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PubMed1996

Anatomic considerations of plate-screw fixation of the anterior column of the acetabulum.

Fifteen cadaveric adult bony hemipelvis specimens and 30 adult dry bone specimens were obtained to evaluate the configuration of the anterior column of the acetabulum and to develop a safe path for screw placement into it. Each cadaveric specimen was sectioned at 1-cm intervals, beginning at the level of the inferior border of the acetabulum (junction between the anteroinferior edge of the acetabulum and the most anterolateral edge of the superior ramus of the pubic bone). The plane of the cross-section was perpendicular to the anterior column. The projection of the medial acetabular boundary on the anterior column was determined by analysis of each cross-section. Results showed that the average width of the anterior column at 1.0, 2.0, and 3.0 cm superior to the inferior acetabular boundary is 31.0 +/- 4.7, 34.2 +/- 5.1, and 39.4 +/- 6.2 mm, respectively. At 1.0 cm superior to the inferior margin of the acetabulum, the average medial angulation for 0.5-, 1.0-, and 1.5-cm entry points lateral to the pelvic brim were 24.9 +/- 4.4 degrees, 35.5 +/- 5.2 degrees, and 44.4 +/- 6.6 degrees, respectively. At 2.0 cm superior to the inferior acetabular margin, the corresponding average medial angulation for 0.5-, 1.0-, 1.5-cm entry points were determined to be 29.2 +/- 5.5 degrees, 38.6 +/- 5.9 degrees, and 48.1 +/- 5.7 degrees, respectively. At 3.0 cm superior to the inferior acetabular margin, these angles were found to be 20.7 +/- 4.3 degrees, 29.4 +/- 6.0 degrees, and 39.3 +/- 5.9 degrees, respectively. All of the above mentioned angles are with respect to the perpendicular of the longitudinal axis of the anterior column without violation of the hip joint. Screws placed 1.0 cm lateral to the pelvic brim at the levels of 1.0, 2.0, 3.0, and 4.0 cm superior to the inferior acetabular margin and directed perpendicular to the anterior column penetrated the hip joint.

Acetabulum↗
PubMed2005

Fractures to the posterior wall of the acetabulum managed with screws alone.

BACKGROUND: The use of a buttress plate in addition to lag screws has been recommended for fractures to the posterior wall of the acetabulum. However, there is a lack of possible criteria for the use of screws alone. This study aimed to evaluate the use of screws alone for fixation of posterior wall fractures to the acetabulum. METHODS: This study retrospectively examined 15 patients with a single fragmented or moderately comminuted posterior wall fracture of the acetabulum who had been treated with internal fixation using screws alone. The modified D'Aubigne and Postel's score system was used for the functional evaluation. RESULTS: The clinical results were excellent for nine hips, very good for one hip, good for four hips, and poor for one hip after follow-up period of more than 2 years. CONCLUSION: The use of screws alone can produce acceptable results for selected posterior wall fractures of the acetabulum.

Acetabulum↗
PubMed1996

Rotational acetabular osteotomy for severe dysplasia of the hip with a false acetabulum.

We have divided Severin group-V severely dysplastic hips with a false acetabulum into three subtypes, based on the height and shape of the socket. We performed rotational acetabular osteotomy (RAO) in 19 hips in 17 young adults with a type-1 'low' false acetabulum which had direct contact with the true acetabulum. This is a periacetabular osteotomy which gives acetabular coverage with articular cartilage and produces a nearly normal position of the head. Concomitant osteotomies of the proximal femur were carried out in 11 hips. We reviewed the patients clinically and radiologically at a mean of ten years (6 to 18) after operation. Of the 19 hips, 15 showed very good or good results. This operation is indicated in young adults with a dysplastic hip and a type-1 low false acetabulum. Subclassification of Severin group V is a convenient way of defining those patients who would benefit from the procedure.

Acetabulum↗
PubMed2003

Posterior-anterior glide of the femoral head in the acetabulum: a cadaver study.

