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PubMedDate not supplied

[Early results in the use of the oblong S-ROM uncemented acetabular component].

Massive deficiency of acetabular bone stock is a challenging problem in the increasing number of patients who need a revision of the failed hip arthroplasty. Oblong acetabular cup has been presented as an alternative reconstruction technique for hips with extensive acetabular bone loss. The aim of this study was to present our results with the use of a bilobed acetabular component inserted during revisional surgery, to define indications, and to introduce this method into our orthopaedic practice. Seven patients underwent revisional hip arthroplasty with a cementless oblong acetabular component between September 2000 and June 2002. Six patients underwent revisional hip arthroplasty, and in one primary hip arthroplasty by oblong acetabular component was performed because of bone defect of acetabulum after gunshot fracture. The average follow up was thirteen months. Radiographic analysis in all patients demonstrated stable, bone incorporated acetabular component with the restored hip. All the patients walked with full weight bearing and were without pain. On the basis of our experience we find this method satisfactory in certain types of bone defects of acetabulum, and that it provides stable reconstruction of acetabulum with the correction of hip joint.

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PubMed2000

Evaluation of a method for experimental induction of osteoarthritis of the hip joints in dogs.

OBJECTIVE: To evaluate a method for experimental induction of osteoarthritis in the hip joints of dogs. ANIMALS: 12 mixed-breed dogs. PROCEDURE: A unilateral triple pelvic osteotomy was performed. In 6 dogs, the iliac osteotomy was repaired with 45 degrees of internal rotation, reducing coverage of the femoral head by the acetabulum. In the other 6 dogs, the fragments were repaired in anatomic alignment. Radiography, force plate evaluations, and subjective lameness evaluations were performed before and after surgery. Dogs were euthanatized 7 months after surgery, and samples of cartilage and joint capsule were examined histologically. RESULTS: Subjective lameness scores, radiographic appearance of the hip joints, and Norberg angles were not significantly different between groups; however, force plate evaluations did reveal significant differences in vertical ground reaction forces. Femoral head coverage was significantly decreased with rotation of the acetabulum. Mild inflammatory changes were discernible in the joint capsule and articular cartilage of some dogs in both groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that 45 degrees internal rotation of the acetabulum does not consistently induce biologically important osteoarthritic changes in the hip joints of dogs.

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PubMed1994

Periarticular bone in rheumatoid arthritis versus arthrosis. Histomorphometry in 103 hip biopsies.

Histomorphologic differences of the periarticular bone in rheumatoid arthritis (RA) and osteoarthrosis (OA) may be of importance for long-term prosthetic fixation. We have evaluated bone specimens, obtained during total hip replacement from an acetabular and a femoral biopsy site, in 42 RA-hips and 61 OA-hips. In both groups the bone turnover was increased in the acetabulum compared to that in the femur. In the acetabulums the total trabecular bone volume was equal, but osteoid volume, osteoid surface, resorptive surface, and the appositional rate were increased in RA. On the femoral side, only the osteoid volume was higher in RA. The increased bone turnover with a greater amount of unmineralized tissue, as well as resorptive activity in the acetabulum, may be of importance for the higher rate of acetabular component migration and loosening after total hip replacement in RA.

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PubMed1988

Acetabular development in Legg-Calvé-Perthes disease.

The normal development of the proximal femur epiphysis and the acetabulum of 50 children with unilateral Perthes disease were analyzed on the unaffected side with serial x-rays using the epiphysis and the acetabular index. The same factors were studied on the affected side. A pathological process has been established in the affected hip. However, while these pathological processes run parallel up to 9 to 10 years of age on the femur epiphysis and in the acetabulum, the elastic ability of the acetabulum ceases over 9 years of age. This smaller plastic ability is the probable cause of unfavorable results in older children.

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PubMed2000

Shape optimization of metal backing for cemented acetabular cup.

