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PubMed1989

Lack of correlation between femoral neck anteversion and acetabular orientation. Radiography and computed tomography in cadavers and in vivo.

Radiography and computed tomography measurements were made of femoral neck anteversion, femoral head cartilage distribution, and the orientation of the acetabulum. The measurements were made in elderly cadaver femurs and in patients. They failed to establish any correlation between the femoral neck anteversion and the orientation of the articulating surface of the femoral head, nor between the femoral neck anteversion and the angles of the acetabulum.

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PubMed1999

Acetabular coverage of the femoral head after triple pelvic osteotomy: no relation to outcome in 51 hips followed for 8-15 years.

In developmental dysplasia of the hip in adolescents and young adults, pelvic osteotomies aim to improve acetabular coverage of the femoral head by reorienting the acetabulum. We determined whether acetabular coverage is related to long-term clinical results after triple osteotomy of the pelvis. We used a previously published computer program (Konishi and Mieno 1993) which calculates three-dimensional coverage of the femoral head from plain anteroposterior radiographs. We studied the pelvic radiographs of 51 hips in 43 patients and the results were correlated with studies on clinical outcome (de Kleuver et al. 1997). Total acetabular coverage improved from a mean of 56% to 70%. We did not find a relationship between total acetabular coverage and long-term outcome, nor could we determine an optimal coverage. Reduced coverage of the posterolateral quadrant of the femoral head was related to a reduced score for walking ability (p = 0.03), and therefore care should be taken not to overcorrect the acetabulum forwards when attempting to improve the deficient anterior coverage. We challenge the concept that total acetabular coverage is a prerequisite for a good long-term outcome after triple pelvic osteotomy, and hypothesize that other factors such as the change in load across the hip are probably more important in determining the outcome.

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PubMed1990

Comparison of radiographic parameters for analysis of normal and dysplastic hips in the adult.

Radiographic quantitation of the dysplastic hip in adults is difficult. This study compares the values for commonly used indices, the acetabular angle (AA), the center edge angle (CEA), and femoral head coverage, and the X-Y coordinate system on the anteroposterior pelvic radiograph in 30 adult patients with 60 normal hips, and 20 adult patients with 27 dysplastic hips. Dysplastic hips demonstrated significantly higher values for the AA and the X-Y coordinates, and significantly lower values for the CEA and femoral head coverage compared to normal hips. Femoral head coverage in dysplastic hips correlated best (negatively) with the Y coordinate, i.e., poorer coverage was associated with greater superior migration of the femoral head. The AA describes the slope of the acetabular roof, but does not take into account the relative position of the femoral head. The CEA measures the position of the femoral head in relation to the lateral lip of the acetabulum, but does not necessarily use the true acetabulum. The X-Y coordinate system relates the center of the femoral head to an identifiable acetabular landmark, the teardrop shadow. These coordinates are easily determined and can serve as an adjunct to other radiographic indices that quantitate the amount of subluxation in dysplastic hips in adults.

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PubMed1998

[Innominate osteotomy in the treatment of subluxation of hip in adult].

The symptomatic subluxation of hip is not uncommon in adults, and several kinds of surgical options are available. Twenty-six patients (26 hips) suffering from residual symptomatic subluxation of the hip were treated with innominate osteotomy during 1985 to 1991. The patients were followed-up for 4 to 9 years. The ages of the patients ranged from 22 to 38 years with an average of 26 years and 6 months. The duration of symptoms ranged from 3 to 6 years with an average of 3 years and 5 months. The pertinent prior diseases were the congenital dislocation of hip in 12 cases, Perthes disease in 10 cases, and in the remaining 4 cases, the causes were not identified. The indications for operative intervention were that presence of a reasonable articular cartilaginous space, a reasonable range of motion preserved and particularly a reasnable joint congruity must exist. A new method of re-alignment of the acetabulum was used to placing the ipsilateral foot on the contralateral thigh. The result was evaluated by the symptoms, the function of the hip and the radiographic findings. According to these criteria, the excellent results were obtained in 11 cases and the good result in 15 cases. It was suggested that the innominate osteotomy were also suitable for the treatment of residual symptomatic subluxation of hip in carefully selected adults and the new method of re-alignment of acetabulum was simple and effective.

