Purpose Our aim was to assess operative treatment for post-traumatic avascular necrosis of the femoral head (ANFH) in adolescents. Methods Eleven patients with an average age of 17 (range 14-26) years were operated up on for ANFH after proximal femoral fractures. The average interval between injury and reconstructive surgery was four (range two to eight) years. The average follow-up of the entire cohort was 89 (range 48-132) months. Five patients with total ANFH were treated by total hip replacement (THR). Six patients with partial ANFH were treated with valgus intertrochanteric osteotomy (VITO). Results In all patients, operation improved hip function. The average preoperative Harris Hip Score (HHS) was 70 points and average postoperative HHS was 97 points. Comparison of magnetic resonance imaging (MRI) scans before and after VITO demonstrated resorption of the necrotic segment of the femoral head and its remodelling in all six patients with partial ANFH. A complication was encountered in one patient.Conclusion Patients treated for ANFH had good mediumterm outcomes after THR for total necrosis and also after VITO for partial necrosis.

Purpose Hip shelf arthroplasty is currently considered to be a salvage procedure. The aim of the study is to present outcomes of Bosworth hip shelf arthroplasty in adolescent dysplastic hips with a minimum ten-year follow-up. Methods The basic group comprised 25 hips in 18 patients with the mean age of 31 years (range, 16-52) at the time of operation. Subgroup A included 20 hips that were evaluated prior to operation as spherical, centric hips without osteoarthritic changes (acetabular dysplasia). The heterogeneous subgroup B comprised five hips. Of these, three hips were evaluated as aspheric, without osteoarthritic changes, and two hips as aspheric, with osteoarthritic changes of grade 2 according to Tönnis. In addition, two hips in subgroup B were evaluated as decentred (subluxated), one hip without and one hip with osteoarthritic changes. The mean follow-up was 15 years (range, ten-23). Results In subgroup A, the positive effect of operation had lasted at the time of the final follow-up for ten to 22 years postoperatively (average follow-up 14 years) in 19 hips. Only one female patient, 46 years old at the time of operation, developed hip osteoarthritis within ten years, that was treated by THA. In subgroup B, a lasting positive effect of operation was recorded in two cases at the time of the final follow-up (12 and 15 years). The third female patient with an aspheric and decentred hip developed severe hip osteoarthritis 21 years after shelf procedure that was treated by THA. In two patients who had hip osteoarthritis already before the operation, the positive effect of the shelf procedure survived over 13 and 20 years. Although hip osteoarthritis progressed, THA was performed as late as 15 and 23 years after the shelf procedure. The mean Harris hip score in 21 hips with a still functional hip shelf was 68 (range, 56-82) before and 90 (range, 76-100) after the surgery. Conclusion The best outcomes of Bosworth hip shelf arthroplasty may be expected in a dysplastic spherical centred hip without osteoarthritic changes. In the presence of asphericity, decentration and osteoarthritic changes, neither the effect of the surgery nor its survival can be clearly predicted.

VFITO provides a good outcome at medium-term follow-up in adolescent patients with partial ANFH after SCFE.

Based on results, the valgus intertrochanteric osteotomy appears to be a reliable treatment for postdysplastic coxa vara in patients older than 30 years.

Long-term results of 69 hip operations for deformities due to avascular necrosis following the conservative treatment of the hip dysplasia were evaluated. The authors' technique of intertrochanteric valgus osteotomy allows for simultaneously handling of varus deformity and shortening of the femoral neck, fusion of the greater trochanter, and correction of increased femoral anteversion, if necessary. This type of surgery was used in children with Buchholz-Ogden type III deformity starting from 3 years of age until adolescence. Patients were followed for an average of 19.3 years. Eighty-seven percent had no marked limitation in range of motion and 57% were free of complaints. Trendelenburg gait was present in only six patients. Radiographs of all patients showed improvement of coxometric values. Acetabular dysplasia was handled in 29 patients with a subsequent shelf arthroplasty. Total hip arthroplasty for hip degeneration was not indicated for any of the patients to date.