Stresses are generated in implant materials and bone, and at their interfaces. These stresses may affect the structural properties of the implant/bone system, or bring it to failure at some time in the postoperative period. Due to these stresses, acetabular cup loosening becomes an important problem for long term survival of total hip arthroplasty. It was found that metal backing would tend to reduce stresses in the underlying acrylic cement and bone. Yet, recent studies of load transfer around acetabular cups have shown that metal backing generates higher stress peaks in cement at the cup edges, while generates lower stress peaks in bone at the central part of acetabulum (dome), thus the bone at the dome becomes more stress shielded. In this study a numerical shape optimization procedure in combination with an axisymmetric finite element model was used in order to optimize the shape of a stainless steel metal backing shell. The design was to minimize fatigue notch factor in cement along cement/bone and cement/metal backing interfaces in order to prevent failure of cement mantel and loosening of acetabular components, at the same time increasing fatigue notch factor in bone at the center of acetabulum to prevent stress shielding. The results of this study indicate that cemented acetabular cup designs can be improved by using metal backing shells of non-uniform thickness, thick at the dome and thin at edges. Fatigue notch factor in cement was reduced by 2.3% at cement/metal backing interface and increased by 1.3% in the central bone of acetabulum. Von Mises stresses in the cement edge were reduced by 17.8% and 19.3% along cement/bone and cement/metal backing interfaces, respectively. Thus the optimal design will reduce the possibility of fatigue fracture of cement and decrease the stress shielding effect and the likely incidence of bone resorption, whereby extend the expected life of the prostheses.

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PubMed2001

[The uncemented cup of the CLS Spotorno joint endoprosthesis--5-years' results].

PURPOSE OF THE STUDY: Authors report on five-year results in patients after THR operated on between 1994 and 1995 in which a cementless CLS Spotorno cup was used. MATERIAL: In the given period 59 patients were operated on (35 women and 24 men). The average age at the time of implantation was 54.6 years. The most frequent causes of the indication for THR was primary osteoarthritis of the hip in 27 patients and postdysplastic osteoarthritis in 16 patients. Applied were 46-62 mm cups for 28 mm and 32 mm diameters of the head. The femoral component used was a cementless Poldi--42 times, cemented MS-30--16 times and cementles CLS--once. The surgical approach was first anterolateral, later Bauer transgluteal approach which allows a better visualization of the location during the reaming of acetabulum and cup positioning. The reaming of acetabulum and implantation of the cup were performed in a standard way. Prior to incision Kefzol (cefazolin) was administered intravenously in the dosage of 2 g. In patients with a preceding operation on the hip joint the administration of Kefzol was extended to 24 to 72 hours (3 x 1 g each 8 hours intravenously). Standard antithrombotic prevention by miniheparinization was applied in all patients until they were able to walk with the help of crutches (7 to 10 days). In case of an increased risk of thromboembolic complications heparin with a low molecule weight (Fraxiparine) was applied over the same period. METHODS: In the period between autumn 1999 and spring 2000 clinical examination of the patients operated on was performed together with a radiograph of the hip joint involved. Clinical findings were evaluated after Harris hip score. Radiograph findings were compared to the postoperative and the control ones made one year after the operation. Evaluated were the position of components and signs of their loosening, if any. RESULTS: After the average follow-up of 59 months 57 patients were checked. Excellent results according to Harris were achieved in 40 patients, good results in 13 patients and satisfactory results in 4 patients. No poor result was recorded. Radiographs proved a full integration of CLS Spotorno cups without any signs of loosening in all checked patients. DISCUSSION: Not very numerous works in both foreign and domestic literature list according to the experience of individual authors the following advantages of CLS Spotorno cup: a small bone loss during reaming of acetabulum, excellent primary stability, excellent secondary stability and its easy reimplantation as compared to all types of cementless cups. Only in one female patient after a peroperative fissure of proximal femur the control examination showed a lower value of Harris score than was the average value of the whole group. Similarly, the Harris score was lower in female patients who postoperatively experienced complications of neurological and internal nature (1 temporary paresis of n. ischiadicus, 1 phlebothrombosis of veins of the limb operated on). Control radiograph examination proved a full bone integration without signs of loosening in both components of the implant in all 57 checked patients. CONCLUSION: After five years the authors have a good experience with CLS Spotorno cup and recently they have started to indicate it more often in postdysplastic coxarthrosis in younger patients and in revision surgery for aseptic loosening of a cup. In young patients they recommend its matching with CLS Spotorno cementless femoral component and in middle-aged patients its matching with MS-30 (Morscher-Spotorno) cemented femoral component the centralizer of which allows an ideal anchoring of the stem in the cement mantle.