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PubMed2000

Fixation of the acetabular cup in cemented total hip replacement: improving the anchorage hole profile using finite element method.

Long-term studies have shown that failure of the acetabular component in total hip replacement increases exponentially ten years following surgery and occurs mostly at the bone-cement interface. During the cemented fixation of the acetabular cup, straight anchorage holes, 3-15 mm diameter and 3-20 mm deep, are drilled in the acetabulum in order to increase torsional resistance at the bone-cement interface. The aim of this paper is to provide guidelines for improving the profile of anchorage holes. Results from our finite element models show that the efficiency of anchorage holes may be improved if they are drilled perpendicularly to the acetabulum floor and if they have chamfered necks. A 10 degree inclination of the anchorage hole increases Von Mises stress in the cement mantle by 6% while creating chamfered anchorage holes, instead of straight holes, decreases it by 14%. Increasing depth of anchorage holes does not improve efficiency.

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PubMed2001

Ilioinguinal approach to manage benign pelvic and acetabular tumors.

Benign osteoblastic and cystic lesions involving the anterior column and wall of the pelvis and acetabulum are technically difficult areas to approach and achieve successful surgical outcomes. Tumors in this area are rare, leaving little information in the literature regarding how best to surgically approach them. Previous authors have reported small series of patients treated using anteromedial, iliofemoral, and intracapsular dissections. The ilioinguinal approach has been extensively described and used in the modern-day treatment of pelvic and acetabular fractures involving the anterior column and wall. Despite its use for acetabular trauma, application of the ilioinguinal approach in the treatment of benign pelvic and acetabular lesions has not been described. We reviewed the management of 5 patients with benign pelvic or acetabular tumors treated using the ilioinguinal approach. Diagnoses included aneurysmal bone cysts in 3 patients and osteoid osteomas in 2 patients, involving the pelvic anterior column and wall. The approach has permitted satisfactory exposure of the lesions for operative treatment. At an average follow-up of 3 years (range, 2-4 years), excellent functional outcome and no recurrences were noted. There were 2 patients with lateral femoral cutaneous nerve palsies, both of which resolved completely by 8 weeks. Encouraging results from our study demonstrate a new application for the ilioinguinal approach in the treatment of benign anterior column and wall lesions of the pelvis and acetabulum.

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PubMedDate not supplied

Immediate passive mobilization of the hip after internal fixation of acetabular fractures.

The authors report the results obtained in 16 patients affected with displaced fracture of the acetabulum treated surgically and mobilized passively immediately after surgery by means of a continuous passive mobilization apparatus for the hip. The age of the patients at the time of trauma ranged from 21 to 54 years. The posterior wall was involved in 12 cases, while the anterior column was also involved in 4. Excellent or good reduction of the fracture was obtained in all of the cases. Immediately after surgery, a continuous passive motion apparatus for the hip was applied to be used for approximately 3 weeks. At final follow-up, which was obtained after a mean time of 5 years, all of the patients except 2 had obtained good results. Moderate joint deficit was present in 1 case, while sciatic nerve palsy that had already been observed prior to surgery persisted in another. Evident radiographic signs of coxarthrosis were not present in any of the cases. Based on the opinion of Salter et al. (1980), who in an experimental study had observed better healing of the cartilaginous lesions in the joints submitted to movement, immediately after surgery we applied a continuous passive motion apparatus for the hip in a group of patients affected with fracture of the acetabulum. As none of the patient followed-up by us presented evident signs of hip arthrosis, the authors hypothesize that continuous passive movement, immediately carried out after osteosynthesis, plays a significant role in preventing post-traumatic arthrosis of the hip. In truth, small irregularities of the acetabular cavity, possibly present after an apparently anatomical reduction, could be minimized by the plasmating effect of the head of the femur in movement.

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PubMed2001

[The Zweymuller endoprosthesis in hip joint revision surgery].

