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PubMed1994

[Reconstruction of the acetabulum using femoral head autograft in total hip arthroplasties].

We have reviewed, at a mean follow-up of 63.7 months, 36 total hip replacements performed with bulk acetabular autograft. Before surgery all the hips had acetabular insufficiency. Improvement of acetabular coverage was achieved in all cases with the patient's femoral head screwed to the ilium. Only one massive graft resorption was observed, simultaneous to loosening of the socket. Partial graft resorption was observed in 6 cases, and was not correlated with loosening of the socket. In all cases we observed radiographic features consistent with graft incorporation. Periprosthetic ossifications were noted in 13 cases. At follow-up, four sockets were loose, among which were included three Weill threaded rings. The mean functional improvement scores evaluated with the Merle d'Aubigné hip rating were: 4 points for pain, 2.7 points for mobility, and 2.4 points for walking. The authors concluded that femoral head, used as a massive autograft during total hip replacement, was a safe procedure for bone stock reconstruction in case of severe acetabular insufficiency.

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PubMed1994

[Standardized analysis of acetabulum cup migration in hip endoprosthesis using digital image processing].

Measurement of the migration of the acetabular component following total hip replacement seems to be a useful method of early detection of aseptic loosening. The methods used so far for migration analysis are either too time-consuming or too elaborate in terms of the technical equipment required, and are therefore not suitable for use in day-to-day clinical practice. Analysis software based on the methods described by Nunn and Sutherland was developed with the aid of digitized conventional radiographs of the pelvis. It allows a planar migration measurement including cup inclination following manual marking of only five reference points on a computer screen. A correction for projection enlargement and rotational malpositioning of the patient is performed. All results are stored in a data bank and automatically compared with those recorded at previous follow-ups. Five different acetabular cups were analysed by a conventional and by a digital method for calculation of intra-observer variability. The standard deviation (SD) for horizontal and vertical migration was 0.2-0.4 mm and that for inclination angle 0.8-1.4 degrees with digital evaluation. For manual measurement the SD was 0.4-0.8 mm for migration and 0.8-1.2 degrees for inclination. A pelvis phantom was measured in nine different positions (neutral, 5 degrees and 10 degrees cranial and caudal inclination, 5 degrees and 10 degrees rotation to each side). Four different acetabular cup design were examined, each of which yielded a series of nine measurements. Within these series the SD for biplanar distances varied between 0.1 mm and 1.2 mm and for inclination between 1.1 degree and 2.3 degrees. Intra-observer variability was negligible.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1993

[Surgical treatment of fractures of the acetabulum].

Since January 1988, 18 patients with acetabular fractures were operated on. Seven fractures were "both columns", six were posterior wall fractures, four were of the transverse/single column types, and one was unclassified. Four patients were operated by ileo-inguinal incision alone, three by combined ileo-inguinal and posterior Kocher-Langenbeck, ten by Kocher-Langenbeck, and one by triradiate incision. Early complications were 1 DVT and 1 infection (subsided after removal of the plate from crista iliaca). One patient with brain injury developed cerebral infarction, and one multi-traumatized patient died of lung embolus after transfer to another hospital. 11 patients are back at work, one has retired, and two are seeking new education after the injury. We conclude that operative treatment is indicated for these fractures, and that the results and rate of complications are acceptable. This treatment should be centralized.

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PubMed1993

[Hip luxation caused by fibrous dysplasia of the acetabulum].

A case of monostotic acetabular fibrous dysplasia in 12 month old twin-girl is described. The location of the disease caused dislocation of the left hip. Open reduction, synovectomy and curettage of the tumor was performed. A stable reduction and no sign of recurrence was found at follow-up.

Acetabulum↗
PubMed1993

[Periprosthetic ossifications of the hip: role of the duration of postoperative indomethacin therapy in the prevention of ossifications and role of screwed acetabulum in the occurrence of ossification].

