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PubMed1989

[Revision arthroplasty of the hip joint with autologous and homologous cancellous bone].

On revision arthroplasty a substantial loss of bone stock is frequently encountered. To anchor the new prosthesis many different additional technical appliances, e.g. supporting rings, wire meshes and fixation screws, are suggested. However, filling of all the bone cavities by cement will lead to further peripheral defects of bone stock, worsening the situation if renewed loosening occurs. Such loosening must be expected since additional bone is damaged by the implants and the large amount of cement. Therefore, it is increasingly recognized that biologic reconstruction of the deficient acetabulum and femoral shaft by bone grafting should be the goal in revision arthroplasty, in order to restore the bone-implant interface to the site of a primary arthroplasty. Autologous bone graft is harvested from the outer iliac wing as a bone paste most easily by use of an acetabular reamer. As an additional approach is needed and the amount is not always sufficient, often homologous bone is used in solid cortico-cancellous blocks or as a bone paste ground by a bone mill. The bone banking procedure is described. At the acetabulum the grafting technique depends on whether there is a contained or non-contained defect. The cup has to be brought to the anatomical position and should be supported at several sites by the original iliac bone and not only by the graft. At the shaft, osteotomy of the greater trochanter can be avoided by a lateral transgluteal approach in the vast majority of cases (90 out of 95 cases). If still possible, a short stem is preferred to an extra-long one. Follow-up examination of 164 patients at 46 months (min. 24, max. 78 months) after cup revision showed that 8 re-revisions had been performed in the meantime: in 6 cases renewed loosening or infection had been treated by implantation of a new component; in 2 cases a Girdlestone procedure was the final outcome.

Acetabulum↗
PubMed1988

The acetabular teardrop and its relevance to acetabular migration.

Five pelvises were photographed, roentgenographed, and sequentially sectioned or reamed to determine the location and appearance of the acetabular teardrop figure. The teardrop is located inferomedially in the acetabulum, just superior to the obturator foramen. The lateral lip is the exterior, and the medial lip is the interior of the acetabular wall. The ilioischial line projects over the medial acetabulum only fortuitously on the straight anteroposterior (AP) roentgenogram. Because of parallax, the relationship between the ilioischial line and the teardrop changes for views varying as little as 10 degrees in horizontal obliquity from the true AP roentgenogram. Because the teardrop comprises a well-defined, constant portion of the medial acetabular wall whereas the ilioischial line does not, the authors recommend using the acetabular teardrop rather than the ilioischial line for the detection and measurement of medial and superior acetabular migration.

Acetabulum↗
PubMed1988

[Late results of the Colonna arthroplasty].

A long term follow-up study (20-26 years after the original surgery) is presented of 7 patients who underwent a capsular arthroplasty according to the method of Colonna for congenital hip dislocation. Clinically and, in part also radiologically, the results were amazingly good. If we respect a few essential rules before, during and after the operation, all aiming at avoiding hyperpressure in the hip joint, the Colonna procedure may still be an alternative to more modern reconstructive procedures of the acetabulum. This is particularly true for congenital dislocations in the older child or unsuccessfully treated high residual subluxations. In both cases the cartilage of the acetabulum is altered and deformed to such an extent, that no method can make it fit the femoral head, which is also deformed.

Acetabulum↗
PubMed1988

Neuropathic arthropathy as a possible cause of failure of a whole joint allograft. A case report.

This report illustrates the fate of a whole joint allograft in a 23-year-old male with chondrosarcoma of the right hip. An extraarticular resection of the right proximal femur and surrounding pelvis was performed. Reconstruction was carried out with a fresh-frozen cadaveric allograft of articulated proximal femur and acetabulum with the capsule intact. Excellent union at the junction of host bone with the allograft was demonstrated roentgenographically 12 months later. Nineteen months after the operation, as weight bearing proceeded, sudden onset of instability of the joint occurred without pain. Collapse of the allograft with partial dissolution of the femoral head and acetabulum were observed roentgenographically. Reconstruction was achieved with a prosthetic implant. The roentgenographic and pathologic features of the allograft are suggestive of neuropathic arthropathy; however, the possibility of allograft rejection cannot be excluded but seems unlikely.

Acetabulum↗
PubMed1987

Treatment of congenital dislocation of the hip in older children.

