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PubMed2004

Assessment of bone graft substitutes in autopsy implant retrievals of the acetabulum in total hip arthroplasty.

Two autopsy retrievals of acetabular reconstruction with different bone graft substitutes were analyzed. One patient underwent surgery with hydroxyapatite (HA) granules, and the other with demineralized bone chips. Incorporation occurred with the biomaterial bone-graft substitute HA primarily in the superior part of the acetabulum, where the HA was in contact with host cortical bone. No bony union occurred with the demineralized bone chips because of motion and migration of the acetabular cup. No bone incorporation of either bone-graft substitute was observed in the medial wall defects in both patients. There were two important findings: (1) the 3- to 8-mm depth and 70% to 75% surface of union of the HA bone graft substitute to host cortical bone was the same as seen with morselized, fresh-frozen bone graft; and (2) union of graft material to host bone was dependent on secure fixation of the acetabular construct.

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PubMed2003

Bone HDR brachytherapy in a patient with recurrent Ewing's sarcoma of the acetabulum: alternative to aggressive surgery.

A 17-year-old girl diagnosed with a previously irradiated, locally recurrent Ewing's sarcoma involving the puboischiatic rami and the adjacent acetabulum was referred to our institution for consideration of salvage hindquarter resection. A conservative resection with implantation of the acetabular remnant for high-dose rate brachytherapy was performed instead. The patient died 11 months after surgery without signs or symptoms of bony damage and retained the ability to walk for the remainder of her life.

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PubMed2001

Fibrocartilage in the transverse ligament of the human acetabulum.

Biomechanical experiments on isolated hip joints have suggested that the transverse ligament acts as a bridle for the lunate articular surface of the acetabulum during load bearing, but there are inherent limitations in such studies because the specimens are fixed artificially to testing devices and there are no modifying influences of muscle pull. Further evidence is thus needed to substantiate the theory. Here we argue that if the horns of the lunate surface are forced apart under load, the ligament would straighten and become compressed against the femoral head. It would thus be expected to share some of the features of tendons and ligaments that wrap around bony pulleys and yet previous work has suggested that the transverse ligament is purely fibrous. Transverse ligaments were removed from 8 cadavers (aged 17-39 y) and fixed in 90% methanol. Cryosections were immunolabelled with antibodies against collagens (types I, II, III, VI), glycosaminoglycans (chondroitins 4 and 6 sulphate, dermatan sulphate, keratan sulphate) and proteoglycans (aggrecan, link protein, versican, tenascin). A small sesamoid fibrocartilage was consistently present in the centre of each transverse ligament, near its inner surface at the site where it faced the femoral head. Additionally, a more prominent enthesis fibrocartilage was found at both bony attachments. All fibrocartilage regions, in at least some specimens, labelled for type II collagen, chondroitin 6 sulphate, aggrecan and link protein, molecules more typically associated with articular cartilage. The results suggest that the ligament should be classed as containing a 'moderately cartilaginous' sesamoid fibrocartilage, adapted to withstanding compression. This supports the inferences that can be drawn from previous biomechanical studies. We cannot give any quantitative estimate of the levels of compression experienced. All that can be said is that the ligament occupies an intermediate position in the spectrum of fibrocartilaginous tissues. It is more cartilaginous than some wrap-around tendons at the wrist, but less cartilaginous than certain other wrap-around ligaments, e.g. the transverse ligament of the atlas.

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PubMed2001

Arthroscopic extirpation of an osteoid osteoma of the acetabulum.

We present the case of a 16-year-old boy with an 18-month history of pain in the left groin for 18 months. In addition to the simple radiographic examination, magnetic resonance imaging, bone scan, and computed tomography were necessary to finally diagnose an acetabulum osteoid osteoma (AOO). Excision of the lesion was performed arthroscopically and pathologic testing confirmed the diagnosis. The patient's symptoms disappeared immediately after the surgery, and had not reappeared as of the 6-month postoperative evaluation. We conclude that arthroscopic excision of an AOO is possible and avoids the aggressive open approach as well as operative hip dislocation.

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PubMed2002

Stress fracture of the medial wall of the acetabulum adjacent to a cementless acetabular component.

There are numerous potential causes of hip pain after total hip arthroplasty other than loosening or infection. A case is described that is consistent with stress fracture of the medial wall of the acetabulum after cementless acetabular revision. The clinical presentation, diagnosis, and treatment are described. This is an uncommon cause for localized groin pain after total hip arthroplasty, which should be considered particularly in an elderly woman with a relatively acute onset of symptoms after an increase in activity level.

Acetabulum↗
PubMed2002

Bilateral pathologic fractures of the hip and acetabulum treated with cementless total hip arthroplasty.

