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PubMed2005

Acetabular augmentation at six- to 30-year follow-up. A biochemical and histological analysis.

In developmental dysplasia of the hip, a deficient acetabulum may be augmented by placing local autogenous iliac osseous graft, or the ilium itself, over the head of the femur with the expectation that the added bone will function as a bearing surface. We analysed this bone obtained en bloc during subsequent surgery which was performed for degenerative osteoarthritis in three patients at 6, 25 and 30 years after the initial augmentation procedure. In each patient, the augmentation comprised of red cancellous bone covered on its articulating surface by a distinct layer of white tissue. Microscopy of this tissue showed parallel rows of spindle-shaped cells lying between linearly arranged collagen bundles typical of joint capsule. Biochemical analysis showed type I collagen, the principal collagen of joint capsule and bone, with no significant quantity of type II collagen, the principal collagen of cartilage. While the added bone produced by acetabular augmentation was durable, histological and biochemical analyses suggested that it had not undergone cartilage metaplasia. The augmented acetabulum articulates with the head of the femur by means of an interposed hip joint capsule.

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PubMed2006

[Total hip arthroplasty for treatment of developmental dysplasia of the hip].

OBJECTIVE: To summarize the techniques of the total hip arthroplasty in the treatment of osteoarthritis secondary to developmental dysplasia of the hip joint (DDH). METHODS: Between February 1986 and November 2004, a total of 32 hips in 24 patients with advanced osteoarthritis secondary to DDH underwent the total hip arthroplasty. Among the patients, 4 were male and 20 were female, with their ages ranging from 33 to 59 years and an average age of 47 years. The bilateral arthroplasty was performed in 8 patients and the unilateral arthroplasty in 16 patients. The patients mainly suffered from pain and claudication. According to the Hartofilakidis classification, semidislocation occurred in 2 hips, low-dislocation in 21 hips, and high-dislocation in 9 hips; and the Harris scores before operation were 56.70 +/- 2.75, 36.09 +/- 4.16, and 29.45 +/- 2.16, respectively. RESULTS: All the patients were followed up for 6 months to 8 years (averaged 3 years and 4 months). The Harris scores after operation were 93.10 +/- 2.10, 92.7 +/- 3.20, and 88.09+/- 3.67, respectively. The differences between preoperation and postoperation were significant (P < 0.01). All the patients were pain-free and there was no sign of aseptic loosening and subsidence. CONCLUSION: The total hip arthroplasty is an effective method for the treatment of osteoarthritis secondary to DDH. The key techniques for the total hip arthroplasty are as follows: deepening the medial wall of the acetabulum, improving the techniques of the bone graft, and firmly placing the acetabular component in the true acetabulum.

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PubMed2006

[Resection and reconstruction for tumors of iliac bone].

OBJECTIVE: To discuss the resection of tumors, reconstruction of defects. METHODS: Sixty-one patients with tumors in ileum were treated surgically in People's Hospital from July 1998 to July 2004. The series comprised 38 males and 23 females with an average age of 43 years old (range from 12 to 78 years old). According to Enneking staging system, 36 cases had lesions in region I, 17 cases in region I and II, and 8 cases in region I and IV. After tumor resected, posterior fixation system of spine was applied to reconstruct the integrality of pelvic ring in series of region I cases. The four pedicle screws were implanted in the lumbar and sacrum superiorly, pubis and ischium inferiorly. For children patients, bone graft or bone cement and Steinmann's pins internal fixation was applied to reconstruct the pelvis. RESULTS: Among all the 61 cases, 48 cases followed up from 16 months to 6 years. Thirty-three cases were survived and had no local recurrence or metastasis. Fifteen cases were dead. Oncology result: local recurrence were found in 19.4% patients with region I resection (7/36), the resection level was close to acetabulum (in order to reserve the acetabulum), and it might be the reason of recurrence. 35.3% of patients (6/17) with region I and II resection had local recurrence, the recurrence maybe related to residual tumor after curettage. 50.0% of the patients (4/8) with region I and IV resection had local recurrence, the tumor residual in sacrum might be the reason of recurrence. Functional result: all of the 36 cases received region I resection regained normal walking function. The hip joint function was normal in 17 cases received tumor curettage, bone cement or hip joint replacement. CONCLUSIONS: The posterior fixation system of spine can be used to reconstruct the integrality of pelvic ring after resection of iliac tumors. Simple reconstruction is more favorable for child patients. Allograft or self-ileum can be implanted in the space of sacral wing and residual ileum, and the bone graft is fixed with compressional screw.

