level IV: Retrospective Therapeutic Study.

The treatment of developmental dysplasia of the hip diagnosed after the first year of life remains controversial. A series of 36 children (47 hips), aged between one and 4.9 years underwent gradual closed reduction using the Petit-Morel method. A pelvic osteotomy was required in 43 hips (91.5%). The patients whose hips did not require pelvic osteotomy were among the youngest. The mean age at final follow-up was 16.1 years (11.3 to 32). The mean follow-up was 14.3 years (10 to 30). At the latest follow-up, 44 hips (93.6%) were graded as excellent or good according to the Severin classification. Closed reduction failed in only two hips (4.3%) which then required open reduction. Mild avascular necrosis was observed in one (2.1%). The accuracy of the reduction and associated low complication rate justify the use of the Petit-Morel technique as the treatment of choice for developmental dysplasia of the hip in patients aged between one and five years.

Diagnostic study, Level II.

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This study highlighted that preoperative function is influenced by comorbidities in DLSS patients. Relationships existed between comorbidities and symptoms related to low back pain and neurogenic claudication, contrary to radicular pain. Therefore, comorbidities might impact the variability of patients' outcomes. This finding should be part of the patient's preoperative information. Moreover, role of comorbidities on postoperative outcomes need to be investigated.

Extended femoral and tibial osteotomies were performed to remove infected cemented hinged knee prostheses in five patients (six knees) with a mean age of 72 years (44-85) and a history of multiple knee surgeries. A tibial osteotomy was used to mobilise the distal quadriceps insertion and to release the tibial extension. The femoral component was extracted by downward traction and its cement mantle was cleared through an anterior osteotomy (n=4) or via the distal approach (n=2). The bone flaps were re-approximated by wire cerclage over articulating acrylic spacers. Mean time to re-implantation of a new knee prosthesis was 11 months (6-24). Revision prostheses with cement fixation restricted to the epiphyseal-metaphyseal region were used. Infection recurred in two cases at 16 and 4 months after the prosthetic re-implantation, and was managed by joint fusion for one and irrigation/lavage for the other, respectively. At last follow-up after a mean of 53 months, the mean Parker score was 4 ± 2, the mean IKS knee score was 66 ± 25 (28-93), and the mean IKS function score was 7 ± 16 (0-40). This technique facilitates the removal of infected cemented components of hinge prostheses and of the cement mantle, most notably in the absence of loosening, without compromising re-implantation of a new knee prosthesis.

Performing the osteotomy helps in the reduction and allows a short fixation, which spares the mobility of the lumbo-sacral junction.

No abstract