We present a series of 30 uncemented total hip replacements performed between June 1985 and January 2002 with a mean follow-up of seven years (5 to 20) in 27 patients who had previously undergone a valgus intertrochanteric osteotomy. No further osteotomy was undertaken to enable hip replacement. We used a number of uncemented modular or monoblock femoral components, acetabular components and bearings. The patients were followed up clinically and radiologically. We report 100% survival of the femoral component. One acetabular component was revised at five years post-implantation for aseptic loosening. We noted cortical hypertrophy around the tip of the monoblock stems in six patients. We believe that modular femoral components should be used when undertaking total hip replacement in patients who have previously undergone valgus femoral osteotomy.

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Insufficiency fractures are often overlooked, particularly when associated with greater trochanteric avulsion fractures. Here, we report magnetic resonance imaging (MRI) findings of insufficiency femoral intertrochanteric fractures associated with greater trochanteric avulsion fractures treated by internal fixation. We identified 8 patients (3 men and 5 women; age range, 58-92 years old). All cases used internal fixation devices. Operations were performed within 30 min with a total recorded blood loss within 50 ml. We studied MRI findings, hospital stay (number of days), the ambulatory status at hospital discharge, and complications. We were able to identify intertrochanteric fractures using MRI which we could not identify with radiographs. The average hospital stay was 28 days. Seven patients could walk with support and one patient could walk without support. There were no complications regarding the operation itself. Insufficiency femoral intertrochanteric fractures associated with greater trochanteric avulsion fractures were often overlooked. We successfully treated these fractures by internal fixation.

We treated 31 hips in 30 patients with advanced osteoarthritis of the hip secondary to acetabular dysplasia, by valgus-extension femoral osteotomy. The mean follow-up was 12.7 years (10 to 17). Acetabuloplasty was added in ten severely dysplastic hips. In 28 hips, radiological widening of the joint space was seen three years after operation, but in 12 had narrowed again by ten years. Survivorship analysis showed that the rate of survival was 82% using the pain score as the index of failure, and 72% based on radiological findings at ten years. Better long-term results were obtained in hips which had an acetabular head index greater than 70% or a roof osteophyte more than 5 mm in length three years after operation. Acetabuloplasty should be added for the hip which is severely dysplastic and with a poorly developed roof osteophyte.