The aims of treatment of a child with congenital dislocation of the hip (CDH) untreated until walking age should be to reestablish the mechanics of the hip joint and avoid complications, especially avascular necrosis, thus delaying the development of osteoarthritis. The pathology in the older child shows that both soft tissues and bony parts are distorted to some degree. The acetabular index and center-edge (CE) angle evaluations are helpful in the initial evaluation and in the follow-up examinations. A computed tomography (CT) scan may be helpful in determining a reduction and distinguishing between dysplasia and subluxation. A controversy still exists as to the relative value of closed and open reduction in the treatment of a child who has reached walking age. For most surgeons, in a child up to three years of age, a careful closed reduction following a period of traction is the most useful form of treatment. The home traction program has been successful in this age group. For gentle closed reduction all maneuvers must be done as gently as possible and carried out as "positioning" the leg rather than forcing a reduction. The indications for open reduction are (1) if the femoral head persistently lies above the triradiate cartilage on roentgenographic examination, (2) if the arc of reduction and redislocation is less than 25 degrees after an adductor tenotomy, (3) if the femoral head will not enter the acetabulum, (4) if the femoral head is still laterally placed in the acetabulum after four weeks of partial reduction, and (5) if a previous reduction has failed.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1986

New plate for acetabular fractures: technique of application and long-term follow-up evaluation.

A stainless steel plate was designed for use on the dorsal rim of the acetabulum of the dog. The surgical procedure, using this plate, is easier and less time consuming than previous techniques, because the plate is easier to contour to the dorsal rim of the acetabulum. The use of this plate, compared with other types of plates, has resulted in more accurate anatomic reduction after fixation. No long-term complications caused by the plate or screws have been identified. Follow-up examinations have revealed that the functional use of the limb is as good as with other types of plates.

Acetabulum↗
PubMed1986

[Peri-acetabular pelvic osteotomy in the treatment of congenital hip dislocation in older children and adolescents].

The author describes a double osteotomy combining a pelvic (Salter) type of osteotomy and a periacetabular (Pemberton) type of osteotomy performed in one procedure by an anterior approach and aimed at a re-orientation of the acetabulum and a correction of any dysplasia. The technique is indicated in older children and adolescents when other procedures are not possible. However, this operation is not possible in cases where the circumference of the upper part of the acetabulum is smaller than that of the femoral head. It was applied in 30 hips with satisfactory results after a mean follow-up of one year.

Acetabulum↗
PubMed1986

Uncemented acetabular cups in dysplastic and protrusio acetabuli.

Total hip arthroplasties using the Ring uncemented polyethylene to metal system were carried out in 84 hips with either protrusio or dysplasia of the acetabulum. The results of the operation, the stability and function of the acetabular implant, and radiologic changes in the medial wall of the acetabulum in the protrusio hips were assessed over a two- to five-year follow-up period. Annual assessment over the follow-up period showed that an excellent functional result was achieved in all patients. Six of the eight hips with severe protrusio showed an increase in the thickness of the medial acetabular wall one year from the time of operation. Lack of bony cover over the lateral surface of the acetabular cup in the dysplastic hips did not have any adverse effect on the stability and function of these hips.

Acetabulum↗
PubMed1987

Acetabular dysplasia and osteoarthritis developed by an eversion of the acetabular labrum.

To investigate adverse effects of acetabular labrumectomy on the growth and development of the acetabulum, the author subjected the hip joints of 20 young rapidly growing dogs to eversion of the acetabular labrum. It was found to produce acetabular dysplasia. The acetabulum gradually became shallower and more vertically oriented, and the femoral head gradually subluxed but never dislocated. The radiographic appearance of the hip dysplasia was similar to that seen in humans. Histologically, a substantial degenerative change in articular cartilage was observed in the subluxed hip, without any evidence of degenerative arthritis radiologically. When operating on congenital dislocation of the hip, a complete excision or eversion of the acetabular labrum should be avoided. Radial splitting of the acetabular labrum may safely avoid the risk of violating the acetabular epiphyseal cartilage.

Acetabulum↗
PubMed1985

Hip replacement arthroplasty in rheumatoid arthritis.

