Search

Global discussions regarding the treatment of Legg–Calve–Perthes disease (LCPD) are still controversial. The aim of this study was to characterize the worldwide regional differences in nonoperative and operative treatment for LCPD. Based on a comprehensive literature search, 123 studies describing the results of nonoperative and operative treatment for LCPD were included. Overall, disease and outcome parameters of 6,968 hips were recorded and compared among the continents—Europe, North America, Asia, Africa, South America, and Australia. Our results showed that the continents differed regarding initial disease progression and therapeutic decision-making, but the final outcome was comparable. The reported proportion of affected hips with mild presentation tended to be higher in Europe, North America, and Africa, whereas disease progression was more severe in Asia, Australia, and South America. Nonoperative treatment was reported more frequently in Europe and North America, while operative management was more common in the rest of the world. Femoral osteotomy was performed more frequently than pelvic osteotomy worldwide, but pelvic osteotomy was comparably more common in North America, Australia, and South America. The continents differed in terms of therapies for LCPD, while the final outcome was similar. Studies with greater evidence and larger sample size are needed to evaluate the effect of therapeutic measures on LCPD outcome. III (systematic review of level III studies).

Background The iliac crest is one of the most used bone graft sources. In this study, we aimed to identify the effects of inner side and two-sided approaches for iliac crest bone harvesting on post-surgery ilium growth in children. Materials and methods We retrospectively analyzed 47 patients who underwent pelvic osteotomy and iliac crest bone graft (ICBG) procedures from January 2015 to September 2018. The patients were divided into an inner table ilium exposure group (group A) and the inner-outer table ilium exposure group (group B) and were followed up with radiography in postoperative months 1, 3, 6, and 12, and the growth areas were measured using PACS software. Complications such as damage to the arteries or nerves, ureteral injury, gastrointestinal hernia, ileus, abnormal cosmetic appearance, sensory disturbances, and functional limitations were recorded based on clinical records. Results There were 22 patients aged 5.3±1.5 years in group A and 25 patients aged 5.9±1.8 years in group B. There were no significant differences in demographics between the two groups, or in growth in the first month. However, bone graft growth at months 3, 6, and 12 was significantly better in group A than in group B. There was no significant difference in complications between the two groups. Conclusion Exposure of only the inner table of the ilium resulted in faster recovery of the bone defect than two-sided exposure in pelvic osteotomy. Therefore, we suggest protecting the outer side of the ilium during surgery. Level of evidence Level III

PurposeThe orthopaedic use of resorbable poly lactic-co-glycolic acid (PLGA) implants carries multiple potential benefits. To our knowledge, only one publication exists regarding the use of PLGA implants in pelvic osteotomies in children, and data regarding resorption and potential side effects are lacking for resorbable pelvic screws in children. The aim of this study is to present an MRI-based evaluation of the resorption pattern and local tissue reactions in a paediatric case series after pelvic osteotomies fixated with PLGA screws.MethodsTwelve children who had undergone a Salter or triple pelvic osteotomy fixated with 4.5 mm PLGA screws were included. A total of 18 MRIs was performed 0.5–4.5 years after surgery and were retrospectively analysed. Eight parameters relating to screw resorption, local reactions and re-formation of bone were interpreted.ResultsThe screw canals were > 90% replaced with solid bone after 2–4.5 years in all cases but one, where the canals were only partly replaced with bone. There were no major soft tissue reactions but small (< 12 mm) bone cysts were observed in 3 of the 18 MRIs and discrete fatty patches in the adjacent bone were common.ConclusionPLGA screws in the paediatric pelvis appear to be resorbed and replaced with solid bone in most cases but this process takes at least 2 years. Minor reactions could be seen in the adjacent bone but were judged to be of no clinical significance.

