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Following hip trauma in children an intra-articular osteocartilaginous fragment may be retained within the hip joint. This fragment may not be visualized by plain films or arthrography. However, computerized tomography clearly demonstrated such fragments in the two children with post-traumatic painful hips reported in this paper.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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A rational approach to acetabular fractures based on a precise diagnosis of the fracture pattern is suggested. The surgeon must adopt an individual approach to these difficult problems and precisely define the type of patient, the type of health care team, and the type of fracture he is dealing with. If the principles of treatment of lower extremity joint fractures are followed, logical management will ensue. If an operative approach is indicated, careful planning is needed to choose the proper approach so that the surgeon can achieve anatomic reduction and rigid fixation. Failure to do so will add needless trauma to an already traumatized patient and compromise the end result as much as will failure to achieve congruity by closed means.
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Because they show fairly good short- and mid-term results frozen, morselized homologous bone grafts have become very popular in acetabular reconstruction after failed total hip arthroplasty. Graft integration proceeds uneventfully. However, very little is known about its longevity. From 1980 to 1984 we performed 121 acetabular revisions in cases with contained bone defects utilizing homologous bone graft and a cementless non-coated or hydroxyapatite coated HDPE cup. At the end of 1991 (7 to 11 years after the operation), 43 patients (35%) were available for review. 41 patients (34% had died, 19 patients (16%) were lost to follow-up. In 18 patients (15%), the cups had been revised because of aseptic loosening. The Harris Hip Score showed 50% good to excellent results. Cups inserted after grafting of cystic defects showed almost no migration. However when cavity defects were filled with large bone grafts (n = 23), slow continuous cup migration and progressive graft resorption over time was observed. Due to this continuous resorption, we conclude, that morselized bone grafts do not guarantee an ever lasting inert interface. Once the non-coated HDPE cup is in contact with the autogenous host bed, bone osteolysis occurs and loosening proceeds. Cementless porous coated cups with morselized allografts alone may be used in acetabular revision only when cystic defects are present. The surface of the cup has to be brought into contact with a well vascularized autochthonous pelvic bone in order to achieve stable fixation. Segmental and massive cavity defects can only be reconstructed with morselized allografts when protected from loading by supporting rings.(ABSTRACT TRUNCATED AT 250 WORDS)
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In each of 20 anatomical specimens with an acetabular defect (Paprosky type 3b) we implanted an acetabular component in the position of a high hip center. We evaluated the interface area and the migration of the hip center in relation to the normal physiological hip rotation center. The interface area showed a wide interindividual range between 1049 mm2 and 527 mm2. This represented a percentage coverage of the hip component by between 44% and 22%, with an average of 31%. The vertical migration ranged between 13 mm and 35 mm, with a consecutive lateralization in all specimens. This lateral migration ranged from 10 mm to 30 mm. Besides this, there was also significant migration in the sagittal plane, with anterior migration by between 5 mm and 25 mm. On the basis of our findings, we do not recommended the implantation of an acetabular component in the position of a high hip center.
Tissue ingrowth in the porous coating of 11 cementless acetabular components has been studied histologically. These cups were retrieved at autopsy from 8 patients who had undergone a primary total hip arthroplasty. Seven cups had a mean implantation period of 5.1 years, the other 4 had been in place for less than one year. This component was made of commercially pure (cp) titanium, with a porous surface of cp titanium fiber metal. The initial fixation of the cup was achieved by screws. The tissues of the porous coating were studied into 1 mm fields at four levels, and were categorized either as bone, marrow, cartilage or fibrous tissue. The fraction of void space within the porous coating occupied by bone was measured by backscattered scanning electron microscopy. The percentage of 1 mm fields with bony tissue was 20.9% and the fraction of void space occupied by bone was 12%. No regional significant difference was found. The number of fields with bone increased from the interface between the porous coating and the substrate of the cup to the interface between the outer surface of the porous coating and the host bone. All the screw threads were covered with lamellar bone. In the longest term cases, fine metallic and polyethylene debris were observed and their amount increased with time. This study showed that, despite the important variability in bone ingrowth, these cementless cups were able to give entire satisfaction to the patients.
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The recent experiences which the university hospital in Heidelberg has made with the spherical Mecring must be valued positively. Clinical, radiological and subjective dates from 147 patients were worked up retrospectively. Indeed, the positive results must be considered as relative because of the short respectively medium-term period of control. Nevertheless, the repeated improvement in the second group after a period of postexamination on a average of 3.05 years lets hope for positive long-term results. In the period between 1985 and 1990 three sockets had to be changed. The reasons that the sockets loosened were not specific for the screwing but depending on the individual patients or on the implantations and technical circumstances. The negative results achieved by Engh et al. 1990 could not be recognized (8). He measured a radiological instability of 18% and a technical instability of 28%. What Engh did was measuring simple review photographs and extracting valuable material from them while using geometrical methods. This method shows various measuring mistakes. Therefore Engh's conclusion that the screwing should not be used for implantation because of its displacement in the bones is doubtful. The doubts seem to be supported by the results of our comparison of two series of X-ray photographs with defined different pelvis positions of the same patient. The screwing seemed to be significantly displaced in cranio-medial direction. This was proved by experimental photographs with a pelvis raised to 6 cm in contralateral direction. But the results were a matter of radiological illusion. Radiological migration of the screwing is only provable by complicated X-ray analyses steered with the computer. These big X-ray series are not accessible at the time.