PURPOSE OF THE STUDY: The aim of the study is the verification of the applicability of the Zweymüller system of total hip replacement in dependence on the size of defects of acetabulum and femur and evaluation of early results in patients operated on in 1998 and 1999. MATERIAL: In 1998 and 1999 we reimplanted 125 total hip replacements. In 60 revision surgeries we used at least one component of Zweymüller Bicon Plus system. We prospectively followed defects of acetabulum and femur in DGOT classification. The size of the stem was planned, final indication of the cup was determined peroperatively. METHODS: During the implantation of the cup we tried to achieve primary stability of the implant. The cup was implanted in uni- and bisegmental defects. In total we implanted 50 Bicon cups, in 24 hip joints we applied morselized allograft in the defect. In tri-segmental defects we used twice the Burch Schneider cage and in 4 hip joints a bone allo-graft with a cemented cup in combination with SL-Plus stem. In one female patients after the implantation of Bicon cup in type 7 defect there occurred an early failure. When removing bone cement we preferred fenestration of the cortical bone of the femoral shaft. In 30 hips SL-Plus stem was used and in 13 hip joints SLR-Plus was applied. We checked 50 hip joints operated on by the method after Harris and by radiographs in two projections. RESULTS: Fifteen patients are without pain, 14 patients take analgesics. The final result is excellent in 24% of patients, good result in 32%, satisfactory in 24% and poor in 20% of patients followed up. By comparison with HHS value prior to the surgery HHS got worse in two patients who are not satisfied with the result of the operation. Average score prior to surgery was 47.4 points (range, 23-82.6). Five times we encountered a radioluscent line of acetabular component in zone III. Radiograph signs of loosening of the cup or stem were not found in any of the hip joints. CONCLUSION: Zweymüller system is applicable in revision surgeries of both cemented and cementless hip joint replacements. The cup may be applied in uni-segmental and bi-segmental acetabular defects under the condition of achievement of primary stability. Applied morselized bone allografts have a good potential for osteointegration and remodeling. The rectangular stem is suitable for the treatment of defects extending as far as 5 cm below the level of lesser trochanter. Bone cement was extracted from fenestration, transfemoral approach was not required in any of the patients. Even with the use of SLR (revision) stem we did not transfer fixation of the femoral component to the lower half of femur.

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PubMedDate not supplied

[Computer tomography in the diagnosis and therapy of acetabular fractures].