STUDY DESIGN: Descriptive study employing cadaver dissection and measurement of posterior-anterior (PA) glide of the femoral head in the acetabulum. OBJECTIVE: To quantify PA glide of the femoral head in the acetabulum in a cadaveric sample. BACKGROUND: Posterior-anterior glide of the femoral head within the acetabulum is a joint mobilization procedure described in orthopaedic physical therapy texts, yet there is no published evidence that the joint structures of the hip allow such movement. This study attempted to quantify PA glide of the femoral head in the hip joints of embalmed cadavers. METHODS: Twelve hips, 3 male and 9 female, from 8 embalmed cadavers were employed in this study. Hips were dissected to the level of the joint capsule and a metal rod inserted through the femoral neck served as a mobilizing handle. A load cell was installed into this handle so that mobilizing forces could be monitored. A dial gauge, which recorded displacement of the femoral head, was mounted to the pelvis via bone pins and an external fixator. RESULTS: Using mobilizing forces of 89, 178, 267, and 356 N, mean femoral head displacements of 0.57, 0.93, 1.20, and 1.52 mm were recorded. Within the 89-N trials, PA displacement ranged from a minimum of 0.04 mm to a maximum of 1.54 mm. Within the 356-N trials, PA displacement of the femoral head ranged from a minimum of 0.25 mm to a maximum of 2.90 mm. CONCLUSION: In an embalmed cadaveric model, measurable PA glide of the femoral head within the acetabulum does exist and it is highly variable between individuals.

Acetabulum↗
PubMed1983

Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip.

Anteversion of the acetabulum and of the femoral neck was determined by use of computed tomography in 47 adults with normal hips and in 39 patients with osteoarthritis. The normal anteversion of the acetabulum was found to be 17 +/- 6 degrees (mean +/- standard deviation) and of the femoral neck 13 +/- 7 degrees. In the patients with osteoarthritis the femoral anteversion was on the average 6 degrees larger than in the normals, whereas no difference was revealed in the figures of acetabular anteversion. The relationship between the degree of femoral and of acetabular anteversion was calculated. No correlation was found, neither in the normals, nor in the patients. Consequently, the relationship between the anteversion of the femoral neck and of the acetabulum was poor in the patients as compared to the controls, and it is concluded that this is a contributing factor to osteoarthritis due to poor adaptation of the femoral head to the acetabulum.

Acetabulum↗
PubMed1995

Dealing with the deficient acetabulum in revision hip arthroplasty.

Variable bone loss is the defining feature of the failed acetabulum. Preoperative planning must include an assessment of the extent of bone deficiency. When bone loss precludes a routine revision there are three reconstructive options, a small cup in the false acetabulum, reconstruction of the lost bone with an allograft, and a jumbo cup filling the expanded acetabulum. The investigators have found that the latter technique can often be used in the setting of the difficult acetabulum with improvement in hip mechanics and avoiding a structural bone graft. When a graft is necessary, the best technique is a small graft and large fixed cup, with support of both the cup and graft on as much host bone as possible. A posterior buttressing plate should be considered for any graft providing substantial posterior support of the acetabular component.

Acetabulum↗
PubMed1999

Development of acetabulum after closed reduction in developmental hip dysplasia.

The radiographic study of acetabulum development after closed reduction of 87 congenitally dislocated hips in 64 patients who were treated between 1980 and 1990 was conducted retrospectively. An average patient's age at the moment of closed hip reduction was 16 months (range between 6 to 24 months). On the average, patients were 16 months old (range between 6 to 24 months) at the moment of closed hip reduction. Development of bony acetabulum was followed for 8 years by measuring the AC angle. According to the age at the moment of closed reduction patients were sorted into three groups, the first group from 6 months to 12 months old (39 hips), the second group from 12 to 24 months old (28 hips) and the third group from 24 to 36 months old (20 hips). At the beginning of the treatment mean values of the AC angle in the first group were 37.2 degrees +/- 3.31 degrees; in the second group 39.7 degrees +/- 3.2 degrees; and in the third group 43.8 degrees +/- 2.7 degrees. The final values of the AC angle in the first group were 14.7 degrees +/- 3.21 degrees, in the second group 21 degrees +/- 3.02 degrees; and in the third group 24 degrees +/- 3.76 degrees. Normally and mildly dysplastic hips were achieved in 80.5% treated hips, while in 19.5% treated hips medium and serious dysplasia retarded. The acetabulum development in dysplastic hip after retained stable concentric reduction was the same as in the normal hip. The operative reconstruction of acetabulum should not be done before the third year of life.

Acetabulum↗
PubMed1975

Study on the surface shape and contours of the femoral head and acetabulum of the human joint.

