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PubMed1995

[3-years results of endoprosthetic management of radiation-induced hip joint necrosis].

Radioosteonecrosis of the acetabulum is a rare side effect of radiotherapy. The latency period of 2 to 17 years is much longer than that reported for other bones (1-3 years). The reason for this is unknown. Plane radiograms show sclerosis, cysts and fractures of the acetabulum and, in most cases, a migration of the femoral head with flattening. The diagnosis of a radioosteonecrosis has to be made by exclusion of malignomas by scintigraphy and MRT or CT. This paper presents the follow-up of four patients treated by total hip replacement (THR) for radioosteonecrosis of the acetabulum. Within 9 months postoperatively the fractures of the acetabulum had healed with full weight bearing. 36 to 78 months after operation no signs of progression of the bone changes were detected. In this period the loosening of one spherical thread cup occurred, but a radiolucent gap above a cemented cup stayed unchanged. We conclude that irradiation damage of the acetabulum can be treated successfully by THR even in cases with fractures of the acetabulum as far as a stable implantation can be achieved and the remaining osteoblasts are preserved by the procedure.

Acetabulum↗
PubMed1998

[Acetabular rotations y triple pelvic osteotomy by the Tönnis method].

Lesions of the acetabular labrum should be treated by correcting the causes. In a steep acetabulum where the femoral head brings the acetabular labrum under tension and traction, the acetabulum should be rotated by triple pelvic osteotomy to slightly over-corrected acetabular measurements. Severely diminished acetabular and femoral anteversion can also lead to tears and impingement of the labrum. Then rotation of the femoral neck and/or rotations of the acetabulum by triple osteotomy to 15-20 degrees of anteversion are indicated. Our triple osteotomy technique differs from that of others mainly in the ischial osteotomy. It is performed from the posterior approach between the sciatic notch next to the ischial spine and the obturator foramen and is directed 20-30 degrees anteriorly from the frontal (coronal) plane. The osteotomies therefore are placed close enough to the acetabulum to allow free rotation, but they do not interfere with the circulation of the acetabulum, and the ligaments between the sacrum and ischium are left in normal tension. Our normal values of the acetabular position were tested by correlating the measurements with the absence of pain. The optimum is reached with a CE angle and a VCA angle of 30-35 degrees, an angle of the weight-bearing zone of +5 to -5 degrees and a migration index of 10-15%. Overcorrections again caused pain and should be avoided. Diminished anteversion of femur and acetabulum towards 0 degree also caused pain and should be corrected by triple and femoral osteotomy to 15-20 degrees of anteversion. In earlier follow-ups of 216 hips 5-10 years postoperatively, 82.3% of the joints showed no change in the degree of osteoarthrosis. Survival rate curves regarding the absence of pain demonstrated that pain was experienced again when joints were corrected insufficiently or overcorrected, while in good corrections the joints were free of pain in about 75%.

Acetabulum↗
PubMed2001

[The uncemented self-threading Ultima cup: first 5 years' experience].