INTRODUCTION: Acetabular fractures and fracture dislocations of the hip joint are frequently complex, and the precise pathological anatomy is not easily demonstrated by routine radiographs. Conventional radiographs are often supplemented by oblique views [1]. The most commonly used classification of acetabular fractures has been based on conventional radiographs which are, in majority of cases, sufficient to determine the type of acetabular injuries [1-3]. It has been shown that computed tomography is useful method in precise evaluation of the fracture type the soft-tissue damage and integrity of joint space [4-6]. AIM: The aim of the study was to evaluate advantages of computed tomography in diagnosis of complex acetabular fractures. METHODS: We studied 737 patients with acetabular injuries over the period from 1989 to 1998. Five hundred and seventy five (78%) were males and 162 (22%) females. Eighty patients with acetabular fractures, with and with out hip dislocation, underwent pelvic CT following AP and 45 degrees oblique pelvic radiographs. Each patient was studied while supine, using 5 mm slice thickness at the acetabulum level and 10 mm at other parts of pelvis. Sections were obtained from the iliac crest to the greater trochanter [7]. RESULTS: The causes of acetabular fractures were: 621 (84.3%) patients participated in traffic accidents, 103 (14%) fell from a height, 7 (0.9%) covered in a mine and 6 (0.8%) were wounded. Femur was the most frequently associated injuries of all bones--155 (66.5%) (Graph 1). Permanent growth of acetabular fractures was noted from 1989 to 1993 regarding gender and years (Table 1), but that growth declined in 1993. It can be explained by a lower number of traffic accidents. Traffic, as an aetiological factor is nearly related with economic and energy crisis in our country (Graph 2). There were 176 (23.8%) fractures of the posterior wall, 23 (3.1%) fractures of the posterior column, 14 (1.9%) fractures of the anterior wall, 29 (3.9%) fractures of the anterior column. Transverse fractures were present in 61 patients (8.3%), "T" fractures in 51 (6.9%) patients and 383 (52.1%) were combined fractures. Of 80 patients loose bodies within the hip joint were noted on the CT scan in 77 (96%) patients, and only in 19 (24%) on radiographs. There was a statistically strong difference between methods (chi 2 = 12.376; p < 0.01). There was no significant difference between two methods in fracture of the femoral head detecting (chi 2 = 1.905; p > 0.05), but it has to bee noted that only two patients had fracture of the anterior aspect of the femoral head, both noted on CT but not on radiographs. In 78 (98%) versus 53 (66%) patients chondral defect of acetabulum was detected on radiografs. Difference was significant (chi 2 = 4.372; p < 0.05). Also, stability of the hip joint regarding size and location of the posterior wall fragment was better seen on CT than on radiographs (chi 2 = 5.555; p < 0.05). DISCUSSION: Our series demonstrates that in many cases details of acetabular fractures are not well visible on conventional radiographs. Because of the complexity of acetabular fractures, precise pathological anatomy is not easily demonstrated by routine radiographs. In a series of Pearson and Shirkhoda et al. [12,13], one third of acetabular fracture was not apparent on the initial radiographs; however, additional views taken three months later demonstrated a fracture. Mossed fractures should decrease with using the CT, which can also reveal the loose bodies in the joint space, occult femoral haed and chondral acetabular impaction. The size of the posterior wall fracture, and thus the stability of the hip, could be better determined by the CT scan than by a conventional radiograph. In conclusion, the information obtained from CT can help the surgeon to decide whether the surgery is necessary, and, if so, the proper approach. We believe that CT is a very helpful supplement to routine AP and 45 degrees oblique views when surgery of acetabular fractures is in question.

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PubMed1998

[Acetabular dysplasia:an experimental study].

OBJECTIVE: To demonstrate whether acetabular dysplasia represents a primary feature of congenital dislocation of the hip or secondary defect. METHOD: The capsule of twelve puppies aged five to nine weeks was incised and the ligamentum teres was completely severed under anaesthesia. A part of gluteal medium muscle was implanted in the acetabulum and the head of the femur was dislocated from acetabulum. Roentagenogram was made three weeks after dislocation in all animals. RESULT: As early as three weeks after dislocation, acetabular dysplasia was clearly noted in all animals. There was more acetabular obliquity and increase of acetabular index. CONCLUSION: The acetabular dysplasia is the result but not the cause of congenital dislocation of the hip. This result provides probably support for the concept of developmental dislocation of the hip.

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PubMedDate not supplied

Posterior acetabular spike: an obstacle to reduction in long-standing hip dislocations.

The posterior insertion of the transverse acetabular ligament can be transformed into a toothlike bony prominence narrowing the acetabulum in its distal part. This deformity can impede the placement of the femoral head deep in the acetabulum, making a complete reduction impossible. The toothlike spike can be detected by computed tomography or by intraoperative palpation, and can be corrected by pushing it back with a punch under palpatory control.

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PubMed2002

[Acetabular bone grafting in primary total hip arthroplasty].

A group of 108 hips in 102 patients (81 females and 21 males; average age: 66.9 years) operated at our Centre between 1989 and 1998 was evaluated. There were 76 hips with idiopathic arthritis, 21 hips with rheumatoid arthritis, 2 hips with post-traumatic lesions and 9 cases of dysplastic arthritis of the hip. Cemented total hip arthroplasty was performed in all cases (62 Weller prostheses, 28 Charnley prostheses, 12 Ultima-Straight prostheses and 6 Centrament prostheses). In the presented material three different kinds of bone grafting were performed: "impaction bone grafting" with autogenous cancellous bone grafts in cases of bone cysts and cavitary lesions (57 cases); augmentation of thin sclerotic or protrusive acetabulums with autogenous cancellous bone grafts with or without allogenous cancellous bone grafts (26 and 16 cases respectively); and reconstruction of the roof of the acetabulum with autogenic cortico-cancellous bone grafts 9 cases). In 17% cases autogenous and allogenous bone grafts were used simultaneously and in 83% autogenous bone grafts only were employed. Acetabular bone grafting was necessary to create proper bone substrate for endoprostheses implantation. Evaluation of results was based on criteria proposed by a joint committee of The Hip Society, SICOT and AAOS. A mean of 83.5% points were achieved in the Harris Hip Score. Aseptic loosening was observed in 15 sockets and 9 stems. Bone grafts didn't heal in 25 hips, of which 14 had loose sockets. These results are comparable to those in primary total hip arthroplasties without acetabular bone grafting. The results in the presented paper support the opinion that acetabular bone grafting is a useful tool in reconstructive surgery of the hip and allows to achieve good results in technically difficult acetabuli.

