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PubMed1987

[Conservative therapy of acetabular fractures--indications and results].

Conservative treatment of acetabular fractures seems to be indicated either in cases of little displacement or wherever reconstruction of the acetabulum by operation is impossible. Following the classification of Judet and Letournel a satisfactory result can be expected only in fractures with little dislocation, such as the caudal transverse type and the anterior wall type. The indication for open reduction and reconstruction is given if cranial and/or dorsal components of the acetabulum are involved. In special cases treatment by vertical traction must be combined with a side traction by means of a trochanter screw; in the early phase of traction frequent radiological controls are obligatory. Early physiotherapy is also necessary to achieve satisfactory functional results. Based on the follow-up examination of 38 patients with 39 fractures of the acetabulum, conservative treatment is discussed in respect of fracture type, the extent of displacement and the clinical results.

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PubMed1988

Incidence and mechanism of failure of cemented acetabular component in total hip arthroplasty.

Clinical results today seem to suggest that acrylic cement is crucial in producing immediate and reproducible results of pain-free joints following total hip replacement. Proper application by the use of contemporary techniques may be suitable in most conditions requiring hip replacement. The incidence of acetabular failure in a specific group of patients at risk may warrant experimentation by the use of a noncemented system. The mechanism of failure of low-friction arthroplasty may be multifaceted, but our experience indicates that the mechanisms of failure of the acetabulum have been due to excessive deepening and expansion of the acetabulum, once thought to be fundamental to the procedure. A rudimentary technique of cement pressurization, both in the femur and in the acetabulum, also may have played a part in late failures of this procedure. Early demarcation at the cement-bone interface was prevalent in young and active or heavy individuals. Demarcation and loosening were time-dependent phenomena. Demarcation and loosening also appeared with the aging process and increased osteopenia. A higher incidence of loosening also was observed in young and light-weight individuals, with presumably increased elasticity of the pelvic bone.

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PubMed1979

[Experience with acetabuloplasty according to Pemberton (author's transl)].

Following a brief description of the conventionally most well-known acetabuloplastic procedures for correcting hip dysplasia, the article gives details on acetabuloplasty as described in 1965 by Pemberton. Only few reports on experience collected with this method of operation have been published. The authors' own earlier evaluations and medium-term treatment results after 53 effected operations show that this procedure will mostly bring about a definite improvement of the acetabulum by reducing the acetabular inclination angle (AC angle) and correspondingly increasing the angle between the centre and the craniolateral corner of the acetabulum (CE angle). During the observation periods reported by the authors, an average reducing of the AC angle by 12 degrees was achieved, whereas the CE angle was increased during the same periods by an average of 17.5 degrees. Basic requirements for this operation are good centering of the head of the femur, which must be created, it necessary, via an open positioning of the hip joint or by intertrochanteral osteotomy; in addition, the Y-shaped piece at the botton of the acetabulum must be open, as will be seen from the roentgenogram.

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PubMed1979

[A morphological and functional analysis of the extent of cartilage coverage in the human hip joint].

The extension and the shape of the cartilage surface of 30 human femora and acetabula were measured. The results were considered and discussed as the response of the articular cartilage to the specific stress on this joint. 3 kinds of cartilage distribution were found on the femoral head; these shapes were understood as the consequence of the position and the dwelling time of the actual cartilage stimulating area. The largest extention of the cartilage was found in the ventrolateral direction and the smallest in medial direction. The cartilage margin of the "A" type was regulary curved. The "B" type has an inlet towards the fovea capitis. This inlet reaches in the "C" type to the fovea as an area free of cartilage. The acetabula could not be divided into types with different cartilage distribution because of the great similarity in shape. Therefore we computed an average acetabulum. The largest extension of the facies lunata was found 15 degrees in front of the roof of the acetabulas as seen in x-ray pictures. The cornu anterius is always narrower than the cornu posterius. The outer margin of the osseous acetabulum does not reach the equator, it lies on a latitude of 11.5 degrees. The incisura acetabuli is inclined against the vertical line with 18.3 degrees. The width of the facies lunata can be considered as a result of mechanical stress. The different extensions of the cartilage of both joint components in ventro-lateral direction seems to be the consequence of different extensions of movement. The area of movement of the caput femoris is larger than the area of the acetabulum.

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PubMed1984

[Value of arthrography in hip dislocation during the 1st year of life].

Forty-four arthrograms were done in 41 infants less than one year old. The author has studied displacement of the femoral head and deformity of the acetabulum. The relationship of the femoral head to the limbus was specifically assessed. The antero-posterior orientation of the acetabulum was found to be normal. The sphericity of the acetabulum varied with the position of the hip. The maximum sphericity was found in 90 degrees flexion, 35 degrees abduction and neutral rotation. In this position the femoral head was better centered.