Numerous factors conspire to make hip replacement arthroplasty for rheumatoid arthritis different from the same operation in osteo-arthritis. Patients are frequently younger, arousing fears that the patient will outlive the prosthesis. However this factor is more than counterbalanced by the constraints imposed by the disease in other joints: polyarticular involvement usually protects the hip arthroplasty from weight-bearing stress thus prolonging its life. Protrusio acetabuli, uncommon in osteo-arthritis is the commonest presentation in rheumatoid arthritis because of the concentric cartilage degradation which erodes the acetabulum medially and proximally. In arthroplasty for protrusio, a plea is made for grafting of the floor of the acetabulum with solid bone derived usually from the femoral head. This offers a stronger and more physiological support for the acetabular component than synthetic devices. The hip is often only one of the many joints requiring arthroplasty to maintain locomotor function in severe cases of rheumatoid and the results of multiple operations are usually very gratifying. However, any form of surgery may be contra-indicated in a patient enfeebled by prolonged immobilisation from involvement of multiple joints. Late infection of cemented prosthesis is commoner in rheumatoid than in osteo-arthritis: such patients need antibiotic cover during transient bacteraemia from any cause such as dental extraction, trivial infections etc.

Acetabulum↗
PubMed1985

[Analysis of the scintigraphic image of bone grafts in reconstruction of total hip prostheses].

Eighteen total hip prostheses required reoperation after loosening of the acetabular component. The authors used autografts (8 cases) or allografts (9 cases) or both (1 case) to reinforce the acetabulum. The fate of the grafts was analysed using Technetium 99 scintigraphy. There were 8 shelf operations and 10 massive grafts replacing either the anterior or posterior wall of the acetabulum. The scintigraphic study came to the conclusion that autografts resulted in intense reaction with fixation after two to sixteen months. From this it can be assumed that their rehabilitation was satisfactory. In contrast, allografts were poorly incorporated. Scintigraphy in these cases was of low intensity, scattered and was not long-lasting. The authors consider that this type of graft has little chance of producing a solid and homogeneous mass of bone in the long term. They consider that, when necessary, a mixture of autograft and allograft should be used.

Acetabulum↗
PubMed1985

Total hip acetabular cup flange design and its effect on cement fixation.

The design of pods and flanges on the acetabular cup surface was investigated to determine the effects on cement fixation of the total hip arthroplasty (THA) acetabular cup. To a basic cup designed with pods, four different types of flange designs were added: a cup without a flange, a cup having a flange with 12 scallops, a cup having a flange with three scallops, and a cup having a continuous flange. The cups were each inserted, via an MTS machine, into an instrumented simulated acetabulum containing polymerizing polymethylmethacrylate (PMMA). The PMMA intrusion pressure was measured by four pressure transducers, and the cement intrusion depth was measured via three rheometers. Also, three continuous-flange cups were manually inserted into cadaver acetabula in order to study the shape of the cement mantle around the cup. A cup with a continuous flange generated significantly higher cement intrusion pressures and depths when compared with the other three cups. A cup with pods and a continuous flange produced concentric positioning of the cup with a uniform cement thickness around the cup and was well contained within the reamed acetabulum.

Acetabulum↗
PubMed1985

[The natural course of osteoarthritis of the hip. Indication of conservative treatment in relation to osteophyte formation at the acetabular rim].

One hundred and eighty-five hips from 152 patients with primary or secondary osteoarthritis were studied in an attempt to assess the degrees of hip pain in contrast to radiological and other clinical findings. In 30.8% and 26.4% of the primary and secondary osteoarthritic hips respectively, hip pain showed some gradual decrease as time elapsed. Pain relief probably in association with osteophyte formation at the craniolateral acetabular rim occurred in 62.5% and 33.3% of the primary and secondary osteoarthritic hips respectively. Significant parameters observed in the primary osteoarthritic cases of the decreasing pain group were as follows: A lesser extent of cranial displacement of the femoral head, poor capital drop development, well developed floor osteophyte. On the other hand significant parameters in the decreasing pain group of secondary osteoarthritis were as follows: Well developed floor osteophyte, a small size of cyst in both the femoral head and the acetabulum, few "b" or "d" type of bony sclerosis in the acetabulum. Careful observation of radiographic changes (cyst and sourcil) would be most important, especially in secondary osteoarthritis, to decide the indication of surgery. On the basis of histological studies of osteophyte at the craniolateral acetabular rim obtained at the operation, it was assumed that the osteophyte formation had initiated from metaplasia of the labrum or synovial membrane and progressed by a form of chondral ossification after the process of fibrous tissue formation. A well developed trabecular density in the osteophyte at the craniolateral acetabular rim was determined by the use of Muto digigrammer system, Model G-002.

Acetabulum↗
PubMed1985

Traumatic loosening of a prosthetic acetabular cup in a young patient.