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PubMed2003

[Bone grafts in hip prosthesis revisions].

PURPOSE OF THE STUDY: We describe the collection, storage and examination of allogenic bone grafts and their use in revision hip arthroplasty, indicated because of acetabular loosening, that involved either an uncemented cup or an augmentation device with a cemented cup according to the extent and nature of acetabular defects. MATERIAL: Allogenic bone grafts, usually long bones, were collected from deceased humans within 12 hours of death. They were processed according to the standards of US tissue banks. Using ELISA, the blood of each donor was serologically examined for antibodies against selected antigens (HIV I, HIV II, syphilis, HbsAg, HCV, and p24HIV I, HTLV I and II, and HbcAg, if required). Microbiological examination of each bone sample was also included. The samples were kept in a quarantine box until the examination results were known. When these were negative, the bones were cut, under aseptic conditions, to obtain parts (condyle, metaphysis, diaphysis, patella, etc.) weighing from 80 to 150 gr. Subsequently, another quality check, involving microbiological and histological examination, was performed. The allografts were stored at -80 degrees C. METHODS: Between October 1999 and October 2000, 67 revision total hip replacements were performed. Of these, allogenic bone grafting was used for acetabular reconstruction in 30 cases (45%). The average amount of graft tissue per operation was 107 gr (range, 43 to 163 gr). Eleven grafts had been harvested from the tibial condyle, nine from the trochanters, eight from the femoral condyle and two from the patella. The graft bone, ground into coarse chips, was washed with an antibiotic solution. Two techniques were used in graft implantation. 1) Impaction grafting, under pressure, of the acetabulum whose surface was free from any granulation tissue and scratched to make the bone bleed, and implantation of a cemented cup (LOR or Spotorno CLS). 2) Filling of large defects with a bulk of allograft bone chips, using an augmentation ring, mesh or Burch-Schneider cage, and implantation of a cemented polyethylene acetabular component. Uncemented implants were used in 17 and cemented cups with an augmentation device in 13 cases. The hips were checked by X-ray at 3, 6 and 12 months and then at yearly intervals. RESULTS: In the postoperative period of 26 to 38 months, an early recurrent infection led to temporary removal of the implant in one case, one hip showed superficial infection that responded to therapy and there was one case of aseptic acetabular loosening. A recurrent dislocation led to femoral stem exchange for a modular component with a longer neck in one case. The remaining 28 cases showed good incorporation of the graft without any signs of implant migration. DISCUSSION: Segmental defects of the acetabulum can be treated by implantation of specific types of acetabular cups or by massive bone grafting. Cavitary defects can be filled with cancellous allograft bone or bioactive, artificial materials. We prefer morselized allograft bone from the tissue bank and this was used in 45% of repeat surgeries for failure of the acetabular component. An uncemented cup is more convenient, supposing sufficient primary stability can be ensured. When defects are extensive, augmentation devices and filling with graft bone are necessary. Cadaver allografts offer advantages over autologous bone because they are available at any amount and thus enable us to avoid extensive damage to the iliac crest by autologous tissue harvesting. Cadaver grafts are bones of good quality, free from degenerative or dystrophic changes because they are usually taken from young subjects. The size of 7 to 10 mm is optimal because it permits the grafts to maintain both structure and strength. The strict procedure of sample collection and examination minimizes the risk of infection transfer. The progress of graft bone ingrowth was evaluated on radiographs that showed incorporation of allograft into the surrounding bone during 3 to 6 months and no radiolucent areas at host bone-implant contact. CONCLUSIONS: Our patients showed good allogenic bone ingrowth in relation to the acetabular bed and good bone restructuring and incorporation in relation to the implant. Neither mechanical failure of implants nor graft rejection were recorded. The risk of infection transfer was low and comparable with routine blood transfusion. The necessary prerequisite for revision hip arthroplasty is a well-operating bone tissue bank.