Pathologic fractures from metastatic cancer pose formidable challenges to the orthopaedic surgeon technically and in terms of surgical decision making with regards to patient quality of life. We present the case of a 47-year-old woman with simultaneous bilateral pathologic femoral neck and acetabulum fractures and severe pulmonary shunt, who was treated successfully with cementless femoral and acetabular implants.

Acetabulum↗
PubMed2000

[Rational diagnostic imaging of pelvic and acetabulum injuries].

In spite of the widespread availability of CT scanners, conventional X-ray radiographs remain the basic imaging modality in patients with pelvic and/or acetabular trauma. However, the extent of their use will depend on local utilities (e.g., availability of CT scanners) and on the patient's clinical condition. Regarding the inaccuracy of conventional radiography in the diagnosis of injuries of the dorsal pelvic ring and of the acetabulum, computed tomography represents the most important imaging modality in the clinically stable patient. CT provides an exact staging of the extent of trauma and allows for differentiation of pelvic instabilities. CT clearly demonstrates the severity of acetabular trauma and is superior in the detection of local complicating factors, i.e., impressions fractures and (sub-)luxations of the femoral head as well as free intraarticular fragments. CT findings provide the basis for definite treatment regimens of the injured patient. By extension of the examination, all relevant organs and systems (craniospinal, cardiovascular, gastrointestinal, respiratory, genitourinary) can be imaged during one session. The speed of spiral CT scanners and their diagnostic accuracy will play a major role in the management of, especially, polytraumatized patients. The indication for angiography with the option of therapeutic embolization exists if a pelvic bleeding persists even after reposition and operative fixation of the injury.

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PubMedDate not supplied

[Roentgen criteria and radiologic results of the Hofer-Imhof (H-I) threaded acetabulum cup in first time implantation].

The Hofer-Imhof cup consists of a parabola-shaped titanium acetabular component with flat threads. These flat threads are designed to be self-cutting and allow accurate insertion without incarceration, even in sclerotic bone. In a prospective study conducted from May 1988 to July 1989, 143 Hofer-Imhof cups were implanted. Radiographic assessment included initial bone contact, cup position, fixation on osteophytes, presence of any radiolucencies or sclerosis, cup migration and bone ingrowth. Initial prosthesis fit was evaluated with a 20 degrees caudally angled anteroposterior X-ray for accurate demonstration of the threads. 119 of the Hofer-Imhof cups (83.2%) were available for radiographic follow-up at a mean of 65 months (min. 37 mo., max. 95 mo.). One cup required revision after 23 months due to infection. The cups had an average inclination of 47 degrees, and complete bone contact was evident in 86.6% on the postoperative X-ray. In 8.4% of the cups, some threads were not in contact with bone at the edge of the acetabulum. At final follow-up, 82.4% had complete bone ingrowth without any evidence of radiolucency (type I), 15.1% had near-complete bone ingrowth with minimal radiolucencies (type II), and 2.5% had predominantly fibrous fixation (type III). One cup (0.8%) showed excessive migration. The technique of anchorage using a flat thread, minimal bone resection as a result of the parabolic shape and the sandblasted titanium surface are the characteristic features of the Hofer-Imhof threaded cup and produce good medium-term results in primary hip arthroplasty.

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PubMedDate not supplied

[Erosion with loosening of an aluminum oxide ceramic acetabulum. Case report].

The arthrodised hip of a 52 year-old female patient that had been absolutely trouble free for 9 years was remobilised by implanting a Mittelmeier, Autophor prosthesis (Al2O3 socket, Al2O3 head). Two years later, the hip joint had to be revised because of loosening of the socket. Since the shaft of the prosthesis was still firmly anchored within the femur, only the socket und the head were replaced. About three years following this revision, signs of loosening of the acetabular component again developed. Finally 4 1/3 years after the first revision (6 1/3 years after primary implantation) the hip was again revised. A polyethylene socket was then cemented into an acetabulum supporting shell and the prosthesis shaft furnished with a ceramic head of 32 mm diameter. Possible disadvantages of ceramic-ceramic bearing surfaces in patients with an altered bone structure of the pelvis and with a high risk of subluxation, due to weakened pelvi-trochanter muscles, are discussed.

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PubMedDate not supplied

[Active acetabulum base stabilization as a supplement to endoprosthesis in polyarthritis-induced acetabular protrusion].