The authors present a case of loosening of the acetabular cup of a total prosthesis resulting from an injury which caused a fracture of the acetabulum. This does not appear to have been previously recorded in the literature. This case also presented a problem of treatment and emphasizes the need for intercompatibility of prosthetic components should only one need replacement. Bone grafts were used in this case to reinforce the acetabular roof for the secure seating of a replacement cup--in this case a cementless acetabular component screwed into the bony acetabulum.

Accidents, Traffic↗
PubMed1985

[Acetabular fractures and sacroiliac dislocations].

Involvement of the sacro-iliac joint is frequently associated with acetabular fractures. It was noted on 23 occasions in fractures of both columns of the acetabulum. Tomodensitometry is a key examination which shows lesions which could be missed on standard X-Rays. Dislocations of the sacro-iliac joint diminished the possibility of exact reduction. In 23 cases, only three sacro-iliac lesions were anatomically reduced and 13 hips were well centered. The results obtained after surgical treatment were better than after conservative treatment. This explained the finding that 10 hips developed arthrosis in 14 patients treated conservatively and only 3 in 9 treated surgically. The sacro-iliac involvement was either an anterior opening of the joint leading to an antero-posterior excentration of the hip, or an inferior opening leading to a lateral shift of the iliac bone and a vertical orientation of the acetabulum. In several cases, both types of displacement were present. The diagnosis of the sacro-iliac joint lesion is helped by tomodensitometry though it can also be made by good antero-posterior pelvic radiographs. Conservative treatment using traction was unable to reduce the sacro-iliac lesion, and in some cases it increased the displacement of the iliac bone. Treatment should be by reduction, either using external fixators or by internal fixation.

Acetabulum↗
PubMed1974

The treatment of fracture-dislocation of the hip by total hip arthroplasty.

Five patients with chronic and subacute unreduced fracture-dislocation of the hip were treated successfully by total hip arthroplasty. The regimen developed was as follows: The first stage, in general, consisted of removal of the head of the femur and reduction and internal fixation of the acetabular fragments. Surgery to the sciatic nerve, if necessary, was done at this time. This was followed by total hip arthroplasty in five to eight weeks as a second stage. If severe fracture of the acetabulum occurred with dislocation of the hip, and the hip could be reduced, total hip arthroplasty could be done in one stage, either soon after the injury or at a later time. Such a procedure restores almost normal function to a hip that otherwise may remain painful and stiff because of traumatic arthritis and disturbed anatomical relationships of the acetabulum to the femoral head, and may save the patient much time and suffering.

Acetabulum↗
PubMed1983

Intracapsular and intraosseous vascular supply to the mature dog's coxofemoral joint.

The intracapsular and intraosseous arterial supply to the mature dog's coxofemoral joint was investigated using a vascular injection, tissue-clearing technique in 6 mixed-breed dogs. Ascending arteries of the femoral neck, arising from an extracapsular vascular ring at the base of the femoral neck, penetrated the articular capsule and traveled subsynovially over the surface of the femoral neck. These intracapsular arteries formed an incomplete intracapsular vascular ring at the junction of the femoral head and neck. Bony components of the acetabulum, ie, ilium, ischium, and acetabular bones, received intraosseous vascular supply from the nutrient artery of the ilium and minute vessels entering nutrient foramina around the rim of the acetabulum. The femoral head received branches (epiphyseal arteries) from the ascending arteries of the femoral neck at the intracapsular vascular ring. Epiphyseal arteries formed anastomosing vascular arches of decreasing caliber up to the subchondral bone of the femoral head. The proximal femoral metaphysis, particularly the femoral neck, received vascular supply from 4 sources: (i) branches from the epiphyseal arteries on the surface of the physeal scar which descended, penetrating the physeal scar, (ii) distally directed branches from the intracapsular vascular ring, (iii) ascending nutrient vessels from the trochanteric fossa, and (iv) terminal branches of the ascending nutrient artery of the femur.

Acetabulum↗
PubMed1978

[Injuries of the pelvis (author'r transl)].

Fractures of the pelvis impair the statics of the body and the dynamics of trunk and leg movement. Concomitant injuries obtain vital importance for the digestive tract, the urogenital system and the greater blood vessels. The operative reconstruction of acetabulum fractures is recommended increasingly. The late results concerning prevention of arthrosis, however, are not convincing. Posterior marginal fractures of the acetabulum, such as those to be found after posterior luxation of the hip joint, should be fixed by operation.

Acetabulum↗