Dysplasia of the hip is a well known cause of secondary osteoarthritis of the hip. The triple pelvic osteotomy (TPO), according to the technique described by Toennis and Kalchschmidt, is a well established procedure to address dysplasia of the hip joint. Non-unions after triple pelvic osteotomies are rare and can occur at each of these osteotomies. The literature is lacking in studies investigating larger group of patients with non-unions after triple pelvic osteotomy. The aim of this study is to evaluate risk factors leading to a non-union after triple pelvic osteotomy. A total of 53 patients with a non-union after triple pelvic osteotomy were included in this retrospective case–control. In addition, we identified a cohort of randomly selected patients undergoing hardware removal after triple pelvic osteotomy (“union” group) but had not developed non-union as the control group. This control group underwent the same procedure by the same group of surgeons in the same time period. The variables obtained from the review of the two groups were analyzed using appropriate statistical methods including Bivariable Analysis (p

Varus derotation femoral osteotomy (VDFO) is a commonly used surgical procedure in association with pelvic osteotomy for dislocated hip in developmental hip dysplasia. Several types of internal fixation devices were described in the literature, but none of them showed a superiority or a lower rate of complication over the others. Different types of external fixator were also described for proximal osteotomy fixation with good results. We describe the surgical technique of the VDFO using a modular external fixator with an illustrative case.

Background: Finite element analysis was used to compare fixation methods for double pelvic osteotomy (DPO). Using 3D scanning a stereolithography (stl) image was produced of a canine pelvis and this was subsequently refined in computer aided design (CAD). Using the CAD files, the images were imported in MSC Marc software to produce a working finite element (FE) model with 3 dimensional tetrahedral elements with linear shaped functions. The dimensions of a precontoured pelvic osteotomy plate with eight screws and a twisted seven screw straight plate were used to build the 2 fixations implants for the FE models. An equivalent load of 300 N was applied progressively on all FE models in order to facilitate its convergence. The load was applied in a distributed manner on the femur-hip joint contact area in order to simulate the actual behavior of the joint. The aim of the present study was to analyze the difference in stiffness and behavior under loading between a lateral vs ventral plate fixation, with unlocked screws and different gap scenarios, for stabilization of a pelvic osteotomy using finite element analysis. Results: From both configurations the maximum displacement of the ventral plate with 7 screws without gap had a value of 1.988 mm, while in the DPO plate had a maximum displacement of 2.191 mm. The load applied for each of the different configurations studied when a gap of 1° was considered and also when a condition of no gap was considered. The ventral plate was stiffer than the lateral plate when a gap was not present. When the gap was closed in the ventral plate, the stiffness increased until a point that remained constant. Conclusions: Ventral plate fixation can be as or more stiff as lateral plate fixation and provides flexible fixation. This behavior should reduce screw loosening. Using ventral plate fixation is recommended to reduce screw loosening or failure. © 2018 The Author(s).

Background: Treatment for developmental dysplasia of the hip (DDH) varies according to the age of the patient. For children under 3 months, the preferred treatment is Pavlik bandaging and/or dynamic hip orthosis;for children of 3-18 months (with/without arthrography), closed and open reductions (ORs) are most common; and for children 18 months and older, pelvic osteotomies are used. Radiological and functional outcomes of patients between 16 months and 7 years of age who underwent Pemberton pericapsular osteotomy (PPO) were evaluated. Materials and Methods: Twelve patients with developmental dysplasia of the hip (DDH) received treatment on 14 hips between 2001 and 2006. All patients with DDH had PPO as pelvic osteotomy. PPO was done solely in 3 hips, PPO and open reduction (OR) in and OR + PPO + femoral shortening in 6. The average age was 39.85 months (range 16-83 months). All had 1-stage surgery. Acetabular index (AI) and the grade of displacement were determined according to Tönnis′. Center-edge (CE) angle was evaluated. Clinical evaluations were made as described by McKay, radiological assessments by Severin′s criteria and femoral head avascular necrosis measurements by Kalamchi-MacEwen′s criteria. Average followup periods were 83.35 months (range 48-115 months). Results: Preoperative and postoperative average AI levels were 41.92° (range 30-50°) and 19,5° (range 5-34°), respectively ( P < 0.001). According to Severin′s classification, 11 (78.57%) patients were Ia, 1 (7.14%) was Ib, 1 (7.14%) was II and 1 (7.14%) was III. According to Kalamchi-McEven criteria, 12 (85.71%) patients were type I, 2 (14.28%) patients were type II. CE postoperatively was measured as 24.24° (range 12-41°). Clinically (McKay), the functional results in 13 (92.85%) patients were very good (I) and in 1 (7.14%) was good (II). Conclusions: Functional and radiological mid term outcomes were found to be comparable in most of the patients with DDH undergoing PPO between the ages of 16 months and 7 years.