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PubMed2003

[Shelf acetabuloplasty in Legg-Perthes-Calve disease].

PURPOSE OF THE STUDY: The purpose of this study was to demonstrate the contribution of shelf acetobuloplasty for the treatment of Legg-Perthes-Calve disease. MATERIAL: Eighteen children with Legg-Perthes-Calve disease were operated on between 1992 and 2001. Mean age at diagnosis was 7 years 2 months, and mean age at surgery was 8 years 5 months (range 5-13 years). Mean motion was limited -25 degrees in abduction and internal rotation preoperatively. The radiological classification was: 2 Catterall II Herring B with signs of risk for the head, 8 IIB, 1 III C, 2 IV B, 3 IV C, and 2 at the sequelar stage. Mean excentration was 6.5 mm and mean overhang was 10.2 mm. METHOD: The indication for surgery was aggravation of the excentration or advanced revascularization. An iliac graft was embedded in the supralimbic and covered with a rectus femoris tendon which, left continuous, provided elastic support. A bermuda cast was used in 17 cases and immediate weight-bearing in 11. The patients were hospitalized 36 hours. RESULTS: Sixteen patients were reviewed at mean follow-up of 3 years 2 months (2 lost to follow-up). There were no complications. Clinically, the patients were pain free. Three patients had persistent limping 10 moderate limitation of motion, and three had severe stiffness. Radiologically, head covering was good in 15 cases, and joint congruency was achieved in 15 (11 of which were concentric). Shelf acetabuloplasty was considered useful in 12 cases, not useful in 1 after complete lysis of a poorly positioned graft, and of uncertain usefulness in 3 (including 2 cases treated at the sequalar stage). DISCUSSION: Femoral osteotomy for varisation and pelvic osteotomy for reorientation or enlargement of the acetabulum are effective but have certain drawbacks (limitation of abduction, leg length discrepancy, reintervention to remove material). The excellent integration of the shelf graft at mid-term is a good sign of correct head-acetabulum adaptation, with radiological and clinical results similar to other techniques. Joint stiffness and limping are observed in very severe forms where the prognosis depends on the stage of the disease. CONCLUSION: The patients in this series have not yet all reached maturity. Shelf plasty is a rapid, easily-performed, and safe means of enabling weight-bearing in Legg-Perthes-Calve hips undergoing excentration and beginning revascularization.

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PubMedDate not supplied

The treatment of congenital hip dislocation between the ages of 1 and 3.

A total of 81 patients (103 hips) with a diagnosis of congenital hip dislocation were reviewed, who had been treated between one and three years of age. All of the patients were initially treated with adhesive band traction prior to non-surgical reduction, which was performed under general anesthesia using gentle reduction maneuvers followed by immobilization in plaster. Non-surgical reduction was performed in 69 hips (67%), surgical in the remaining 34 (33%). A total of 91 associated surgical procedures were performed for the treatment of residual subluxation. Average follow-up was 12 years (minimum 5, maximum 19). The clinical results of the non-surgical reductions were excellent in 75% of the cases. Radiographically, 48% are hips which have a normal aspect, while 42% have a moderate degree of residual dysplasia or deformity of the femoral epiphysis and of the acetabulum. Hips that were initially classified as grade III dislocations show fair results. Hips treated non-surgically included 11 cases of avascular necrosis (16%); recovery was adequate. Hips treated surgically included 14 cases of avascular necrosis (30%), which was more accentuated in those hips that had initially been treated elsewhere, and in those classified as grade III. The clinical and radiographic results obtained for the hips treated surgically demonstrate poor results in 17% of the cases (6 out of 34), as a consequence of types III and IV osteochondrosis. It may be concluded that in this age group congenital hip dislocation is best treated by non-surgical reduction, possibly followed by surgery of the femur and acetabulum. Surgical reduction was only indicated when conservative methods failed.