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PubMed1984

Mechanisms of acetabular growth in the foetus in relation to the pathogenesis and treatment of congenital dislocation of the hip.

The development of the acetabulum has been studied histologically and histochemistry from the beginning of the foetal period to birth. The acetabular roof develops by interstitial growth of the acetabular cartilage and the limbus, enchodral ossification of the growth cartilage of the acetabulum and periosteal ossification of the iliac ala. In congenital dislocation of the hip (C.D.H.) this mechanism is altered but can be restored to normal by stable reduction during the first 4-5 years of life. Plastic operations to create a new roof ("shelf operations") are often destined to failure because they can not only damage the delicate histological structures concerned in the growth of the acetabulum, but the bone grafts used do not grow like the neighbouring osteocartilaginous structures.

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PubMed1983

[Changes of the acetabular cartilage following experimental subluxation of the hip joint in rabbits].

Subluxation of hip joints and subsequent acetabular dysplasia was experimentally produced by fixation of young rabbits' knee joints at each extension position. The restoration of processes of acetabulum after the reduction of subluxation of one-week-fixed group (Group I) and of two-week-fixed one (Group II) were followed up. The difference in time course of the processes were discussed roentgenographically, histologically and autoradiographically using 35S. The results are as follows; Roentgenologically, acetabular angles of Group I were restored in two weeks after the removal of the wires. However, acetabular dysplasia of Group II persisted at four weeks and even six weeks after the removal of the wires. Histologically, a remarkable change of growth cartilage was observed in each hypertrophic zone of the two groups when the wires were removed. Normalization of histological changes required two weeks in case of Group I and four weeks in that of Group II. In autoradiograms using Na2 35SO4, acetabulum was normalized in four weeks after the reduction of subluxation in both groups. However, the two restoration processes showed a different pattern from each other. Judging from the above results, it is assumed that a restricted unusual stress on an acetabulum causes some morphological and functional lesion to growth cartilage more quickly than expected and that the lesion becomes more unrestorable the more the period of the stress is prolonged.

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PubMed1984

Rotational acetabular osteotomy for the dysplastic hip.

A circumacetabular osteotomy of the acetabulum was initially done at the University of Tokyo Hospital by one of us (H. T.) in 1968. This procedure, which rotates the acetabulum, was designed to correct a dysplastic acetabulum in adolescents and adults. The surgical exposure combines both an anterior and a posterior approach. Between 1974 and 1982 this operation was performed on 103 patients (120 hips) with acetabular dysplasia, some showing early degenerative arthritis. The forty-five hips (forty-one patients) that form the basis of this report were followed for three years to eight years and ten months (average, four years and six months). Thirty hips showed only acetabular dysplasia, and fifteen were in the early stage of degenerative arthritis. The ages of the patients at the time of operation ranged from eleven to forty-two years, the majority being in the second or third decade of life. All of the forty-five hips had a preoperative center-edge angle of 10 degrees or less, but most of them had a nearly normal value after surgery. In the majority of the hips either limp or pain with exertion, or both, had disappeared, and a satisfactory range of motion had been restored.

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PubMed1983

A stress analysis of acetabular reconstruction in protrusio acetabuli.

UNLABELLED: We are reporting the results of a finite-element analysis of acetabular reconstruction for total hip replacement in the presence of protrusio acetabuli. In a protruded acetabulum, cortical bone stresses on the medial part of the pelvic wall increase with medial placement of the acetabular component, while normal placement of the component (more lateral placement) reduces these stresses. Metal backing of a polyethylene acetabular component causes a reduction in the peak cement and trabecular-bone stresses. A metal protrusio ring about only the periphery of the acetabular component increases stress levels within the lateral part of the pelvic cortex and has little effect on stresses in the medial part of the pelvic wall. A complete metal protrusio cup increases stresses in the lateral part of the pelvic cortex while decreasing substantially the stresses in the medial part of the cortex and the trabecular bone. Prosthetic reinforcement of the medial part of the acetabular wall has little effect on stress patterns in the acetabular region. CLINICAL RELEVANCE: The major long-term problem with cemented total hip prostheses is loosening. Loosening is probably related in part to the stress state in the cement and surrounding bone. The protruded acetabulum is particularly difficult to reconstruct in a manner that ensures longevity of the total hip replacement. In patients with protrusio acetabuli, the prosthetic acetabulum should be placed in a normal and not in a protruded position. A metal-backed acetabular component or a complete metal cup incorporated within the cement reduces stress levels within the medial aspect of the pelvic bone and thus may reduce the incidence of loosening.