Developmental dysplasia of the hip (DDH) is a spectrum of disorders that results in anatomic abnormalities leading to increased contact stress in the joint and, eventually, secondary osteoarthritis. However, many patients with DDH become symptomatic before the severe degenerative changes of the hip because of abnormal hip biomechanics, mild hip instability, impingement, or associated intra-articular pathology. Early diagnosis and appropriate treatment for DDH are of the utmost importance. With the modification of techniques like pelvic osteotomy and capsular arthroplasty, and the introduction of intracapsular procedures such as arthroscopy and femoral head-neck junction osteochondroplasty, many young patients with symptomatic hip dysplasia may benefit from joint preservation procedures. We review the current development of these concepts and the associated surgical techniques.

Bei der einfachen Beckenosteotomie im Kindesalter gelingt eine bessere laterale Uberdachung, eine sichere Zentrierung des Femurkopfs und eine Volumenanpassung von Huftpfanne und Femurkopf durch die Kombination einer anterioren bogenformigen, schragen Osteotomie, modifiziert nach Pemberton mit einer dorsalen Osteotomie nach Salter. Patienten mit Pfannendysplasie ab 2 Jahre bis ins Jugendalter, Subluxation oder Luxation des Huftgelenks, auch bei neurologischen Krankheiten wie Spastik, Hypercontainment bei Morbus Perthes. Kritisch kleine Beckenknochen, z. B. Kleinkinder junger als 18 Monate, Syndromkinder mit retardierter Knochenentwicklung. Alter uber 15 Jahre: Symphyse zu straff fur ausreichende Pfannenschwenkung, keine Nachreifungspotenz der Pfanne mehr. Zunachst erfolgt die Inzision lateral des Beckenkamms bis zur Mitte der Leiste, dann Spalten der Beckenkammapophyse, subperiostale Darstellung der Incisura ischiadica. Spickdrahtmarkierung der Hohe und der Mitte der Osteotomie. Dorsal des Drahts gerade Osteotomie mit einer Gigli-Sage, ventral bogenformig und schrag von lateral-kranial nach medial-kaudal gefuhrte Meiselung. Das distale Iliumfragment wird nach weit lateral und anterior gebracht. Entnahme eines dreieckigen Knochenkeils von der anterioren Beckenschaufel und Einbringen in den geoffneten Osteomiespalt. Fixation mit 3 Spickdrahten. Fester Verschluss der Beckenkammapophyse. Bei kooperativen Kindern absolute Bettruhe fur 3 Wochen. Nach 3 Wochen Mobilisierung im Scheinschritt, Teilbelastung nach 6 Wochen, Vollbelastung nach 8–10 Wochen. Bei jungeren unkooperativen Kindern postoperativ Becken-Bein-Scotchcast-Verband fur 4 Wochen. Die kombinierte Salter-Pemberton-Beckenosteotomie wurde von 1999 bis 2008 bei 49 Patienten 56-mal durchgefuhrt. Unsere Untersuchungen zeigen, dass sie ein sicheres und effektives Operationsverfahren darstellt. Sie ermoglicht nicht nur eine suffiziente Korrektur bei der klassischen Huftgelenkdysplasie, sondern auch bei hohergradigen Huftgelenkdezentrierungen aufgrund einer Zerebralparese.