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PubMed2001

Contribution of acetabular labrum to articulating surface area and femoral head coverage in adult hip joints: an anatomic study in cadavera.

The purpose of our study was to describe the gross anatomy of the adult acetabular labrum and to determine its contribution to the depth, surface area, and volume of the acetabulum. Fifty-five embalmed hips were studied. Each hip was disarticulated, and standardized measurements were taken. Calculations of the acetabular articulating surface area and volume, with and without the labrum, were performed based on these measurements. Average width of the acetabular labrum was 5.3 mm (SD, 2.6 mm). The labrum was wider anteriorly and superiorly than posteriorly. The surface area of the acetabulum without the labrum was 28.8 cm2; with the labrum, it was 36.8 cm2 (P < .0001). The volume of the acetabulum without the labrum was 31.5 cm3; with the labrum, it was 41.1 cm3 (P < .0001). There was no side-to-side difference in contribution of the labrum to either surface area or volume between right and left hips. Comparison of these indices for males and females showed statistically significant differences in absolute but not relative increases.

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PubMed2001

[Rotational acetabular osteotomy in the treatment of Legg-Calve-Perthes disease].

PURPOSE OF THE STUDY: The material of prospective study involving 57 surgically treated hips in 55 patients suffering with a severe form of Legg-Calvé-Perthes disease (LCPD) was analysed by the use of statistical methods to depict the influence of age, of sex, of the amount of head involvement on the outcomes of surgical treatment by rotational acetabular osteotomy (Salter or Steel osteotomy from 9 years of age). MATERIAL: During the period 1990-2000 rotational acetabular osteotomy for Legg-Calvé-Perthes disease was performed totally in 124 patients. Excluded were cases, in which the operation was done for residual subluxation as a definitive outcome of former LCPD, cases which did not return for controls, cases with not yet completed consolidation after surgery and cases operated by me abroad. Totally were analysed stastistical sheets from 57 rotational acetabular osteotomies, including basis dates from medical history, clinical and x-ray examinations. Special concern was given to the evaluation of remodellation of the affected femoral head chronologically. METHODS: All patients were operated by the group of three senior orthopaedic surgeons. Indication for surgery was based on the evidence of the progressive collapse of the femoral head issuing in the lateral and anterior head extrusion. As the Mose as well as Stulberg classification are showing inter-rater discrepancies, authors measured as well head-neck index, epiphyseal index and acetabulum-head index to eliminate subjectives errors. RESULTS: Age at operation and sex did not affect the results expressed in epiphyseal quotient and acetabulum-head index. With the increasing age the head-neck index dropped down depicting the progressive shortening of the femoral neck the older kids. The periods from the operation till the consolidation of the lateral pillar of the femoral head were longer in younger than in older children. Although the evaluation of results in Mose classification showed poorer results generally and also specifically in relation to the increasing age, distribution of results in Stulberg classification showed excellent and fair results in almost 90% of all treated patients. DISCUSSION: Prospective study based on the use of rotational osteotomy, avoiding the routine combination with varisation of the proximal femur in older kids using in them Steel triple osteotomy, showed promising results especially in Stulberg classification. Contrary to Salter and others prerequisiting for the indication of operation only slight deformity of the affected femoral head, many of the enrolled cases appeared with the remarkable deformity of the femoral head before the operation. Rotational acetabular osteotomy showed its potential to involve the enlarged head and follow-up depicted its subsequent slow remodellation. CONCLUSIONS: Submitted study was prepared to be matched nextly with the conservative group, which will be published in another publication. Internal analysis of the presented cohort disclosed that presented surgical treatment (Salter or Steel osteotomy respectively) assured, that irrespective of higher age, the important parameters like epiphyseal quotient and acetabulum-head index did not become worse than in younger groups. Even in the group over 9 years of age, 87.5% were categorised like excellent and fair results in Stulberg classification.