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PubMed2006

[Slotted acetabular augmentation in treatment of acetabular dysplasia].

OBJECTIVE: To improve the slotted acetabular augmentation to treat acetabular dysplasia. METHODS: Fifteen pediatric patients with developmental dysplasia of the hip, 3 male and 12 female, aged 8 - 16, with 20 ill acetabuli, underwent improved slotted acetabular augmentation: a piece of cancellous bone was grafted into a groove of the acetabulum, and the volume of acetabulum was enlarged. The effects were evaluated by clinical examination, X-ray examination, Charnley scoring, and Harris scoring. RESULTS: After the operation, the acetabular covering rate became 85%, and the mean acetabular index was decreased from 35 degrees to 25 degrees. CONCLUSION: Slotted acetabular augmentation is safe, simple, and effective in the treatment of acetabular dysplasia.

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PubMed1991

The letournel lateral approach for treatment of acetabular fractures.

The authors report 9 cases of acetabular fracture, 6 recent complex and 3 inveterate, treated surgically through the lateral incision of Letournel. This approach provides excellent exposure of the acetabulum, the iliac wing, the posterior column, and the anterior column up to the iliopectineal eminence. Nevertheless, the high incidence of often serious complications makes the combined anterior-posterior approach preferable for severe inveterate fractures of the acetabulum.

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PubMed1991

[Complete remission of bone metastasis of bladder cancer treated by cisplatin-etoposide therapy].

A case of bone metastasis from TCC of the bladder that attained complete remission by cisplatin-etoposide therapy was reported. The patient was a 68-year-old male, already treated with total cystectomy. At 29 months after operation, bone metastasis in left acetabulum was found. 3 courses of cisplatin-etoposide therapy were started. At 12 weeks after initiating the therapeutic regimen, the tumor mass of left acetabulum had disappeared completely on the computed tomogram.

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PubMed1990

Osteolysis in alloarthroplasty of the hip. The role of bone cement fragmentation.

Movement at the interface between bone and cement and fractures of the cement can cause fragmentation of the polymethylmethacrylate (PMMA) bone cement implant. In order to obtain further information about the effect of PMMA fragments on the surrounding tissue and the role of such particles in the development of bone resorption, the authors investigated 17 patients with cemented total hip endoprostheses showing osteolysis and implant loosening in the femoral shaft with (Group B) and without (Group A) involvement of the acetabulum. The roentgenographic follow-up examinations revealed an initially slow and later more rapid extension of the endosteal bone erosions, with a predilection for the tip of the stem, the lesser trochanter, and laterally for the middle of the stem. At revision surgery, tissue samples were taken from the joint capsule and the bone-cement interface, in particular from the osteolysis in the femoral shaft and the acetabulum. The tissue samples were processed for histology, microscopically examined, and semiquantitatively evaluated. The retrieved devices were also carefully inspected. Large foreign-body granulomas were found at the bone-cement interface and in the joint capsule. Histiocytes and foreign-body giant cells stored particles of PMMA and polyethylene, of which fragmented bone cement predominated. Granulomatous tissue invaded bone canals and marrow spaces and induced resorption of the surrounding bone. In four cases in Group A, tissue from the osteolysis contained only fragmented bone cement, demonstrating that PMMA particles alone may be responsible for triggering focal bone resorption. Osteolysis seems to begin at the site where disintegration of bone cement begins. In cases in which polyethylene particles were found in the tissue in addition to fragmented bone cement, wear from the ultrahigh molecular weight polyethylene socket has been increased by entrapment of PMMA particles between the joint surfaces. Thus, fragmentation of bone cement and abrasion of polyethylene enhance each other. Bone cement particles promote polyethylene wear, which in turn promotes granuloma formation, bone resorption, and subsequent bone cement disintegration.

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PubMed1990

Osteolysis in alloarthroplasty of the hip. The role of ultra-high molecular weight polyethylene wear particles.

Massive localized osteolysis around artificial joints has been seen more frequently in the past few years. It is still not generally accepted that ultra-high molecular weight polyethylene (UHMWPE) wear particles can induce massive bone resorption, even distant from the joint. This article describes a series of eight soft-top prostheses with large UHMWPE ball heads that contributed to the erosion of surrounding bone. Roentgenographically, all of the cases showed a marked loss of proximal cortical bone, more or less combined with osteolysis, which was distal to the femoral shaft and deep into the acetabulum. In two cases, remodeling and resorption transformed the bone into a tumorlike appearance. Tissue samples from areas of osteolysis as well as from the joint capsule were taken at revision surgery, processed for histology, examined microscopically, and evaluated semiquantitatively. The retrieved devices were also carefully inspected. Large amounts of UHMWPE wear debris were found not only in the joint capsule but also in layers of granulomatous tissue from the acetabulum and femur, whereas metal particles and fragmented polymethylmethacrylate were either completely absent or occurred only in very small amounts. The results of this study demonstrate that UHMWPE wear products alone can cause massive osteolysis by triggering foreign-body granuloma formation at the bone-cement interface; the bone cement may remain fixed in areas beyond the osteolytic transformation.