(1) The degree of change and degeneration of the surface of articular cartilage were classified into 6 stages and a distribution chart indicating 6 stages of classification was prepared for each case. (2) The construction of the superficial fine fibrous net-work of the cartilage of the weight-bearing area is different from that of the non-weight-bearing area. (3) The construction of the fiber underneath the surface of the acetabular cartilage is different from that of the surface of femoral head cartilage underneath. (4) When only weight-bearing part was compared, the degeneration at the upper anterior side was least for both femoral head and acetabulum and was most at the slightly posterior part of the upper outer side. (5) The fine fiber of superficial layer of the femoral head and acetabular cartilage were peeling from the periphery toward the center, but no difference of surface roughness was observed by way of measurement directions. (6) Surface roughness of the cartilage increases in proportion to the degree of degeneration and change. (7) The surface roughness of the acetabulum is about twice as large as that of the femoral head cartilage, this being due to the difference in the degree of degeneration. (8) There are 4 kinds of undulations at the surface of the femoral head cartilage. (9) Both femoral head and acetabulum have less waviness of large size at the part bearing large weight. (10) The contour of the femoral head as a whole is slightly ellipsoidal, whose longitudinal axis extends in a craniocaudal direction but the weight-bearing part is nearly circular. (11) The general contour of the acetabulum indicates an ellipsoidal shape with its craniocaudal longitudinal axis slightly inclined forward or backward. The contour of the slightly postero-upper part which is considered to be the maximum weight-bearing part is slightly flat ellipsoidal.

Acetabulum↗
PubMed2004

Periprosthetic fractures of the acetabulum.

Periprosthetic fractures of the acetabulum after total hip arthroplasty are uncommon, but are increasing in number and severity. These fractures may occur intraoperatively, during the perioperative period, or many years after the total hip arthroplasty. Periprosthetic fractures of the acetabulum vary in severity and may involve stress fractures of the pubis or medial wall, significant bone loss secondary to osteolysis and subsequent loss of column integrity, or complete pelvic discontinuity. Treatment differs depending on the complexity of the fracture and the stability of the acetabular prosthesis. Surgical treatment for an unstable acetabulum should stabilize the bony columns of the acetabulum, provide bone grafting of defects, and should maintain adequate bone stock for replacement of a stable acetabular implant. Strict adherence to the principles of fracture surgery is required to achieve bony union of the acetabular columns and provide a stable environment for reimplantation of an acetabular component.

Acetabulum↗
PubMed2004

Morphological characteristics of the acetabulum.

The aim of this research was to accurately measure the surface of the semi lunar articular surface of the pelvis (facies lunata acetabuli) and the variability of the acetabular geometry, as well as to determine the correlation between measured parameters. 30 macerated anatomical specimens of pelvic bones were measured. The radius and depth were measured in the classical way, while cartilaginous surface area was measured using small fragments of measuring paper to avoid errors in measurement due to the curvature of the surface. Computerized calculations provided accurate surface values. In our research, facies lunata acetabuli measured 2294+/-329 mm2. Diameter of the opening of the acetabulum measured 25.8+/-1.9 mm. Acetabular depth was 30+/-3.2 mm. Correlations between the surface area of the facies lunata acetabuli and the radius of the acetabular opening curvature (r=0.71), surface area of the facies lunata acetabuli and the depth of the acetabulum (r=0.80) and the radius of the acetabular opening curvature and the depth of the acetabulum (r=0.80) were confirmed. For precise assessment of the facies lunata acetabuli surface area, the simplest and the cheapest method is the method of measurement using small fragments of measuring paper and software analysis. There is a significant correlation between the depth, opening of the acetabulum and surface area of the facies lunata.

Acetabulum↗
PubMed2005

Combined pelvic osteotomy in the treatment of both deformed and dysplastic acetabulum three years--prospective study.

Kuwait has a very high incidence of all types of developmental dysplasia of the hip. One of the most complicated forms is the deformed dysplastic acetabulum, which has not only abnormal orientation but it also has lost its shape by the pressure of the subluxed femoral head. The outer part of the socket involves the upper part of the original acetabulum, thus giving it a bipartite appearance. Clear border like edge separates this outer part from the inner part, which represents the lower part of the original acetabulum and it has no direct contact with the femoral head. Combined pelvic osteotomy (CPO) restores both the original shape and treats the malalignment of the acetabulum. Twelve children, aged between 18 and 54 months underwent CPO, two of them bilaterally. The follow up is between 36 - 60 months. In all cases, concentric stable reduction with good acetabular cover was obtained.

