Between 1995 and 2003, we operated upon 18 children with 20 hips involved, aged 5-11 years (average: 7.5 years) suffering from an inveterate high developmental dislocation of the hip joint. An average follow-up period of our middle-term study was 51 months (range: 34-96 months). A two-staged management was applied. First, femoral head was lowered back to the level of acetabulum with an external fixator or a distractor device. The second stage involved open reduction combined with pelvic osteotomy and, in four cases with femoral derotation osteotomy. We noted two cases of avascular necrosis. Equal limb length was achieved in 15 cases. There were two cases of 0.5-cm length discrepancy, two cases of 1-cm length inequalities, and one case of 5-cm limb shortening. We endorse this method in neglected cases of previously untreated unilateral high developmental hip dislocations in children aged 8-10 years. It results in a usable hip joint without the need of femoral shaft shortening and facilitates future joint replacement.

The reported case adds to the literature on vertebral fractures by describing another mechanism leading to aortic wall disruption. Similar vascular complications may be identified more frequently in the future given the high prevalence of osteoporosis and atherosclerosis in the general population.

Total hip arthroplasty with metal-on-metal bearing is associated with specific complications: local delayed hypersensitivity reaction (ALVAL) to metal particles, osteolysis and the development of pseudotumors. This process results from the low resistance of the metal bearing to abrasion and corrosion, which causes the release of metal ions into the surrounding tissues. This paper presents the case of a 54-year-old man who required revision surgery due to aseptic loosening of the endoprosthesis with a ceramic (TiN)-on-metal bearing. The removed implants were subjected to material analysis. Mean chemical analysis revealed that the main component of the residue samples was titanium, which constituted 65% of the sample weight, followed by calcium (16%), phosphorus (11%) and aluminum (3.8%). The fissures on the insert were a result of trauma caused by the head, with both elements matching in terms of visible damage. More than 50% of the surface of the head had been damaged due to abrasive wear. The transitional area between the normal and completely delaminated TiN coating shows uneven abrasion, a gradual decrease in coating thickness. In conclusion, the use of endoprosthesis heads with TiN ceramic coating involves very low polyethylene wear. The low resistance of TiN ceramic coating to trauma and the fragility of this coating prevent the use of TiN-coated heads in combination with any non-polyethylene hip endoprosthesis inserts.

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