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PubMed2001

The Frank Stinchfield Award: Morphologic features of the acetabulum and femur: anteversion angle and implant positioning.

Morphologic features of the hips, in particular those features germane to determination of acetabular and femoral anteversion angles and femoral head offset, were studied in 50 male and 50 female human skeletons with bilateral normal joints. Four distinct configurations were identified relative to the anterior acetabular ridge. The majority (121, 60.5%) were curved; 51 (25.5%) were angular; 19 (9.5%) were irregular; and nine (4.5%) were straight. The acetabular anteversion angle measured 19.9 degrees +/- 6.6 degrees (range, 7 degrees-42 degrees) and was significantly larger in females (21.3 degrees +/- 7.1 degrees) versus males (18.5 degrees +/- 5.8 degrees). The notch acetabular angle, which can be identified easily intraoperatively, was defined as the angle created at the intersection of a line from the sciatic notch along the posterior acetabular ridge and a line from the posterior to the anterior acetabular wall. This angle is almost perpendicular (89.0 degrees +/- 3.5 degrees) and, therefore, may provide an accurate estimate of acetabular anteversion during cup placement. Awareness of the anatomic differences between genders for acetabular anteversion angle, anterolateral bowing of the femur, and neck shaft angle may help reduce the relatively higher incidence of dislocation in females and may lead to different implant designs for male and female patients.

Acetabulum↗
PubMed2001

[Investigation of explanted hip and acetabulum hip prostheses].

Retrieved ceramic femoral heads and acetabular cups were investigated. On the basis of the case studies, the reasons for revision are discussed. Wear patterns and wear rates were found to differ from those observed in hip simulating testing. Monolithic ceramic cups showed a high wear rate. Owing to their limited range of motion, ceramic "mushroom heads" are associated with impingement that leads to a high risk of cup loosening, high wear rates and in vivo fractures. The combination of ceramic "mushroom heads" and cups is not recommended. An evaluation of complications shows that some can be explained by patient behaviour--e.g. Japanese sitting position, horse riding. Designers need to develop new concepts offering a larger range of motion, for example, with head diameters of 32 and 36 mm that reduce the risk of impingement, subluxation and dislocation, while increasing the range of motion. The potential of ceramic/ceramic coupling has been known since the 70s, and ceramic concepts for total hip replacement are currently experiencing a renaissance, although further developments are still possible.

Acetabulum↗
PubMed1992

[Screwed acetabulum: results of 72 cases with a mean follow-up of 5 years].

Ninety-seven threaded acetabular prostheses (44 cups of Lord and 53 Motta, type cups) were implanted among which 72 were examined at an average follow-up of 5.9 years. After an initial phase of good tolerance, the results became rapidly degraded. Clinically, the lack of fixation was translated by a start up pain. On examination, the pain provoked by the opposed hip flexion was pathognomonic. A radiographic analysis of our checks allowed us to classify them in four types: Type I: painful hip, normal radiography or presence of a radiolucent line in one of the DeLee's zones; increased uptake at bone scanning. Type II: total radiolucent demarcation; Type III: axial migration; Type IV: migration and tilting; Finally analysis of our series with Kaplan-Meier method showed a survivorship rate at five years of 59.3 per cent. It is concluded that this kind of implant must be abandoned.

Acetabulum↗