Acetabulum↗
PubMed1987

[Contribution of x-ray computed tomography to the diagnosis and treatment of fractures of the acetabulum. Apropos of 88 cases].

Eighty-eight recent fractures of the acetabulum have been investigated by standard antero-posterior and oblique radiographs and by CT scanning. The results of the two examinations have been compared. Whilst the type of fracture is well defined by radiography, CT scanning frequently reveals associated lesions, not seen on standard radiographs, which may have an effect on the relationship between the femoral head and the acetabulum. Thus, out of 28 cases with intra-articular fragments, 18 were not visible on standard radiographs and were discovered by CT scan. Similarly, out of 25 peripheral impactions of the acetabulum, 16 were not visible on standard radiographs, of 12 notching lesions of the femoral head, nine were not visible and six out of 23 sacro-iliac displacements were not recognised. CT scanning improved the appreciation of congruence between the femoral head and the acetabular roof in 15 cases and between the femoral head and the acetabulum in 24 cases. Only in 17 patients was there complete agreement between standard radiographs and CT scans. In particular, there is no doubt about the value of CT scanning in comminuted fractures and in fractures of the posterior wall or posterior column. It is a useful adjunct in the choice between conservative and operative treatment.

Acetabulum↗
PubMed1993

[Osteosynthesis of displaced fractures of the acetabulum with Letournel plate. Apropos of 14 cases].

Up to 1989, conservative treatment was used for fractures of the acetabulum at the Dakar teaching hospital, with in previous study, of poor result. The same authors present here their first experience of surgical treatment of displaced fractures of acetabulum using LETOURNEL plate at the "Centre de Traumatologie" of Dakar for three years. Fourteen patients (12 men and 2 women) presented after traffic road accident: fracture of posterior wall: 7 cases transversal fracture: 1 case complex fractures: 6 cases. Those displaced fractures were associated with hip dislocation in 8 cases. The initial emergency treatment by reducing the dislocation, associated with transfemoral pin traction was realized. At the day 7 through a posterior surgical approach in 11 cases and through a combined anterior and posterior approach in three cases. The anatomical reconstruction of the acetabulum was achieved in 12 cases. It's still early to make a final clinical assessment, but the early functional results using MERLE D'AUBIGNE's criteria (pain, lamenliss, mobility) are very good in 10 cases and poor in 2 cases. The reliability of the procedure, and the adequate post operative kinesitherapy is according to the authors the main indication for displaced fractures of the acetabulum.

Acetabulum↗
PubMed2000

Calcification and measurements of net proton and oxygen flux reveal subcellular domains in Acetabularia acetabulum.

Vegetative adults of Acetabularia acetabulum (L.) Silva were studied as a model system for subcellular patterning in plants, and a description of several phenotypic and physiological characteristics that reveal patterns of subcellular differentiation in this unicellular macroalga was undertaken. Initially, calcification patterns were studied. Under favorable conditions, the rhizoid and most of the stalk calcified. Only the apical 10-20% of the stalk and a small region adjacent to the rhizoid remained uncalcified. Calcification in algae has been reported to result from a biologically mediated local increase in alkalinity. To test this model extracellular pH and extracellular hydrogen ion gradients were examined with ion-selective, self-referencing, electrodes. In the light, A. acetabulum displayed a general pattern of extracellular alkalinity around the entire alga, although in some individuals the region near the rhizoid and the rhizoid itself displayed extracellular acidity. Acetabularia acetabulum also displayed net hydrogen ion influx at the rhizoid and the apical half of the stalk, variable flux in the lower part of the stalk, and net hydrogen ion efflux at the base of the stalk next to the rhizoid. The lack of complete correlation between external pH patterns and calcification suggests that other factors contribute to the control of calcification in this alga. To examine whether net hydrogen ion flux patterns correlated with photosynthetic or respiration patterns, oxygen flux was measured along the stalk using self-referencing O2 electrodes. Photosynthetic oxygen evolution occurred at comparable levels throughout the stalk, with less evolution in the rhizoid. Respiration mainly occurred near and in the rhizoid, with less O2 consumption occurring more apically along the stalk. Our studies of calcification patterns, net hydrogen ion flux and O2 flux revealed several overlapping patterns of subcellular differentiation in A. acetabulum.