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PubMed1990

Acetabular dysplasia in the adolescent and young adult.

Hip dysplasia is a major cause of osteoarthrosis in adults. Early aggressive osteotomy has the potential of preventing the development of arthritis, but carries with it significant risks. The problem is further complicated because the surgeon has no means of quantifying the dysplastic deformity or of predicting what a particular combination of osteotomies would do to correct the deformity. This study describes methods of quantifying hip-joint geometry in three dimensions based on computed tomography and magnetic resonance studies, and of simulating pelvic osteotomy to correct the deformities. The study analyzes 49 normal hip joints and 20 dysplastic hip joints. The results show that the normal acetabulum is nearly a full hemisphere, which is anteverted 20 degrees and abducted 53 degrees. The normal lateral center-edge angle is 37 degrees. The dysplastic acetabulum is not anterolaterally maldirected, as has been assumed, but is globally dysplastic. Analysis of the individual dysplastic hip joints showed a wide variability. Some patients were deficient globally, some anterolaterally, and some posterolaterally. Methods of analyzing a patient's hip joint, quantifying abnormalities, simulating surgery, and predicting results are demonstrated in a case example.

Acetabulum↗
PubMed1990

Failure of acetabular autogenous grafts in total hip arthroplasty. Increasing incidence: a follow-up note.

We reported previously on the application of an autogenous femoral-head graft to the acetabulum during total hip arthroplasty for compensation of marked osseous deficiency in patients who had arthritis secondary to severe congenital dysplasia or dislocation of the hip. An average of seven years postoperatively, the graft seemed to have been a successful adjunct to the arthroplasty. Five years later, to assess our long-term results, we reviewed the findings in the same forty-six hips (thirty-seven patients) that we had studied previously. An average of 11.8 years after the total replacement and use of the autogenous femoral-head graft, nine hips (20 per cent) needed a second operation because the acetabular fixation had failed. Two had had a resection arthroplasty and seven, a complex revision. In one additional hip, a resection arthroplasty was done for infection that had developed after operative reattachment of the greater trochanter. In twelve of the remaining thirty-six hips, there was definite radiographic evidence of acetabular loosening. Thus, the total incidence of loosening of the acetabular component was 46 per cent (twenty-one hips). The average time from the index operation to the first definite radiographic evidence that the fixation had failed was 6.4 years (range, 2.9 to 12.7 years). While we recognize that application of a bulk autogenous graft to the acetabulum is useful when the acetabular bone stock is extremely deficient, we no longer recommend the use of bulk corticocancellous autogenous grafts in other situations.

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PubMed1990

[Experimental study on the etiology of pathogenesis of acetabular dysplasia in congenital dislocation of the hip].

In order to investigate the etiology of pathogenesis of congenital hip dislocation and acetabular dysplasia, experiments using fetuses of pregnant rabbits were conducted. The following findings were obtained. (1) Dislocation occurred in approximately 40% of total animals used. The earliest dislocation was seen 2 days after birth. (2) The hip dislocation could be relatively and easily generated by exogenous factors during the perinatal period, even without such primary cause, as hip joint dysplasia. The acetabular dysplasia could be generated secondarily to dislocation. (3) There was a difference in the cause of acetabular dysplasia between areas of the acetabulum with and without load. (4) The acetabular depth growth in the dislocated hip was more seriously impaired than the longitudinal and transverse diameters of the acetabular entrance. These results have indicated that endochondral ossification of the epiphyseal cartilage of the acetabulum in the dislocated hip was more markedly impaired than that of Y epiphyseal cartilage.

Acetabulum↗
PubMed1990

Acetabular reaction to the Bateman bipolar prosthesis.