PURPOSE OF THE STUDY: To present the first 3-5 year experience in primary implantation of the Ultima cementless hemispherical threaded cup. MATERIAL: In the period between October 1995 and June 1997 we implanted in total 30 Ultima cementless cups in 28 patients (10 men, 18 women). The average age of the operated on was 60 years (41-74 years). Twenty-four patients, i.e. 26 hips were available for the follow up. From the viewpoint of diagnosis the group of patients included 15 cases of primary osteoarthritis, 9 cases of acute intracapsular femoral neck fracture, 3 cases of postdysplastic osteoarthritis, 2 cases (1 female patient with bilateral affection) of rheumatoid osteoarthritis (RA) accompanied with the protrusion of acetabulum and 1 case of idiopathic necrosis of the head. METHODS: The average follow up was 39 months (31-51 months). Subjectively, we followed the patients' satisfaction with the result of the surgery, i.e. subsidence of pain, range of motions and the willingness to undergo the surgery once more on the basis of its result. Radiologically, we assessed the shape of acetabulum prior to operation, the position of the implanted cup in ap projection on the postoperative radiograph, on the last control radiograph we evaluated osteointegration of the cup and also potential particular ossification. RESULTS: Nineteen patients out of 24 were subjectively satisfied with the result of the operation. The primary shape of acetabulum was in 24 cases spherical, 4 times dysplastic slightly lower CE (Wiberg) angle and twice there occurred protrusion of the head (the female patient with RA). The position of the cup in ap projection was evaluated in 25 cases as correct (45 degrees declination), in 2 cases as valgus (more than 55 degrees declination), in 3 cases as varus (less than 35 degrees declination) and in 1 case the cup was inserted too deep. Osteointegration was evaluated in 25 cases. In 22 cases we considered the osteointegration as good, i.e. without signs of a radioluscent line around the circumference of the cup. This line we encountered in 2 patients around the whole circumference of the cup but without any signs of a change in the position of the cup and without subjective complaints (pain in the hip). Both patients operated on for the primary osteoarthritis had a spherical shape of acetabulum and the declination of the cup was assessed as satisfactory. In 1 case we had to re-operate on due to the migration of the cup in the pelvis, namely in the female patient with RA and bilateral affection. The migration occurred on the left side 2.5 year after the primary surgery. Particular ossification was encountered 3 times, one case required extirpation. Complications were recorded in 8 patients. In one case the lateral cortex was peroperatively perforated by the stem of the femoral component. In another patient with a dysplastic acetabulum the cup was inserted to deep in the medial wall of the acetabulum. In the third patient the greater trochanter got broken, remained displaced and only the ligaments healed. Early postoperative complications were recorded twice. In one case it was a serous secretion from the wound which subsided after a few days without the necessity of revision. Revision was required in the second case when the R-drainage broke in the course of its removal. Late complications occurred in 3 patients. In one case there developed a mitigated infection requiring revision surgery, in case of the female patient with RA the cup protruded in the pelvis which necessitated a revision surgery. DISCUSSION: So far there are no literary data on this type of cup. The only existing information relates to the preceding type of a similar design, i.e. Mecring cup, which failed. CONCLUSION: Despite relatively good but short-term results of this small series the unusual design of the Ultima hemispherical threaded cup requires a great prudence in its application and additional long-term follow-up. Therefore the cup cannot be recommended for a regular use for the time being.

Adult↗
PubMed1986

Treatment of secondary osteoarthritis and rheumatoid arthritis by Bateman hip prosthesis.

The Bateman hip prosthesis was applied in reconstruction of secondary osteoarthritis and rheumatoid arthritis. Forty-five joints that could be followed up for 45-18 months (mean 26 months) were clinically and roentgenographically re-examined. Forty joints (90.0%) were painless. The clinical score improved from the preoperative mean of 44.8 to the postoperative mean of 87. In 34 patients with secondary osteoarthritis, postoperative protrusion of the outer head into the acetabulum reconstructed by excavation of the previous shallow, steep architecture was only 0.8 mm (mean). Postoperative protrusion of the outer head into the acetabulum reconstructed by bone grafting was only 2.0 mm (mean) in 11 patients with rheumatoid arthritis. Roentgenograms revealed the appearance of sclerosis supermedially in the excavated acetabulum 4-6 months after the operation. This sclerotic change expanded in the entire area of contact with the outer head in 36 of 45 joints within about 1 year. Once the sclerosis had spread completely, the outer head stopped protruding into the acetabulum. A computerized simulation experiment with a rigid spring model demonstrated that central displacement of the outer head can be avoided if the continuity between the sclerosis in the articular surface of the reconstructed acetabulum and the lateral wall is restored for transmission and dispersion of the resultant head force toward the lateral wall as in normal hip joints; this verified the clinical findings.

Acetabulum↗
PubMed1998

An in vitro study of a new design of acetabular cement pressurizer.