We studied changes of contact stress distribution in the hip joint after Tonnis triple pelvic osteotomy applied in the treatment of dysplasia and hip joint incongruence in adolescents.In a group of 75 patients, 54 (72 %) female, who underwent surgery by triple pelvic osteotomy in adolescence for developmental disorder of the hip and avascular necrosis of the femoral head, a three-dimensional hip joint model was used based on the radiography of the pelvis with hips. The following biomechanical parameters were calculated: resultant hip force normalised to body weight (R/Wb), inclination of the resultant hip force (θ-R), the position of the stress pole (θ), peak contact hip stress (Pmax), and peak contact hip stress normalised to body weight (Pmax/Wb). Gait quality was also assessed.After surgery the Wiberg CE angle was increased by 17.85° (114 %), resultant hip force normalised to body weight (R/Wb) was decreased by 0.107 (3.3 %), the position of the stress pole was shifted medially by 27.59° (63.5 %), and peak contact hip stress normalised to body weight (Pmax/Wb) was decreased by 2249.74 (55.9 %). Waddling gait was reduced from 17 (23.9 %) to four cases (5.6 %). All changes were statistically highly significant (p0.01).The effect of Tonnis triple pelvic osteotomy lies in the improvement of stress distribution across the acetabular cartilage of the hip joint, thus slowing down the degenerative damage of the hip joint.

Currently, the cover of the femoral head was mainly assessed using conventional plain films after Chiari pelvic osteotomy in most studies. The purpose of the current study was to observe whether the femoral head coverage measured by three-dimensional computed tomography (3D-CT) was consistent with the radiographic findings.A total of 24 patients (24 hips) with an average age of 11.5 years, underwent Chiari osteotomy due to acetabular dysplasia, and 15 subjects (30 hips) of normal control with a mean age of 12 years were involved in the study. The pre- and postoperative coverage of femoral head was measured by using conventional plain film and 3D-CT on the anterior 1/4, middle 1/2, and posterior 1/4 coronal plane. The anterolateral, mediolateral and posterolateral coverage measured by 3D-CT were compared with the coverage measured by plain radiograph, and which were also compared with the normal control individuals.The postoperative anterolateral, mediolateral coverage measured by 3D-CT was significantly smaller than that measured by radiography (P0.01). No significant difference was found between the 3D-CT measurements on the posterolateral coverage and the radiographic results. The anterolateral femoral head coverage in the patients following Chiari pelvic osteotomy was also smaller than that in the normal control individuals (P = 0.026). In contrast, the postoperative posterolateral coverage in the patients was more excessive than that in the normal control individuals (P = 0.001).Conventional radiographs may show sufficient cover of the femoral head after Chiari osteotomy, whereas in fact, the cover may be not perfect, especially on the anterolateral part. Therefore, the postoperative 3D-CT is beneficial for evaluating the outcome of Chiari osteotomy, especially when the anterolateral coverage o

Developmental dysplasia of the hip (DDH) is a leading cause of disability in childhood and early adult life. Clinical and sonographic screening programmes have been used to facilitate early detection but the effectiveness of both screening strategies is unproven. This article discusses the role for screening in DDH and provides an evidence-based review for early management of cases detected by such screening programmes.We performed a literature review using the key words 'hip dysplasia,' 'screening,' 'ultrasound,' and 'treatment.'The screening method of choice and its effectiveness in DDH still needs to be established although it seems essential that screening tests are performed by trained and competent examiners. There is no level 1 evidence to advise on the role of abduction splinting in DDH although clinicians feel strongly that hip instability does improve with such a treatment regime. The definition of what constitutes a pathological dysplasia and when this requires treatment is also poorly understood.Further research needs to establish whether early splintage of clinically stable but sonographically dysplastic hips affects future risk of late-presenting dysplasia/dislocation and osteoarthritis. There is a need for high quality studies in the future if these questions are to be answered.

This article presents the results of Legg-Calve-Perthes (LCP) disease treatment using triple pelvic osteotomy. Thirty patients were analysed. The conditions for inclusion in the study were complete medical documentation and follow-up until the disease was resolved. Postoperatively, no patients were immobilised. Rehabilitation was initiated early in all patients, and full weight bearing was allowed after ten weeks. With this method, an increase of the CE angle of 17.43 +/- 4.020 degrees was achieved. Containment was increased from an initial 6.67% to 53.33% of patients at the final check-up. Similar improvement was achieved by using Herring classification of the damage; preoperatively most hips belonged to group C, and postoperatively to group A. Postoperatively, functional results were also considerably improved. The authors recommend triple pelvic osteotomy as the method of choice in the treatment of severe cases of LCP disease.