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PubMed2002

Isolated supra-acetabular insufficiency fracture: a case report.

In the absence of trauma, fracture of the acetabulum is a rare injury, and an isolated insufficiency fracture in the supra-acetabular region is extremely rare. We describe a 59-year-old postmenopausal woman with systemic lupus erythematosus (SLE) who developed a fracture in the roof of the acetabulum with underlying corticosteroid-induced bony insufficiency. Faint medullary sclerosis over the roof of the acetabulum was observed on plain roentgenograms. Diagnosis was made using magnetic resonance imaging. Irregular linear low signal intensity lines were observed on T1-weighted, T2-weighted, proton density, and contrast enhanced images, and these represented the fracture. The fracture healed with conservative management. Insufficiency fracture in this location should be suspected in an osteopenic woman with spontaneous hip pain.

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PubMed2004

The determination of male adult age at death by central and posterior coxal analysis--a preliminary study.

In forensic anthropological analysis, the pelvis is of particular interest as it is often a comparatively well-preserved part of the skeleton. This study in age determination uses the acetabulum, the central element of the pelvis, as a complement to the examination of the auricular surface. The test sample consisted of 30 individuals. First, the authors studied the auricular surface using the Lovejoy criteria. Second, they isolated four criteria based on chronological changes in the acetabulum. Third, they conducted an evaluation of each of these variables. The study examines the correlation between these criteria and the age of the individuals. A significant correlation was found between the acetabular criteria and age, and between the acetabular criteria and the Lovejoy criteria of the auricular surface. For forensic purposes, the acetabulum is an effective predictor in the determination of age. This newly proposed method explores the same criteria of ageing as the Lovejoy method. The combination of the two methods produces relatively consistent results in the estimation of age.

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PubMed2004

[Resection and reconstruction for primary pelvic tumors around acetabular].

OBJECTIVE: To discuss the resection of tumors, reconstruction of defects and the postoperative complications. METHODS: Thirty-one patients with tumors around acetabular were treated surgically in People's Hospital between July 1997 and July 2003. The series comprised 19 males and 12 females. Twelve patients were diagnosed with chondrosarcoma, 1 with Ewing sarcoma, 3 with osteosarcoma, 1 with lymphoma, 1 with carcinosarcoma, 1 with malignant fibrohistiocytoma (MFH), 2 with myeloma, 9 with giant cell tumor (GCT), 1 with aneurysmal bone cyst. Among 31 patients with peri-acetabular tumors, 8 were reconstructed with hemi-pelvic prosthesis, 7 with saddle prosthesis, 6 with cauterized tumor bone and total hip arthroplasty, 10 with total hip replacement after curettage of lesion and cemented. RESULTS: Among 21 patients who underwent tumor resection and reconstruction in region II, 6 had local relapse. Two of 3 patients with osteosarcoma were dead. Five of 12 patients with chondrosarcoma were free of disease. Twenty-one patients with acetabular reconstruction after resection of lesions in region II could sit and stand normally and walked with a cane, several of which even had normal gait. CONCLUSION: Allograft or pelvic prosthesis can be used to reconstruct the acetabulum after resection of tumors. We must pay more attention on the following points in the surgical treatment of periacetabular tumors: (1) Extensively resect tumors as far as possible; (2) Be acquainted with advantages and disadvantages of different reconstructive methods of acetabulum to prevent the complications; (3) The reconstructed acetabulum is unstable, so the patients must stand with a cane to protect the reconstructed hip joint; (4) Prevent wound necrosis and infection; (5) Surgical treatment of pelvic tumors would easily result in poor wound healing especially in the patients receiving chemotherapy or radiotherapy because of extensive soft tissue stripping. The destroyed soft tissue caused by chemotherapy or radiotherapy may increase the great tissue tension after implantation of allograft. And the factors of poor blood supply and hematoma in the wound theoretically increase the chance of infection.