Aseptic loosening of the acetabular component remains one of the limiting factors in the long-term success of total hip arthroplasty. Cement pressurization has been shown to improve fixation. A new pressurizer has been designed that seals around the rim of the acetabulum and covers the transverse ligament notch with a flap. The results of in vitro testing of this device are presented and compared with those of pressure generated by insertion of an acetabular cup. The pressurizer allowed sustained, uniform cement pressurization. Peak pressures with the new pressurizer were 180 kPa at both the iliac region of the rim and the pole of an instrumented model acetabulum, compared with 55 kPa at the rim and 120 kPa at the pole on cup insertion. Pressures were maintained in the range of 80-90 kPa. The flap was effective in preventing cement leakage from the notch, and pressures were higher than when the flap was absent. Cup insertion alone gave only transient pressurization, substantially less near the rim of the acetabulum than at the pole. Peripheral pressurization may be significant in producing secure local fixation at the rim of the acetabulum, in particular in the region of the ilium (Charnley zone 1), where radiolucencies are most commonly observed and where stresses in the implanted acetabulum are highest. Improved rim fixation may also play a role in preventing the ingress of wear debris.

Acetabulum↗
PubMed1997

Advantages and disadvantages of various access routes in sonographic diagnosis of dysplasia and luxation in the infant hip.

The purpose of the study is to clarify the access route that is most suitable in sonography of the infant hip for diagnosis of luxation and dysplasia. The process of luxation gives rise to deformation of the hyaline cartilaginous preformed part as well as the osseous acetabulum. These deformations are located in the superoposterior part of the acetabulum. With a posterior exposure only the luxated head of the femur can be imaged sonographically, but the dysplastic acetabulum cannot be diagnosed. In anterior exposures the pathological changes in the superior part of the acetabulum are detected poorly or not at all. The lateral exposure can image all deformations of the acetabulum. The strictly standardized lateral sonographic exposure is hence recommended using a standardized plane of measurement.

Acetabulum↗
PubMed2002

Correlation between the acetabular diameter and thickness in Thais.

We conducted a study on dried cadaveric pelvic bones to determine the relation between acetabular diameter and thickness of the acetabular wall. The acetabulum was divided into four quadrants: antero-superior, postero-superior, postero-inferior, and antero-inferior. The diameters of the acetabulum were measured for 152 pelvic bones. The thickness of the center of the acetabulum was measured with the use of a caliper at four quadrants of the acetabulum. The average acetabular diameter was found to be 51.8224 mm for all the acetabuli. The average thickness in the posterior quadrant has been calculated to be about 50% of the acetabular diameter, which is about 26 mm. The acetabular diameter and the thickness of the acetabulum correlated very well though there was very little significance statistically (0.099) due to the lack of full data for all the individual bones. Linear correlation between the thickness and the diameter is definitely collinear but the correlation is not statistically significant. Some additional factors such as bone density, body mass, etc, are required to correlate the thickness and the diameter. Further study is required in this field.

Acetabulum↗
PubMed1996

Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty.

We describe three distinct types of congenital hip disease in adults. The first type is dysplasia, in which the femoral head is contained within the original true acetabulum. The second type is low dislocation, in which the femoral head articulates with a false acetabulum, the inferior lip of which contacts or overlaps the superior lip of the true acetabulum, giving the appearance of two overlapping acetabula. The third type is high dislocation, in which the femoral head has migrated superoposteriorly and there is no contact between the true and the false acetabulum. We describe and classify the acetabular abnormalities and deficiencies found with these three types. If the anterior, posterior, and superior aspects of the acetabular component cannot be covered during a total hip arthroplasty because of a deficient acetabulum in an adult who has congenital hip disease, we advocate and acetabuloplasty technique (which we have named a cotyloplasty) that involves medial advancement of the acetabular floor by the creation of a controlled comminuted fracture of its medial wall, autogenous bone-grafting, and the implantation of a small acetabular component with cement. This procedure was performed in sixty-six patients (eighty-six hips). Forty-nine of the hips had a high dislocation, thirty-one had a low dislocation, and six were dysplastic. Two to fifteen years (mean, seven years) after the operation, the clinical and radiographic results were satisfactory. Only two acetabular components needed to be revised for aseptic loosening, at 5.3 and 7.5 years postoperatively. Moreover, the cumulative success rate for the acetabular components was 100 percent at five years and 93.2 percent at ten years.

Acetabulum↗
PubMed2004

Histologic analysis of acetabular and proximal femoral bone in patients with osteonecrosis of the femoral head.