Innominate osteotomy of Salter remains the most commonly used pelvic osteotomy for children in the age of 18 months to 6 years. Kirschner wire is inserted across the osteotomy site to fix the bone graft. We present an unusual case of migration of Kirschner wire through the abdominal region. Migration of pins to the femoral head is well-known complication. To our knowledge, this is the first case reporting migration of Kirschner wire through the abdominal region.

The presence of a damaged labrum is one of many factors influencing the outcomes of Chiari pelvic osteotomy. However, there are few previous papers describing the long-term outcomes of Chiari pelvic osteotomy with labrectomy. The purpose of this study was to evaluate the long-term clinical and radiological outcomes of Chiari pelvic osteotomy for dysplastic hips with labral tears. We compared outcomes between labrectomy (+) and labrectomy (−) groups. Chiari pelvic osteotomies were performed by one surgeon on 34 dysplastic hips with labral tears between 1983 and 1996, in which labrectomy was performed on 23 hips but not on 11 hips. Three patients undergoing labrectomy were lost to follow-up evaluation within 5 years after surgery. The average age of the remaining 31 patients was 35.5 years (range, 16–54 years). The clinical and radiographic surveillance averaged 16.0 years (range, 10–23.3 years). In all patients, pain disappeared after the operation. At the end of the study, 8 of the 31 patients displayed clinical deterioration. Progression of osteoarthritis (OA) was observed in 11 hips. Patients with poor results have not opted for revision surgery except for one patient. In the labrectomy (+) group, 10 of the 20 hips showed progression of OA and the clinical outcomes of 6 patients deteriorated. In the labrectomy (−) group, 1 of the 11 hips showed progression of OA and 2 patients deteriorated clinically. Radiological outcomes differed significantly between the two groups. Labrectomy accompanying Chiari pelvic osteotomy is an acceptable procedure for relieving pain caused by the damaged labrum, but the outcomes have a tendency to deteriorate after 10 or more years postoperatively.

Introduction: Many reports have suggested that Chiari pelvic osteotomy would improve the results of acetabular component placement and fixation in subsequent total hip arthroplasty. However, little is known concerning the biomechanical, radiological, and clinical effects of Chiari pelvic osteotomy on subsequent total hip arthroplasty. Materials and methods: Ten total hip arthroplasties for developmental dysplasia of the hip after previous Chiari pelvic osteotomy (Chiari group) were compared with 20 total hip arthroplasties for developmental dysplasia of the hip without previous surgery (control group). Preoperative patient demographic data and operative technique were well matched between the groups. The mean duration of follow-up was 3.0 years. Biomechanical, radiological, and clinical evaluations were performed. Results: No acetabular or femoral components exhibited loosening. All patients had good or excellent clinical score according to the Merle d’Aubigne-Postel rating system at the most recent follow-up. Abductor force and joint force were smaller in the Chiari group, although long operative time, more blood loss, and verticalization of joint force were noted in this group. Conclusion: This limited study suggested that Chiari pelvic osteotomy changed the biomechanical features of the hip joint, and that this alteration might have compromised subsequent total hip arthroplasty.

Objectives Improvement of joint stability, reduction or elimination of pain and joint contracture, prevention of osteoarthritic changes.

Dysplasia of the hip in adults can be treated by a pelvic osteotomy. In order to assess pelvic anatomy in relation to surgical approach and osteotomy sites, 12 cadaver hips were studied. A triple pelvic osteotomy as described by Tonnis [6] through ilium, pubis and ischium was performed, followed by an intrapelvic and anterior and posterior dissection of the hip. At the ischium, the pudendal and inferior gluteal neurovascular bundles are most at risk medially and proximally respectively. Much less in danger is the sciatic n. as it runs 1 to 3 cm lateral to the osteotomy site. At the pubis osteotomy the femoral v. lies close on the bone and is prone to damage. The artery lies further off the bone. The ilium osteotomy starts just proximal to the anterior inferior iliac spine and exits posteriorly at the sciatic notch. Here the sciatic n. and the superior gluteal neurovascular bundle may be damaged. The practical surgical implications of these three osteotomies are discussed, especially with respect to the requirement of meticulous subperiostal dissection and accurate placement of retractors.