Calcification, Physiologic↗
PubMed2004

Comparison of ESTs from juvenile and adult phases of the giant unicellular green alga Acetabularia acetabulum.

BACKGROUND: Acetabularia acetabulum is a giant unicellular green alga whose size and complex life cycle make it an attractive model for understanding morphogenesis and subcellular compartmentalization. The life cycle of this marine unicell is composed of several developmental phases. Juvenile and adult phases are temporally sequential but physiologically and morphologically distinct. To identify genes specific to juvenile and adult phases, we created two subtracted cDNA libraries, one adult-specific and one juvenile-specific, and analyzed 941 randomly chosen ESTs from them. RESULTS: Clustering analysis suggests virtually no overlap between the two libraries. Preliminary expression data also suggests that we were successful at isolating transcripts differentially expressed between the two developmental phases and that many transcripts are specific to one phase or the other. Comparison of our EST sequences against publicly available sequence databases indicates that ESTs from the adult and the juvenile libraries partition into different functional classes. Three conserved sequence elements were common to several of the ESTs and were also found within the genomic sequence of the carbonic anhydrase1 gene from A. acetabulum. To date, these conserved elements are specific to A. acetabulum. CONCLUSIONS: Our data provide strong evidence that adult and juvenile phases in A. acetabulum vary significantly in gene expression. We discuss their possible roles in cell growth and morphogenesis as well as in phase change. We also discuss the potential role of the conserved elements found within the EST sequences in post-transcriptional regulation, particularly mRNA localization and/or stability.

Acetabularia↗
PubMed1992

Aseptic osteonecrosis of acetabulum following prosthetic replacement of the femoral head. A case report.

Acetabular osteonecrosis is a rare condition. Only five cases with histological analysis have been reported in the literature, and these patients had previously received radiotherapy. The 67-year-old woman reported on here, who had had no major systemic disorder or local radiotherapy, and who had never consumed alcohol, developed aseptic osteonecrosis of the acetabulum after femoral head replacement with a cemented Austin-Moore prosthesis for aseptic osteonecrosis of the femoral head following femoral neck fracture. The necrosis was found during surgery to go so deeply into each bone composing the acetabulum that the hip joint could not be revised, and we had to perform a Girdlestone resection arthroplasty. The radiographic and histological findings resembled those reported in cases of aseptic osteonecrosis of the acetabulum after radiotherapy.

Acetabulum↗
PubMed2005

Early MRI findings of the acetabulum and femoral head in a dysplastic hip resulting in a rapid destruction of the hip joint.

We documented a case of rapidly destructive arthrosis of the hip joint (RDA), in whom abnormal findings were observed not only in the femoral head but also in the acetabulum on magnetic resonance images (MRI) in the early stage. Radiographs made 1 month after the onset of pain showed a slight narrowing of the joint space. MRI obtained 2 months after the onset detected small foci of low signal intensity in the subchondral area of the femoral head on the T1-weighted images, and a linear pattern of high signal intensity in the lateral side of the acetabulum on the T2-weighted images. During the 17-month follow-up period, this case eventually underwent massive destruction of the femoral head as well as the acetabulum.

Acetabulum↗
PubMed2001

Hip-shelf procedure in the treatment of osteonecrosis of the transpositioned acetabulum after rotational acetabular osteotomy.

Necrosis of the transpositioned acetabulum after rotational acetabular osteotomy (RAO) is a major complication characteristic of this procedure. This complication, although rare, has been thought difficult to treat. We report a patient with acetabular osteonecrosis and subsequent collapse after RAO that was effectively treated with a shelf operation, providing satisfactory remodeling of the hip joint. A 16-year-old female had undergone RAO for the treatment of developmental acetabular dysplasia. Postoperative radiography showed that the osteotomized acetabular fragment was unusually thin, and that the osteotome entered the hip joint during the surgery. Five months after the RAO, X-rays revealed significant collapse of the transpositioned acetabulum, and femoral head subluxation caused by postoperative osteonecrosis. Seven months after the RAO, the patient underwent a hip-shelf procedure. The remaining acetabular fragment was used in this procedure, according to the Spitzy method. Seven years after the second operation, favorable remodeling of the hip joint was observed; however, early osteoarthritic changes, including slight joint space narrowing, bone sclerosis of the new acetabulum, and bone cysts within the femoral head, were seen.

Acetabulum↗