BACKGROUND: The purpose of this study was to investigate the hypothesis that osteonecrosis of the femoral head may also involve the acetabulum and the proximal part of the femur. METHODS: Twenty-five patients who underwent simultaneous bilateral total hip arthroplasty and thirty-eight patients who had a unilateral total hip arthroplasty for treatment of symptomatic osteonecrosis of the femoral head were included in the study. There were fifty-five men and eight women. The etiology of the osteonecrosis was idiopathic in forty patients (fifty-six hips, 64%), associated with ethanol abuse in eighteen patients (twenty-five hips, 28%), and associated with steroid use in five patients (seven hips, 8%). The mean age of the patients at the time of arthroplasty was 47.1 years. We performed cancellous bone biopsies in the acetabulum, the proximal part of the femur, and the femoral head intraoperatively and then examined the specimens histologically. RESULTS: Of the eighty-one hips with idiopathic or ethanol-associated osteonecrosis, seventy-six (94%) had normal or stage-1 bone in the acetabulum and the proximal part of the femur according to the system of Arlet and Ficat, and seventy-eight (97%) of the eighty-one had a grade of 0 or 1 according to the system of Humphreys et al. Of the seven hips with steroid-associated osteonecrosis, four had normal or stage-1 bone and a grade of 0 or 1 and three had stage-2 or 3 disease and a grade of 2 or 3. Therefore, the vast majority of hips with idiopathic or ethanol-associated osteonecrosis had normal or nearly normal bone in the acetabulum and the proximal part of the femur. Three of the seven hips with steroid-associated osteonecrosis had abnormal bone in the proximal part of the femur only. CONCLUSIONS: One can expect to find normal or nearly normal cancellous bone in the acetabulum and the proximal part of the femur of patients with either idiopathic or ethanol-associated osteonecrosis of the hip. More extensive osteonecrosis may accompany steroid-associated osteonecrosis of the hip.

Acetabulum↗
PubMed2004

Acetabular fractures revisited: part 2, a new CT-based classification.

OBJECTIVE: The objective of this investigation was to provide a new CT-based classification of acetabular fractures. MATERIALS AND METHODS: The axial CT scans of 112 randomly selected acetabular fractures in patients admitted to a level 1 trauma center between January 1998 and December 2000 were analyzed by an experienced orthopedic trauma surgeon and two experienced emergency radiologists. When available, 3D reformatted images were analyzed as well. The fracture pattern for each acetabular fracture, with respect to column walls and extension beyond the acetabulum, when present, was recorded. Fracture comminution was not a defining characteristic. RESULTS: Analysis of the 112 acetabular fracture patterns showed that each fracture fell into one of four broad categories. Category 0 included wall fractures only. Category I included acetabular fractures limited to a single (anterior or posterior) column. Category II fractures included those involving both the anterior and posterior columns; category II fractures were further subdivided into those with no fracture extension beyond the acetabulum, those with superior or inferior extension, and those with both superior and inferior extensions beyond the acetabulum. Category III fractures included only the "floating" acetabulum, which is defined as an acetabular fracture in which the acetabulum is separated from the axial skeleton both anteriorly and posteriorly. CONCLUSION: The axial CT display of acetabular fracture patterns provides a basis for a classification of acetabular fractures that is simple, unambiguous, readily understood by both radiologists and orthopedic surgeons and provides clear direction for both diagnosis and surgical treatment planning. Category and subcategory fracture specificity creates a mechanism for intra- and interdepartmental postoperative assessment of any of the individual acetabular fracture types.

Acetabulum↗
PubMed1992

The acetabular opening angle in Perthes' disease. Radiographic study of 62 unilateral cases.

Pelvis AP radiographs in 62 patients with unilateral Perthes' disease were studied in search of changes of the acetabulum throughout the active stages of this disease. The length of the acetabular roof, the diameter of the acetabulum, and the opening angle of the acetabulum, were compared with the contralateral hip. The length of the acetabular roof did not change, but the opening angle and the diameter of the acetabulum increased. This increase began in the earliest stage of the disease in half of the cases; it reached a maximum during the resorptive and the reconstructive stages, then it decreased to reach normal values at skeletal maturity. These changes were related to the extent of the epiphyseal necrosis. Probable causes were local hyperemia and a mechanical adaptation of the acetabulum to a cartilaginous coxa magna. The opening angle has a prognostic value and influences our choice of therapy.

