure

In a five-year period, 153 feet in 101 patients were treated by a Wilson's osteotomy of the first metatarsal for hallux valgus. Postoperative support was provided by either a below-knee or a forefoot plaster, and was continued for either three weeks or six weeks. The results showed overall success in 91% with no significant difference between the four groups. We suggest that a forefoot plaster for three weeks is adequate support after a Wilson's osteotomy

We present simple but effective retractors used in pairs to expose the sciatic notch during Salter innominate osteotomy. We have found them to be useful for a wide range of procedures requiring similar exposure. We present them here in tribute to the memory of the designer Mercer Rang

We performed distal chevron osteotomy of the second, third, or fourth metatarsal for painful plantar callosities in 19 non-rheumatoid patients (16 women, 3 men; 21 feet); their mean age was 59 years (32 to 85). The mean follow-up was four years (2 to 7). The overall results were good in 16 feet, fair in two, and poor in three, with four patients still having painful plantar callosities. There was union in all feet, but transfer metatarsalgia developed in three and three required an orthosis. Distal chevron osteotomy for intractable plantar callosities was successful both clinically and radiologically in most patients

We describe a new operative procedure for patients with chronic trochanteric bursitis. Between March 1994 and May 2000, a trochanteric reduction osteotomy was performed on ten patients (12 hips). All had received conservative treatment for at least one year. Previous surgical treatment with a longitudinal release of the iliotibial band combined with excision of the trochanteric bursa had been performed on five hips. None had responded to these treatments. The mean follow-up was 23.5 months (6 to 77). The mean Merle d’Aubigné and Postel score improved from 15.8 (8 to 20) before to 27.5 (18 to 30) after operation, six patients showing very great improvement, five great improvement and one fair improvement. We conclude that trochanteric reduction osteotomy is a safe and effective procedure for patients with refractory trochanteric bursitis who do not respond to conservative treatment