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PubMed1981

[Studies of shelf operation on congenital dislocation of hip (author's transl)].

Part I The author examined 62 hips in 58 patients treated by shelf operations, and their long-term results were studied as a follow-up for an average of 10 years. Satisfactory results of the shelf operation were obtained in 51.7% of patients, if over 10 years of age when operated on, but in as many as 72.0%, if under 6 years of age. But as the age of each group changed from that of the time of follow-up age it was impossible to carry out any comparable study between the two groups. Better roentgenographical results appear to be obtained, if this procedure is performed on those over 10 years of age. Part II In an attempt to detect the changes of a hip after the destruction of the outer rim of the acetabulum, experimental studies were undertaken on 50 young rabbits about 40 days after birth. In order to destroy the outer rim of the acetabulum, a small piece of autogeneous iliac bone was embedded in the outer rim of acetabulum where the bone graft is done in human's acetabuloplasty. The results showed that this procedure had no influence on the development of osteoarthritis in a rabbit.

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PubMed1980

The hip-shelf procedure. A long-term evaluation.

Renewed interest in the hip-shelf procedure as a solution to the dysplastic acetabulum in the older child stimulated an evaluation of the long-term results in an effort to clarify the role of this procedure. Only patients with a minimum of ten years of follow-up were evaluated in the study. The average follow-up for the entire series of twenty-nine hips in twenty-seven patients was twenty-two years and ten months. At evaluation, pain was present in fifteen hips, a limp was present in twenty-five, and degenerative changes were present in twenty hips. Complications occurred in twenty-one hips and additional operative procedures were required in fourteen hips. Twenty-one of the twenty-nine hips were evaluated by us, with an average follow-up of twenty-five years and eight months. One hip was rated as excellent; eight, as satisfactory; and twelve, as poor. Although the hip-shelf procedure has been described as a safe, conservative, and reliable approach to the problem of a dysplastic acetabulum, our long-term results suggest a more cautious view of the use of this procedure. We recommend consideration of other stabilizing procedures for the dysplastic acetabulum.

Acetabulum↗
PubMedDate not supplied

Long-term results of closed reduction of complete congenital dislocation of the hip in children under one year of age.

Eight to 29 year follow-up investigation of the results of closed reduction in 40 completely dislocated hips in children, treated under one year of age, show that 92.5% of the hips had good functional results and 77.5% had good anatomical results. The slant and depth of the acetabular roof rapidly improved during the first year after reduction and slowly during the following 8 years. Femoral head necrosis occurred in 12 hips (30%). The necrosis was mild in 4 hips and severe in 8. The 8 hips with severe femoral head necrosis had poor anatomical results. Surprisingly, the development of the acetabulum was not influenced by femoral head necrosis. Femoral head necrosis was frequently observed when the head was in a high position in relation with the acetabulum prior to reduction. Closed reduction should not be attempted unless the head can be brought down below the level of the acetabulum.

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PubMed1993

[Radiologic analysis of osseous changes in coxarthrosis].

Morphologic and osteogenetic changes of the hip joint in patients with coxarthrosis were studied. Examination included 224 patients treated and operated on Department of Orthopaedics, Clinic Hospital Osijek. Coxarthrosis was proved in 331 hips, 183 cases (55,29%) referred to a secondary and 148 844,71%) to primary arthrosis. Osteogenetic changes on the head of femur were found in 148 x-rays (44,71%). The upper osteophyte of the head of femur was found in 79 x-rays of the hip (22,36%) but lower osteophyte of the head of femur only in 26 cases (7,85%). In 48 x-rays (14,50%) osteophytes were found both on the upper and lower sides of the head of femur. 217 x-rays of hips (65,56%) proved the existence of medial cervial osteophyte, according to frequency mostly type 1. Osteophyte of the roof of acetabulum were expressed on 158 x-rays (44,73). The double bottom of the acetabulum was studied on several measurement levels and showed from 0,24 to 2,35 mm observed from cranial to caudal measurement levels. The studies proved that the patients with coxarthrosis experienced a number of morphological and osteogenetic changes on the head and neck of femur as well as on the acetabulum. Their features on x-rays will depend on the cause and degree of the development of coxarthrosis.

Acetabulum↗
PubMedDate not supplied

Indications and limits of acetabular reimplantations using screwed prostheses.