Acetabulum↗
PubMed2004

[Personal experience with treatment of acetabular fractures].

PURPOSE OF THE STUDY: The article presents a retrospective evaluation of a group of 119 patients treated for acetabular fractures between 1996 and 2002. MATERIAL: In the monitored period 119 patients, (89 men, 30 women) average age 35 years, were hospitalized with an acetabular fracture. Surgically treated were 91 patients (70 men, 21 women), average age 29 years. Prevailing in this group were Type A fractures which accounted for 45%, Type B was represented by 35% and Type C included 19%. Twenty-eight patients were treated conservatively. METHOD: Indication for surgical treatment was instability, hip incongruence or combination of both. Conservative treatment was chosen in the fractures without displacement, in fractures with secondary congruency and in case of contraindication of surgical treatment. The indication was always based on CT examination with a three-dimensional reconstruction. The surgery was performed within 24 hours in 42%, within 48 hours in 64%, within 72 hours in 87%. Posterior Kocher-Langenbeck approach was used in 54%, anterior ilioinguinal approach in 22% and the combination of both approaches in 24%. Posterior approach was indicated in A1, A2, B1 fractures, ilioinguinal approach in A3, B3, C1 Types, the combination of both approaches in B2, C2, C3 fractures. Osteosynthetic material was chosen according to the fracture type, bone quality and fragment size. RESULTS: The evaluation was based on subjective complaints, radiograph and clinical examination using Harris Hip Score. In the group of 91 patients treated surgically we achieved excellent result in 41 cases (45%), very good result in 28 cases (31%), fair result in 7 cases (9%) and poor result in 13 cases (15%). We recorded 17 peroperative complications--11 times inadequate reduction, 5 times nerve injury, once vascular injury. Early complications included infect--twice and loosening of implant--once. Late complications occurred in 26 cases--paraarticular ossification in 17 cases, aseptic necrosis of the femoral head in 8 cases. DISCUSSION: The treatment of fractures of the acetabulum as any intraarticular fracture is based on a precise anatomical reduction, stable fixation and early mobilization. Difficulties of the treatment of the acetabulum arise from the anatomical relations. Decisive for the indication, the method of treatment and prognosis is the type of the injury of the weight-bearing area of the acetabulum. In order to understand the type of the fracture it is necessary to make a careful preoperative examination based particularly on CT examination with a three-dimensional reconstruction. The indication and treatment strategy--surgical approach, method of reduction, type of fixation--is selected accordingly. Each surgical approach has its limits and also the possibilities of fixation are limited by the type of the fracture. The outcomes depend directly on the quality of the reconstruction of the articular surface and the incidence of complications, caused either by the injury or preoperatively. CONCLUSION: The treatment of displaced fractures of the acetabulum is on principle surgical. Satisfactory results are produced only by anatomical reconstruction of the weight-bearing area of the acetabulum. Surgical treatment is highly demanding and the long-term results not always correspond to the efforts made.

Acetabulum↗
PubMed2006

[Hip joint arthroplasty following surgical treatment of acetabular fracture].