Six pelvic osteotomies (Salter, Sutherland, Steel, Tönnis, Chiari, and periacetabular) were performed on the right hemipelvis of adult female pelvic plastic models. Each pelvis underwent conventional X-ray and computed tomographic digital pelvimetry before and after osteotomy. The change in the anteroposterior and transverse dimensions at the inlet, midpelvis, and outlet were calculated. None of the osteotomies significantly decreased the inlet. The Salter and Sutherland osteotomies decreased the midpelvis to borderline low. The Salter, Sutherland, and Steel osteotomies significantly decreased the pelvic outlet. These changes correlated closely with those in living patients. Much of this decrease is nullified when the osteotomy is performed prior to the pubertal growth spurt.

Classical methods for pelvic osteotomy, such as those of Salter, Pemberton, Chiari, and Wagner, have been developed for reconstruction of the subluxed hip joint in children and young adults. Regarding pelvic osteotomy involving a middle-aged patient, however, there are not as many operation methods to consider, and it is difficult to choose the most suitable technique for alleviating advanced osteoarthritis. Based on current practice, total hip replacement (THR) seems the accepted method, though it presents problems such as loosening, sinking, and infections; because of these factors physicians hesitate to recommend THR surgery, particularly if the patient is otherwise healthy and appears to have many good years ahead of him. As an alternative, we have been developing and improving the acetabular osteotomy, based on Tagawa's rotational acetabular osteotomy (RAO) and Wagner's acetabular osteotomy (type II). In this paper we present the results of a modified RAO operation performed on 50 middle-aged patients with an average age of 42 years and 2 months (31-61). The average follow-up was 3 years and 3 months (1-9 years). In 82% of patients the result was satisfactory (41 of 50 cases). A similar osteotomy technique has been used by Eppright and Wagner. We feel that our method achieves a more favorable result for an older patient with severe osteoarthritis, since both the surgery and the follow-up rehabilitation are more comprehensive. A modified acetabular osteotomy should not be regarded as merely an alternative to total hip replacement, but as the preferred choice for hip-joint reconstruction.

Nos 168 hanches operees se repartissent entre 102 hanches feminines et 66 hanches masculines. 22 patients ont ete operes des deux cotes. L'on retrouve une majorite de lesions dysplasiques chez les femmes dont l'âge moyen au moment de l'intervention est de 43 ans par rapport aux hommes qui presentent surtout des lesions d'arthrose primitive et ont un âge moyen de 47 ans lors de l'operation. La douleur constitue le handicap preponderant. Il existe une correlation entre l'intensite du handicap clinique et l'importance des lesions radiologiques. Sur le plan technique, il existe une nette predominance des osteotomies de varisation. Tous ces patients n'ont de commun que le fait de presenter des lesions d'arthroses indiscutables.

Anterior abdominal wall closure without pelvic osteotomy for bladder exstrophy can be very diffecult and more often than not calls for various reconstructive measures. A technique is described that involves bilateral detachment of the rectus abdominis from the pubic ramus, midline vertical closure, and refixation to the pubic rami after medial and caudal advancement. A relaxing fascial incision may be required. This technique has been used in 15 patients and has obviated the need for pelvic osteotomy, thereby decreasing the postoperative morbidity. It has resulted in good cosmetic repair in all patients in addition to the ease of abdominal wall closure. The healing has been remarkably good. This technique is particularly useful in children coming for primary surgery after the neonatal period.