Acetabulum↗
PubMed2005

[The application of reconstruction with autograft implantation in total hip replacement with regional acetabular deficiency].

OBJECTIVE: To evaluate the effect of reconstruction with autograft implantation in total hip arthroplasty(THA) with regional acetabular deficiency. METHODS: From 1991 to 2000, 39 cases of THA with acetabular deficiency were conducted. Autogenous bone implantation was used to reconstruct the deficient acetabulum. Of the 39 patients, 25 were males and 14 were females. The age ranged from 34 to 62 (45.2 on average). There were 21 cases of developmental dysplasia resulted deficiency, 14 cases of fracture of femoral neck complicated with head necrosis (10 hips) and fracture of acetabulum(4 hips). The resected femoral heads or autologous ilium were made the wedge-shaped graft and implanted into the deficient acetabulum, which included 12 cases with cement THA and 27 with cementless THA. Of all the cases, 24 were followed up 2 to 10 years (6.7 years on average). Harris scores before operation were 18 to 50 (38.1 on average). RESULTS: The limbs were lengthened by 2.4 cm on average. No serious complications were observed in these patients. Compared with the scores before the operation, the average Harris scores after the operation were 92.1 (P < 0.01)and 86.3 (P < 0.05) in the one-year and the latest follow-up respectively. The rates for the good were 91.7% and 83.3% in the one-year and the latest follow-up respectively. CONCLUSION: The acetabular reconstruction with autograft in THA will bring better stability in those patients with acetabular deficiency.

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PubMed2005

[Acetabular retroversion in hip dysplasia].

OBJECTIVE: To study the occurrence and radiograph features of the acetabular retroversion in hip dysplasia, and to evaluate the effects on the retroversion by the traditional maneuvers in the periacetabular osteotomy. METHODS: Bernese periacetabular osteotomy was performed to 45 continuous dysplastic hips (43 patients) from December 2001 to November 2003. There were 37 female (39 hips) and 6 male (6 hips), average age was 28.9 (range, 15-45). The diagnosis of acetabular retroversion was based on the "cross-over" and "posterior wall" signs on the standard radiographs of the patients pre- or postoperatively. RESULTS: Among total 45 hips, the "cross-over" sign was positive in 8 hips, whereas including the "posterior wall" sign positive in 5 hips. The occurrence of retroversion was 17.8%. And the cross-over points were located within the superior 1/3 of the acetabulums in all cases. After the osteotomy, all the cross-over points moved to the inferior 1/3 of the acetabulums, and the "posterior wall" sign was seen in all 8 cases. CONCLUSIONS: Approximately one sixth of the patients with acetabular dysplasia have retroversion in which the superior 1/3 of the acetabulum faces posterolaterally. The retroversion can be identified with the standard AP pelvic radiographs. With the traditional maneuvers in periacetabular osteotomy, the retroversion will be aggravated in these patients.

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PubMedDate not supplied

First implant acetabular components: historical aspects, a comparison of models and a review of the literature.

The article describes the features of the most commonly-used acetabular components in first implants in light of development in construction as regards intrinsic features, materials used, biological behavior, and design. The following versions are examined: screwable cone-shaped trunk, cemented polyethylene, cemented metal-back, HA-coated press-fit, expansion, dysplastic hip, and anti-dislocating components. The screwable cone-shaped trunk acetabular component takes hold in the acetabular bone through torsion and compression, and threading provides greater stability as compared to equivalent models that have wings or screws. Cemented polyethylene acetabular components are characterized by low costs and good results, on the condition that some specific parameters are respected (the presence of a dry bone bed, pressurization of the cement, use in elderly patients who do very little physical activity). Cemented metal-back acetabular components have features similar to polyethylene components, from which they differ because of the possibility of being able to substitute the internal polyethylene component without having to revision the entire acetabulum. HA-coated press-fit components have solved the problems encountered in cemented versions, such as loosening and the generation of polyethylene particulate, at the same time obtaining excellent osteo-integration. The expansion cup self-stabilizes thanks to a memory effect due to the contraction-relaxation mechanism with which it is lodged, adapting to the micro-movements of the acetabulum. Components used in the dysplastic hip are particular versions with a reduced diameter that have specific hooks that provide stabilization, capable of settling in the pathologic bone with minimum reaming of the same. Anti-dislocation cups are special models that have bipolar inserts or a ring (plastic or metal) that blocks the head in the prosthetic acetabulum, obstructing its dislocation.