PURPOSE OF THE STUDY: A group of 49 patients treated by total hip arthroplasty after previous surgery for an acetabular fracture are evaluated in this retrospective study. MATERIAL: In the period from 1997 to 2004, 49 patients, 35 men and 14 women, with posttraumatic arthritis following acetabular fracture were treated in our department. The average age was 42 years, with 67 % of the patients being younger than 40 years. The average follow-up was 42 montsh (range, 18 to 92). The acetabular fractures evaluated by the AO classification included type A1 in 17 patients, type A2 in seven, type B1 in nine, type B2 in six, type B3 in seven, type C1 in three and type C2 in two patients. METHODS: In 11 patients with aseptic necrosis of the femoral head without acetabular deformity, cementless Zweymüller Bicon or Spotorno CLS acetabular components were used. Twenty-nine patients with acetabular defects of type I and II, according to the American Academy of Orthopedic Surgeons (AAOS) classification, underwent acetabular reconstruction with the bone impaction grafting technique, using allogenic grafts and cementless Zweymüller Bicon acetabular components. Four patients with AAOS type III acetabular defects were treated with impacted morsellized bone allografts, using titanium mesh and cemented polyethylene acetabular cups. Three patients were treated with solid bone grafts fixed with osteosynthetic material. In two patients with type IV defects, osteosynthesis using a plate completed with allogenic bone graft, a mesh and a cemented cup were used. RESULTS: The patients were evaluated with the use of Harris hip scores. In 20 patients (43 %) the outcomes were excellent, and very good in 18 (37 %), satisfactory in six (12 %) and poor in four (8 %) patients. DISCUSSION: Hip joint arthroplasty following the surgical treatment of acetabular fracture is indicated in patients with post-traumatic hip arthritis. This frequently occurs due to complications associated with surgery for acetabular fractures, or the cause remains unknown. Some types of these fractures show a high proportion of poor results. The group can be divided into two different subgroups: the patients with a spherical, healed acetabulum and the patients with acetabular deformity or defect, of which the most serious condition is pseudoarthrosis of one or both columns. In the first subgroup, the surgical technique of acetabulum replacement is the same as in cases with arthritis due to degenerative disease. In the other subgroup, the procedure for cup implantation resembles revision arthroplasty for acetabular loosening. The options for treating defects or deformities and the implants used are identical in both situations. Therefore the results should be compared with those of revision arthroplasty and not primary implantation. Scars, fibrotic changes in muscles, para-articular ossification, bone defects, residual deformities of the acetabulum, devitalized bone fragments or hindering previous implants make the surgical procedure more difficult and interfere with good results. CONCLUSIONS: Total hip arthroplasty carried out after acetabular fracture is technically demanding. The prerequisite for a good result is to achieve primary stability of the acetabulum. Acetabular reconstruction is based, in the first place, on replacement of the missing bony tissue, and on providing conditions for correct alignment of the acetabulum and reliable primary and early secondary osteointegration. THA after acetabular fracture achieves poorer results than when it is indicated for degenerative disease. Key words: acetabular fracture, post-traumatic hip arthritis, total hip replacement.

Acetabulum↗
PubMed1990

[Computed tomography in untreated congenital hip dislocation in adolescence].

Untreated cases of congenital dislocation of the hip (CDH) in the adolescent age are rarely encountered in the western world but are not uncommon in our clinical practice. The pathoanatomy has not been well studied. Previously poor results of operative treatment are partially related to this lack of understanding of the true pathoanatomy and the failure to select the appropriate modality of treatment. Computed tomography (CT) has the capability to show the three-dimensional structure and was used in this study. From September 1985 to July 1988, we had 15 patients (18 dislocated hips) for CT study. Their ages ranged from 8 years 6 months to 22 years 5 months. The patients were divided into 4 types according to the position of dislocation, formation of pseudojoint and size of the true acetabulum: (1) high dislocation without pseudojoint formation; (2) high dislocation with pseudojoint formation; (3) low dislocation with pseudojoint formation; and (4) wide acetabulum. By measuring the diameter of the true acetabulum and femoral head, and the anteversion of the true acetabulum and proximal femur, we had the following results: (1) the size of the acetabulum and femoral head in dislocated hips were smaller than the normal side; (2) most of the acetabula in the dislocated hips were still large enough to accommodate the corresponding femoral heads, even up to the age of 22 years; and (3) the degree of anteversion was similar between the acetabula in normal and dislocated hips, but was more prominent in the proximal femur of a dislocated hip than the normal side.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1979

[Innominate osteotomy (Salter) related to the correction of the acetabular abnormality and the prediction of the acetabular angle after operation (author's transl)].

The purpose of this paper is to know how to correct the maldirection of the acetabulum. The author devised a new system for the measurement of the degree of the forward rotation of the acetabulum. The acetabular improvement after the osteotomy is classified into two types, namely the primary and secondary improvement. The primary improvement is seen immediately after the osteotomy and the secondary improvement follows gradually. The effective factors for each of them were analyzed. The primary improvement is influenced mostly by the lateral inclination of the distal fragment. The secondary improvement was intimately correlated to the forward rotation of the acetabulum at the operation. The development of the acetabulum after operation can therefore be predicted from the post-operative X-ray film. In the case of the residual subluxation of the hip, there is about 10 degrees of acetabular elevation (frontalization), so the acetabulum should be rotated forward by more than 10 degrees in this operation.