The Bateman bipolar prosthesis has been used by the authors since 1974. The purpose of this study is to determine whether the implant functions as a bipolar device or as a unipolar hemiarthroplasty, which may cause damage to the acetabulum. Of 478 hips replaced from 1973 to 1983, 19 with acetabular changes were randomly selected to evaluate the response of the prosthesis. From the 11 cases with protrusio at the time of surgery, six showed thickening of the acetabular wall, while no changes were observed during ten years follow-up study in the five remaining cases; in one case, the wall gave way, and a revision was necessary. In five patients with subchondral cysts, the cysts tended to gradually disappear. Three patients showed sclerosis in the subchondral acetabular bone, which also decreased gradually. Previous facts suggest the acetabulum tolerates the implant well even with some damage at the time of surgery. Whether this depends on the amount of movement and friction occurring between the head and the insert is still undetermined.

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PubMed1990

[Current role of the osteoplastic shelf in the treatment of sequelae of hip dislocation in adults].

This operation, first described by König at the end of the 19th century, continues to have some indications. This simple operation should be performed with a very precise technique: the new shelf is placed at the rim of the acetabulum on the capsule; the shelf should be solid and well-fitting, making any secondary displacement impossible, even when the patient is walking. The hip should be covered anteriorly and superiorly. The main indication is a dysplastic acetabulum, especially with a vertical roof. The best results are seen after operation on dysplastic hips without osteoarthritis; when osteoarthritis is present, the results are less good. The procedure is generally indicated only in patients younger than 45 years and it is relatively contraindicated in patients over 50 years old. It is very important to discuss the indication for this operation with the patient; it is a prophylactic measure performed on a hip with normal mobility and little pain.

Acetabulum↗
PubMed1989

Posterior acetabular fracture-dislocations: fragment size, joint capsule, and stability.

In acetabular fractures, the size of a significant posterior wall fragment remains undefined as it affects joint stability. The purpose of this study was to quantitatively evaluate fragment size and hip stability in cadaveric specimens after serial osteotomies. Also, the role of the posterior capsule, in the various osteotomies, was evaluated for changes in hip stability. We found that fragments involving 25% or less of the acetabulum are insignificant, i.e., do not affect joint stability, while fragments involving 50% or more are significant. The significance of transitional fragments (25-50% of the acetabulum) is determined by the posterior capsule.

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PubMed1989

[Total prosthesis implantation with added pelvic osteosynthesis].

This report documents our limited experience with total hip replacement requiring large bone-graft reconstruction of the acetabulum with internal fixation. Four of the 14 patients were elderly and had a fresh fracture of the acetabulum; 6 had severe loosening of the acetabular companent with non-union, necessitating plate fixation along the pelvic rim in 5 patients. Four patients had large defects after tumor resection. In only 1 of these 14 cases did loosening occur. Our results are promising and we plan to increase the use of pelvic plates in these extremely unstable cases. Following stabilization of the pelvic ring, a metallic reinforcement ring increases stability. These operations were performed via an anterior ilioinguinal approach.

Acetabulum↗
PubMed1989

[Triple osteotomy of the pelvis in children].

The innominate osteotomy described by Salter was used to redirect the acetabulum in the course of the treatment of a number of hip diseases in children. This resulted in an immediate improvement of coverage of the femoral head. One can also expect a more congruent growth of the two constituents of the hip joint in the forthcoming years. In older children in whom rigidity of the pubic symphysis did not permit a sufficient amount of acetabular tilt the acetabulum had to be isolated from the rest of the pelvis by a triple osteotomy which consisted of, in addition to the osteotomy of the ilium, osteotomies of the superior pubic ramus and the ischium or the inferior pubic ramus.

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PubMed1989

The Müller reinforcement ring in surgery of the hip.

The author reports 15 cases (16 hips) in which the Müller reinforcement ring was used. This is an effective alternative to more difficult and complicated surgery in cases of acetabular dysplasia, coxa profunda and, in particular, cases involving the reimplantation of a broken or loose prosthetic acetabulum. In cases of dysplasia it avoids complicated pelvic osteotomies, or the use of bone transplants to fill defects. In reimplantation, in particular, when the base of the acetabulum is defective, the ring avoids reconstruction of the base making the operation simpler and quicker, with a correspondingly more rapid recovery.

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PubMed1989

Traumatic iliofemoral arterial injury: an association with high anterior acetabular fractures.

Two patients with documented anteroposterior compression injuries to the pelvis sustained concomitant injury to the iliofemoral artery and fracture of the acetabulum involving the high anterior column (the portion of the ilium forming the anterior component of the acetabulum). In a series of 800 major pelvic fractures similar arterial injuries have not occurred in association with other documented mechanisms. A high index of suspicion for iliofemoral artery injuries should be held by the clinician treating patients with acetabular fractures of the high anterior column sustained from anteroposterior compressive forces.

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