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PubMedDate not supplied

Preoperative and postoperative assessment of rotational acetabular osteotomy for dysplastic hips in children by three-dimensional surface reconstruction computed tomography imaging.

The three-dimensional relationship between the acetabulum and femoral head was evaluated using three-dimensional computed tomography (CT) reconstruction before and after rotational acetabular osteotomy. This method provides exact anatomic information on acetabular coverage so that precise operative planning is more easily made. Evaluation of six dysplastic hips indicated the possible dangers of anterolateral rotational shift of the acetabulum when there is marked posterior deficiency, such as in the case of a high decree of subluxated femoral head covered by a shallow false acetabulum. In these circumstances, it may be safer and preferable to plan a lateral shift instead of an anterolateral shift.

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PubMed1990

Distraction arthroplasty of the hip by bicentric femoral head prosthesis.

Distraction arthroplasty of the hip with bicentric femoral head prosthesis was performed on 18 hips with advanced secondary osteoarthritis. This method of hip arthroplasty consists of reconstruction of the deformed acetabulum into the dome-shaped acetabulum, replacement of the femoral head by the bicentric femoral head prosthesis, and postoperative continuous long-axis traction to the lower extremity. Postoperative physical therapy is performed on the assumption that the articular cartilage is formed in a narrow empty space between the articular surfaces made by continued application of distraction to the hip. In distraction arthroplasty, the hip may regain a wide range of painless motion. Roentgenographically, the dome-shaped acetabulum was covered by a narrow radiolucent zone backed with a dense bone plate. The functionally remodeled structure of the hip was maintained during the follow-up period of six months to four years 11 months.

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PubMedDate not supplied

Migration of the femur head in rheumatoid coxitis.

The direction of penetration of the destroyed femoral head into the acetabulum in rheumatoid coxitis has been determined by means of the method of geometrical analysis in 81 affected hip joints. Of 48 patients, the duration of coxitis was 1-17 years (mean 4 years). Displacement of the femur head, destroyed by rheumatoid inflammation, was expressed in millimeters by means of a geometrical parameter called "transposition of the center of the femur head". The direction of transposition of the femur head into the deepened acetabulum has been expressed quantitatively by authors making use of the new geometrical parameter "the angle of transposition of the center of the femur head" which is referred to as angle delta. The angle delta is an angle between the line of transposition of the femur head center (tC) and its vertical component. The mean value of the delta angle for the entire group investigated measured 27.6 degrees and ranged from -5 degrees to +54 degrees, whereby an angle of 0 degrees marked the cranial direction of transposition, positive values marked the craniomedial transposition direction of the femur head. The angle delta varied from 21 degrees to 40 degrees in the majority of affected hip joints. The values of the delta angle were constant in every hip joint, thus indicating that the direction of transposition of the femur head did not change in the course of the progression of rheumatoid coxitis. It was found and statistically confirmed that no reciprocal dependence existed between the rate of progression of coxitis and the direction of displacement of the femur head into the acetabulum.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1989

[Biomechanical substantiation of the form and position of endoprosthesis of the acetabular vault in dysplasia].

Many surgical methods have been suggested for the reconstruction of the vault of the acetabulum affected by dysplasia. However, the absence of the mathematical substantiation in most of them makes the choice of an optimal intervention difficult. In this paper a graphic analysis of the forces acting on the formed vault of the acetabulum is presented. It is demonstrated that the chosen pyramidal form and the position of the endoprosthesis are adequate to the pressure of the femoral head. The calculations that have out have been carried shown that the forces contributing to the consolidation of the whole construction act in the "endoprosthesis-hipbone" contract area. These mathematical prerequisites are the substantiation for the clinical application of such kind of endoprosthesis both for children and for adults with dysplasia of the vault of the acetabulum.

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