In many cases, rheumatoid arthritis results in protrusio acetabuli. In order to effect a durably stable support over the whole extent of the acetabulum, the active stabilization of the socket base in an endoprothetic joint replacement through a corticospongy plastic is more promising than the application of passive measures. Rheumatoid arthritic persons underwent 127 hip-joint replacements as first-time surgeries. In 47 operations out of the 127, we also carried out the active stabilization of socket bases because of protrusio acetabuli. Through the implantation of corticospongy bone material into the protrusions, socket bases with enough strain capacity could be recreated. Loosenings or reprotrusions were not observed over a period of up to 5 years.

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PubMedDate not supplied

[Results of experimental testing of a screw-in in polyethylene acetabulum in sheep].

In 12 sheep 21 total hip endoprosthesis were implanted, using a polyethylene acetabulum, which was provided with a continuous conique thread for implantation without cement. Out of 14 non luxated hips only 2 acetabula were loosened. After an implantation between 1 week and 18 months the remaining 12 sockets were macroscopically stable and were examined radiologically and histologically. After 3 months of increased osteogenesis a layer of collagenous tissue developed between implant and bone. In the loadbearing area this layer is from 50-80 microns thick and often the ridges of the thread are stabilised by a thin layer of fiber-cartilage, expanding around the implant with longer implantation. Bore-holes in the thread are filled with partially lamellous bone after 6 months. Though sometimes a considerable amount of polyethylene wear particles caused by the disadvantageous and small shape of the sheeparthroplasty was observed, none of the examined acetabula showed any signs of loosening.

Acetabulum↗
PubMed2001

Rotational acetabular osteotomy for hip dysplasia: spontaneous medial enlargement of the acetabulum.

We followed 56 patients (63 joints) who had undergone rotational acetabular osteotomy (RAOs) between 1987 and 1993, mean 7 (5-12) years. The Merle d'Aubigné score increased by 15 points or more in 59 and decreased in 4 hips. The arthrosis progressed in 5 joints. In about 2/3 of the cases, we observed some medial and/or lateral expansion of the subchondral bone in the acetabulum 3 years postoperatively, suggesting enlargement of the load-bearing area.

Acetabulum↗
PubMed1997

Acetabulum augmentation for Legg-Calvé-Perthes disease. 12 Children (14 hips) followed for 4 years.

Between 1986 and 1992, we performed 14 lateral shelf augmentation of the acetabulum in 12 children suffering from severe Legg-Calvé-Perthes disease. All children were over 9 years of age and none of the patients had previously undergone any other treatment. All children presented with a limitation of hip movement and episodes of pain during long walks and athletic activities. The clinical outcome was good in all children who were free of pain and walked without limping. Hip movement was painless and improved satisfactorily.

Acetabulum↗
PubMed2005

Use of activated recombinant coagulation factor VII in patients undergoing reconstruction surgery for traumatic fracture of pelvis or pelvis and acetabulum: a double-blind, randomized, placebo-controlled trial.

BACKGROUND: Activated recombinant coagulation factor VII (rFVIIa) effectively prevents and controls bleeding in patients with coagulopathy. Data show that rFVIIa may reduce blood loss and eliminate the need for transfusion in patients with normal haemostasis undergoing major surgery. We assessed the efficacy of rFVIIa in patients with normal haemostasis undergoing repair surgery of major traumatic fracture of the pelvis or the pelvis and acetabulum, who were expected to have a large volume of blood loss. METHODS: We performed a double-blind, randomized, placebo-controlled trial involving 48 patients undergoing major pelvic-acetabular surgery. Patients were randomized to receive an i.v. bolus injection of rFVIIa 90 microg kg(-1) or placebo as add-on therapy at the time of the first skin incision. All patients also received intraoperative salvaged red blood cells (RBC). RESULTS: There was no significant difference in the total volume of perioperative blood loss, the primary outcome variable, between the rFVIIa and placebo groups. In addition, there were no differences between the two groups in the total volume of blood components, including salvaged RBC transfused, number of patients requiring allogeneic blood components, total volume of fluids infused, total operating time, time taken after entry to the intensive care unit to reach normal body temperature and acid-base status, and time spent in hospital. No adverse events, in particular thromboembolic events, were reported in either group. CONCLUSIONS: In patients with normal haemostasis undergoing repair surgery of traumatic pelvic-acetabular fracture, the prophylactic use of rFVIIa does not decrease the volume of perioperative blood loss.

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PubMed1997

Anatomic basis of lag screw placement in the anterior column of the acetabulum.