Acetabulum↗
PubMed1982

[Therapeutic dilemmas in the care of acetabular fractures].

Breakages of acetabulum take special place in traumatism of pelvis luxation breakages of acetabulum are serious wound, which are followed by traumatic shock. Such wounds are hard medical-surgical problem what puts traumatology surgeon in dilemma how to look after the same. Etiologic fact of these breakages in 90% is direct or indirect accident trauma. In our work we demonstrate the mechanism of becoming of such breakage and after that we give classification of fracture and luxational-breakages of the acetabulum. The meaning of radiographically diagnostics in marking out fragments the place of the head of femur operating indication and with which approaching. The central place in the work takes empirical results of treating of 56 patients in the period of April 1975 to 31 st of March 1980 on Traumatological-orthopaedic Department to Common City Hospital in Skopje. The meaning of the surgeons about surgical treatment of breakage of acetabulum are still divided. We give algorithm of surgical treatment of breakage of acetaleulum. We present surgical approaching and surgical methods in those breakages. We'll explain three times meaning of biomechanical splint "Hornik" Dr Nikodinovski own model in postoperative treating so as in conservative treatment in luxational breakages of the acetabulum. Out attitudes are surgical reconstruction and fixation to young patients with early activating. We give rights double tractin to the old patients. We'll show post-traumatic and post surgical late sequelae of these breakages as they aseptical necrose of head of femur and coxatrose that go to 35%.

Acetabulum↗
PubMed1997

Acetabular strains produced by oversized press fit cups.

The purpose of this study was to determine the amount of acetabular deformation that occurs when acetabular components of different sizes are press fit. The change in acetabular volume was calculated for 1- to 3-mm oversized cup diameters with acetabuli ranging from 40 to 80 mm. An axisymmetric finite element model was used to determine the maximum acetabular strain that occurs when oversized cups are inserted in different acetabuli. The highest acetabular strains occur at the cup periphery, indicating that the resultant compressive force between the lateral pelvis and cup enhances press fit stability. In addition, higher maximum strains occur when the same millimeter amount of oversizing is used in a small compared with a large acetabulum. When a constant millimeter increment in cup oversizing is used, there may be a greater risk of pelvic fracture in a small acetabulum and a greater risk of inadequate press fit stability in a large acetabulum. To achieve the same amount of acetabular deformation and magnitude of strain, more oversizing is needed in a large acetabulum and less oversizing is needed in a small acetabulum. These results suggest that 1 mm of oversizing should be used for cups that are less than 52 mm in diameter, 2 mm of oversizing should be used for cups from 52 to 76 mm in diameter, and 3 mm of oversizing should be used for cups that are more than 76 mm in diameter.

Acetabulum↗
PubMed1976

Acetabular growth potential in congenital dislocation of the hip and some factors upon which it may depend.

The factors which determine the rate and amount of acetabular growth in congenital dislocation of the hip are ill-understood. A prospective radiological study has been devised in order to assess the influence of the age of congruity, femoral anteversion and neck/shaft angles on acetabular growth. To be included, the children must have reached at least 8 years of age. Those with associated congenital abnormalities and subluxation were excluded, as were those who had operations for acetabular reconstruction. Seventy-four hips were suitable for analysis, and the age range at follow-up was from 8 to 17 years. The acetabular angle was used as an index of acetabular growth. Measurement of this angle, and the anteversion and neck/shaft angles were made before, and each year after reduction of the hip. Congruity was assessed from a radiograph with the legs in the functional position. A satisfactory acetabulum was obtained in 44 hips and the mean age of congruity was 33 months; the acetabulum was unsatisfactory in 30 hips, with a mean age of congruity of 48 months. Four years is the critical age, for if congruity is obtained later, the risk of producing a moderate or severely dysplastic acetabulum is more than doubled. If congruity is obtained under four years of age, growth of the acetabulum with continue in most patients up to 8 and in some to 11 YEARS OF age; the resulting acetabulum was normal or mildly dysplastic. Fifty-nine per cent of the satisfactory hips at follow-up had a normal anteversion angle, and 6 per cent a normal neck/shaft angle. Correction of these angles by themselves, seems not to be a major importance for promoting acetabular growth.

Acetabulum↗