The clinical and radiographic results of 95 acetabular reimplantations performed between 1984 and 1992 are presented. A screwed acetabular prosthesis was used in 56 patients, the acetabulum was cemented in 15, and a press-fit acetabulum stabilized by screws (1 case without screws) was used in 24. Mean clinical follow-up was 35.6 +/- 24 months, ranging from 7 to 94 months. Clinical results were good and excellent (> or = 5 points according to Merle D'Aubigné) in 77% of the cases for pain, in 70% for walking, and in 71% for joint movement. Forty months after surgery 48% of the screwed acetabula and 44% of the cemented ones were osteointegrated. The incidence of loosening for the screwed acetabula was 24%. The preliminary results 24 months after the press-fit acetabula with screws had been inserted showed 100% osteointegration. Radiographic results of the screwed acetabula were satisfactory (92% osteointegration) only in reimplantations performed in patients with minimum acetabular osteolytic injury (Paprosky types I and IIA). The use of homoplastic bone grafts did not improve the radiographic results of the screwed acetabula in the cases with severe osteolysis: 57% of the acetabula screwed on grafts distributed throughout the acetabulum were, in fact, loosened.

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PubMed1994

Current attitudes to cementing techniques in British hip surgery.

Aseptic loosening is the major problem in hip joint replacement. Improved cementing techniques have been shown to improve the long-term survival of implants significantly. To assess the use of modern cementing techniques in British surgeons, a detailed questionnaire was sent to all Fellows of The British Orthopaedic Association (BOA) regarding cement preparation, bone preparation, cementing technique and prostheses used in total hip arthroplasty. Excluding retired fellows, surgeons who use no cement, and those who had filled in forms inadequately, 668 responded, who between them performed 43,680 hip arthroplasties per year. In this survey, 21 different types of hip prostheses were implanted by the surgeons; 48% of hips implanted were Charnley type. Of the surgeons, 46% used Palacos with gentamicin as their cement for both the femur and acetabulum. For the femur, 44% of surgeons remove all cancellous bone, 40% use pulse lavage, 59% use a brush to clear debris, 94% dry the femur, 97% plug the femur, 76% use a cement gun and 70% pressurise the cement. For the acetabulum, 88% of surgeons retain the subchondral bone, 40% use pulse lavage, 100% dry the acetabulum, 22% use hypotensive anaesthesia and 58% pressurise the cement. Overall only 25% of surgeons (26% of hips implanted) use 'modern' cementing techniques. This has implications for the number of arthroplasties that may require early revision.

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PubMed1993

Massive resection and prosthetic replacement for the treatment of metastases of the trochanteric and subtrochanteric femoral region bipolar arthroplasty versus total hip arthroplasty.

Twenty-eight metastases of the proximal femur were treated by resection and by prosthetic replacement using a large femoral component with diaphyseal support (megaprosthesis). When metastatic involvement of the acetabulum was not evident a mobile self-centering cup was used (bipolar hip arthroplasty: 17 cases). When metastatic destruction of the acetabulum was evident acetabular reconstruction was performed (total hip arthroplasty: 11 cases). Postoperative pain relief according to Habermann was excellent in 81.5% and good in 14.8% of the patients. The functional results according to Merle d'Aubigné were rated as excellent in 19%, very good in 22%, and good in 22% of the hips. The rate of postoperative dislocation was significantly lower (p < 0.05) in the bipolar arthroplasty group when compared to the total hip arthroplasty group. Our experience indicates that, when bone disease of the acetabulum is not evident, a bipolar arthroplasty rather than a total hip arthroplasty should be recommended. In the current series pain relief as well as postoperative walking ability were comparable in both groups but the dislocation rate was significantly lower with bipolar arthroplasty.

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PubMed1993

[Treatment of acetabular fractures. 1. Indications for surgical approaches].

The results of surgical treatment of fractures of the acetabulum depend on the selection of the surgical approach. Therefore the authors focused their attention on the surgical approaches which are best known and used most frequently at present. They present a review and brief characteristic of different surgical approaches. On a group of 70 fractures in the region of the acetabulum they demonstrate their own practical experience with the application of different approaches. Based on their experiences and analysis of data reported in the literature, they submit indications of these approaches when dealing with actual traumatological situations in the region of the injured acetabulum.

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PubMed1993

[Clino-static syndrome].

The clinostatic syndrome described in 1953 by Pierre Lehman is defined by weakness of the lower limb in the supine position contrasting with absence or only slight disorders on standing, normal neurological examination and passive mobility of the hip. The aetiology generally corresponds to a malignant lesion of the base or roof of the acetabulum and very rarely a fracture of the acetabulum or aseptic necrosis of the acetabulum, detected by bone scan or plain X-rays. An inverse clinostatic syndrome of the lower limb due to lysis of the ischium has also been described.

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