The projection point of the axis of the anterior column of the acetabulum on the outer table of the iliac wing was determined in 15 adult bony hemipelves. The optimal entry point for lag screw fixation in the anterior column was located 16 +/- 3.9 mm superior to the midpoint of the line connecting the apex of the sciatic notch with the notch between anterior superior iliac spine and anterior inferior iliac spine, and 46 +/- 5.9 mm superior to the acetabular rim. The mean inclination of the projected axis was 90.6 degrees +/- 5.0 degrees in the sagittal plane and 29.0 degrees +/- 4.4 degrees in the transverse plane. These data may facilitate insertion of a lag screw into the anterior acetabular column and minimize the risk of articular violation or cortical penetration because there is a narrow margin of safety. The lag screw placement also may be aided by palpating the anterior column with a finger and by intraoperative fluoroscopy for visualization of the hip joint and the anterior column in the obturator or pelvic outlet views.

Acetabulum↗
PubMed2000

Open reduction and internal fixation of posterior wall fractures of the acetabulum.

The results of 94 patients with posterior wall fractures of the acetabulum associated with hip instability treated within 3 weeks of injury by open reduction and internal fixation were reviewed. Patients were followed up for an average of 3.5 years (range, 1-13 years). Fracture reductions were graded as anatomic (0-1 mm displacement) in 92 patients and imperfect (2-3 mm displacement) in two patients, as determined by plain radiography. However, postoperative computed tomography scans obtained in 59 patients revealed incongruency of more than 2 mm in six patients and fracture gaps of 2 mm or more in 44 patients. Complications included deep wound infection (one patient), deep vein thrombosis, (seven patients), and revision surgery to redirect an errant screw (one patient). Clinical outcome was graded as excellent in 34 patients (36%), good in 49 (52%), fair in two (2%), and poor in nine (10%). Radiographic results were excellent in 79 hips (84%), good in four (4%), fair in two (2%), and poor in nine (10%). There was a strong association between clinical outcome and radiographic grade. Variables identified as risk factors for an unsatisfactory result included age greater than 55 years, a delay greater than 24 hours from the time of injury for reduction of a hip dislocation, a residual fracture gap greater than 1 cm, and severe intraarticular comminution. The apparent disparity between the accuracy of surgical fracture reduction, as determined by plain radiographs obtained postoperatively, and clinical outcome is explained only partially by the limitations of plain radiography. Other variables are involved, many of which are under the surgeon's control but some are not. As is the case with other acetabular fracture types, the best results are predicated on anatomic fracture reduction.

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PubMed1993

Unrecognized posterior dislocation of the hip associated with transverse and T-type fractures of the acetabulum.

Five patients who had displaced transverse or T-type fractures of the acetabulum and who were transferred 3-5 days after their injury with an unrecognized posterior dislocation of the hip are reported. On the anteroposterior pelvis radiograph, central displacement of the acetabular fragment dominated the radiographic appearance; however, superior displacement of the femoral head with superimposition on the intact acetabular roof was a consistent finding. The typical radiographic findings of adduction and internal rotation of the femur were not present. Oblique views of the pelvis, and/or a computed tomography scan made the diagnosis obvious. Appropriate initial radiographic evaluation is imperative in all patients with acetabular fractures. Failure to recognize the posterior hip dislocation in this group of patients may have led to an increased incidence of avascular necrosis of the femoral head, nerve palsy, and femoral head articular cartilage damage. We recommend either closed reduction with the patient under anesthesia followed by skeletal traction and delayed open reduction/internal fixation, or immediate open reduction/internal fixation if the reduction is not stable.

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PubMed1994

The reliability of detecting screw penetration of the acetabulum by intraoperative auscultation.

Open reduction and internal fixation of the acetabulum frequently requires placement of screws in a blind fashion that risks penetrating the joint surface. While in the operative suite, direct visualization of the joint surface may not be possible, and fluoroscopy can be difficult to interpret. Auscultation of the hip with motion in a quiet room has been suggested as a useful adjunct to detecting screw penetration. Carrying that concept further, we auscultate the hip using a sterile esophageal stethoscope at the operating table and have found this to be a highly reliable method of detecting intraarticular screw placement. To test the reliability and reproducibility of this technique, an experiment was performed using inexperienced volunteers. In part I, two adult mongrel dogs were prepared. A screw was placed violating the hip joint in one dog, and in the other dog a screw was placed near but not penetrating the joint. Screw placement was verified under direct vision. Seventy-seven volunteers who did not know which hip was penetrated then auscultated both hips in random order and recorded their impressions after each hip was heard. After hearing both hips, 74 of 77 were able to identify the screw in the hip joint correctly; 69 were able to recognize the extraarticular screw correctly. In part II, both hips of a human cadaver were exposed and dislocated. In one hip, a screw was placed that tangentially violated the joint, and in the same area of the contralateral hip a screw was placed that did not penetrate the joint surface.(ABSTRACT TRUNCATED AT 250 WORDS)

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