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PubMed1992

Debris from cobalt-chrome cable may cause acetabular loosening.

To address the issue of nonunion with trochanteric osteotomy, surgeons have experimented with various modes of fixation, wire and cable being the two most popular. From a group of 643 primary cemented total hip arthroplasties performed by a single surgeon via the trans-trochanteric approach, minimum four-year roentgenographic follow-up evaluations were performed on 322 hips (50%). The method of fixation was stainless steel monofilament wire in 162 cases and Co-Cr cable in 160. Trochanteric union rates were 75% (122 patients) for the wire group and 79% (126 patients) for the cable. Breakage rates of the entire trochanteric fixation construction (all three wires or cables) were 43% (68 patients) for the wire and 12% (20 patients) for the cable. Unraveled cable was seen in 56% of the hips (90 patients), and in 47% of these hips, there were no broken cables. Blinded roentgenographic analysis of the acetabulum, preformed independently, revealed that loosening of the acetabulum in the cable group was greater than in the wire group. Cables offer no significant benefit over wires and may have potential adverse effects. Generation of significant particulate debris was noted roentgenographically, and marked reaction/destruction was found at the time of revision surgery.

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PubMed2003

[The Beznoska uncemented acetabular cup in hip joint arthroplasty].

PURPOSE OF THE STUDY: To present the results of a trial of the non-cemented Beznoska cup. MATERIAL: During the period from 1993 to 1997, a total of 43 Beznoska cups were implanted in 40 patients, 17 men and 23 women, with the average age of 61 and 65 years, respectively. Primary hip arthritis was the most frequent indication for arthroplasty. Most cups were used in combination with a cemented stem. METHODS: In 2002, 37 patients were examined. The follow-up period ranged from 5 to 10 years. Clinical evaluation was based on the Harris hip scores. X-ray films were examined for cup osteointegration and wear, and para-articular ossification. RESULTS: During the follow-up period, two patients died and one underwent reimplantation. The remaining 37 patients were satisfied with the surgical outcome. The Harris hip scores higher than 80 points were achieved in 80% of the patients. No loosening or wear of the cup was found at the follow-up. DISCUSSION: Good primary fixation in the acetabulum is the results of reliable anchorage by means of 16 spikes on the metal surface of the cup. Good secondary fixation is shown by the results of this study, although to confirm that the incorporation of a surface without a bioactive coat is long lasting will require at least 5 more years of follow-up. CONCLUSIONS: Total hip arthroplasty with the Beznoska cup achieved good outcomes. It was used several times to manage situations in which a press-fit cup initially indicated lacked sufficient primary retention because of the bone being too soft or the acetabulum defective.

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PubMed2004

Periacetabular giant cell tumor treated with intralesional excision and allograft reconstruction.

Giant cell tumors of the acetabulum are uncommon lesions. Their diagnosis is often delayed due to their slow progression, late onset symptoms and easily been obscured by bowel gas in plain pelvic radiographs. The tumor size is always very large at the time of diagnosis, with major nerve and joint involvement. Management of such tumor remains challenging to orthopedic surgeons. Between 1992 and 1999, 3 acetabular giant cell tumors were diagnosed and managed at our institution. The treatment modality was intralesional tumor excision with structural allograft reconstruction. The margin of tumor was routinely managed with high-speed burring and phenol application. All 3 patients were free of local recurrence at a mean follow-up of 89 months. Postoperative palsy of sciatic nerve occurred in 1 patient, but no complications such as wound infection or fracture were seen. The nerve palsy recovered completely 1 year later. The final functional outcome of the 3 patients was excellent. The result appears that intralesional excision with adjuvant therapy is feasible in the management of giant cell tumor of the acetabulum and is able to obtain a satisfactory outcome.

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