After showing, as many others did, in an article published in 1987, that indomethacin administered immediately after surgery and for about 3 weeks at a dose of 75 mg/day effectively protected THA against heterotopic ossification, the authors have searched whether treatment duration could be reduced, and to investigate the existence of risk factors other than those classically known. They studied the prevalence of heterotopic ossification in two groups of THA with known risks of ossification, one with one-week prophylaxis, the other with two-week prophylaxis using Indomethacin. The results obtained were compared with a third group of THA performed during the same period, which presented no known risk of ossification and were not treated with indomethacin, and with the THAs of the initial study, where indomethacin had been administered for 3 weeks. Occurrence of heterotopic ossification was equally prevented by an 8-day course and by a longer one. No etiological, radiological or pathological risk factor other than those described in 1987 were fund (with all due caution given to hips re-operated on that had not ossified the first time): in contrast, the type or acetabular cup appears to have some influence on the occurrence of HO: uncemented prosthesis clearly favours ossification.

Acetabulum↗
PubMed1996

Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury.

The results were reviewed for 259 patients who had open reduction and internal fixation of 262 displaced acetabular fractures within twenty-one days after the injury. Two hundred and fifty-five hips were followed for a mean of six years (range, two to fourteen years) after the injury; the remaining seven, which clearly had a poor result, were followed for less than two years. According to the classification of Letournel and Judet, associated fracture types accounted for 208 (79 per cent) of the fractures, with both-column fractures being the most common type (ninety-two hips; 35 per cent). Two hundred and fifty-eight hips were operated on with a single operative approach (Kocher-Langenbeck, ilioinguinal, or extended iliofemoral). The four remaining hips were operated on with a Kocher-Langenbeck as well as an ilioinguinal approach. The reduction was graded as anatomical in 185 hips (71 per cent). The rate of anatomical reduction decreased with increases in the complexity of the fracture, the age of the patient, and the interval between the injury and the reduction. The over-all clinical result was excellent for 104 hips (40 per cent), good for ninety-five (36 per cent), fair for twenty-one (8 per cent), and poor for forty-two (16 per cent). The clinical result was related closely to the radiographic result. The clinical result was adversely affected by associated injuries of the femoral head, an older age of the patient, and operative complications. It was positively affected by an anatomical reduction and postoperative congruity between the femoral head and the acetabular roof. Osteonecrosis of the femoral head was noted in eight hips (3 per cent), and progressive wear of the femoral head was seen in thirteen (5 per cent). Subsequent operations included a total replacement of seventeen hips (6 per cent), an arthrodesis in four (2 per cent), and excision of ectopic bone in twelve (5 per cent). These findings indicate that in many patients who have a complex acetabular fracture the hip joint can be preserved and post-traumatic osteoarthrosis can be avoided if an anatomical reduction is achieved. An increase in the rate of anatomical reduction and a decrease in the rate of operative complications should be the goals of surgeons who treat these fractures.

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PubMed1996

[Ceramic acetabulum components for hip endoprostheses. 2: Evaluating design and safety].

In the field of hip arthroplasty, there is a clearly recognizable towards the use of modular acetabular cups involving metal-backed sockets into which cup inserts made of either polyethylene or alumina ceramic (Biolox forte) can be fitted. The design aspects for this concept have already been discussed in [17]. In the present paper, we discuss the question of component reliability and the criteria for testing acetabular cups with ceramic inserts. To date, neither standards nor government regulations for ceramic cups are available. In the absence of such regulations, those laid down bei the American Food and Drug Administration (FDA), together with our own longterm experience with femoral ceramic heads are used as a guide for the testing of ceramic cup inserts.

Acetabulum↗
PubMed1997

[Acetabulum deformations after implantation of a cemented cup with or without metal-back component. An in vitro comparative study of monopodal load].

PURPOSE OF THE STUDY: The purpose of this study was to find a biomechanical explanation for a clinical failure of metal backed acetabular components. Periacetabular deformations were measured on fresh cadaver bones equipped with strain-gauge rosettes. MATERIAL AND METHODS: Two skeletons, including pelvic bone, the two last lumbar vertebrae, and both femurs were maintained in unipodal equilibrium using metallic cables for muscle simulation. Loads were applied up to 700 N the approximating average body weight. A comparative study of periacetabular deformations was performed: right sides of each pelvic bone were implanted with conventional cemented implants, and left sides with metal backed cemented implants of same diameter and size. RESULTS: Significant differences were noted: whereas no modification was brought by implantation of conventional cemented sockets, periacetabular deformations were reduced and smoothed after implantation of cemented metal backed implants. Such results are in agreement with recently published data obtained, using the finite element analysis method. DISCUSSION: A study of pelvic ring and acetabular walls displacement was performed, but the authors couldn't find any clinical relevance to this biomechanical study.

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