Erratum to: International Orthopaedics (SICOT) DOI 10.1007/s00264-009-0769-2 Due to an oversight in production, one of the author’s names was rendered incorrectly. The correct spelling is: Sina Rahimpour

Chiaris pelvic osteotomy with or without intertrochanteric osteotomy was performed in more than 100 cases during the past ten years. An evaluation of 97 operations showed good results in younger patients (age groups from 5-17 years). In adults with evident signs of arthrosis a higher rate of failures was obvious and therefore the indication for the pelvic osteotomy in this group of patients should be restricted.

Between 1971 and 1985, 461 adult patients were treated by Chiari's pelvic osteotomy with medial displacement. Of these, 161 patients (171 hips) were followed up for an average of 9 years. The average age at operation was 29 years. We describe five groups of painful dysplastic hips in which the operation is indicated. Clinical evaluation by Colton's rating system gave 84% of excellent, good or fair results. Radiographs showed that the secondary osteoarthritic changes were arrested in 73%, improved in 11% and that there was deterioration in 16%. Pain was largely or completely relieved in 87%, the range of movement was maintained in 80% and the gait improved in 77% of our cases. The late results were better in younger patients. We conclude that improved biomechanical conditions are responsible for good congruency of the joint which is preserved for a long time.

The reasons are discussed for differences in functional results of the pelvic osteotomy after Chiari, regardless of the fact that the CE and AC angles were equal in all patients. When lateralization and distal displacement of the greater trochanter were performed in addition to the pelvic osteotomy, the functional results proved to be better. Biomechanical analysis of the relationship between gluteal force and body weight revealed that these relations change; in all examined cases where lateralization and distal displacement of the greater trochanter were performed, the relationship proved postoperatively to be considerably more favorable. In the same group of patients, the relationship between the force of reaction and body weight was also changed after surgery. Therefore, lateralization and distal displacement of the greater trochanter are important factors for the undisturbed functioning of a hip; in all examined patients the functional results were better when lateralization and distal displacement of the greater trochanter were performed.

Es wurden fruhe und spate Ergebnisse der Beckenosteotomie nach Salter bei 149 Luxationen und Subluxationen der Hufte bei 102 Kindern im Alter von 18 Monaten bis 12 Jahren vorgestellt. Die Salter-Osteotomie wendete man in 4 Rekonstruktionstypen an, und zwar: a) die isolierte Beckenosteotomie und verbunden b) mit der offenen Reposition, c) mit der Richtungsosteotomie des Femurs, d) mit der Verkurzung des Femurs. Mit der vorgestellten Methode behandelte man verschiedene Formen der angeborenen Huftluxation, dabei 32 Falle der Luxatio alta. Erhaltene Spatergebnisse: 77,2% sehr gute und gute morphologische Beurteilung, 12,1% restliche Dysplasie ohne die Subluxation und 8,1% Rezidivsubluxationen. Regelrechte Tatigkeit zeigten 79,8% der operativ angegangenen Huften.

Indikationen, Prinzipien und Operationstechnik einschlieslich Nachbehandlung der Huftarthrodese mit Kreuzplatte und Beckenosteotomie wurden besprochen. Die klinikeigenen Erfahrungen stutzen sich auf 35 derartige Eingriffe. Die Ergebnisse der Nachuntersuchungen wurden mit ahnlichen Verfahren verglichen. Nach unserer Auffassung stellt diese relativ aufwendige und keinesfalls gefahrlose Methode besonders wegen der Moglichkeit der Fruhmobilisation einen wesentlichen Fortschritt bei der Durchfuhrung der noch immer berechtigten Huftarthrodesen dar. Eine subtile Beherrschung des Verfahrens und die Kenntnisse der moglicherweise auftretenden Komplikationen sind jedoch besonders hier unerlaslich.

A 10-year period of surgical management of Legg-Calve-Pethes disease (LCP) is reviewed. A total of 40 hips were operated on in 36 of 213 patients with LCP using four different techniques: femoral varus osteotomy, Salter's innominate osteotomy, Le Coeur's triple osteotomy, and Chiari's pelvic osteotomy. The choice of each technique was based on the clinical and roentgenographic anomalies present in each case. The benefits and disadvantages of these techniques in LCP are discussed. Overall results were judged as good in 65% of cases, fair in 23%, and poor in 12%.