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PubMed1994

[Letournel's ilio-femoral way in acetabular fractures of the two columns. A prospective study].

PURPOSE OF THE STUDY: The authors present the anatomical and functional results of the systematic use of Letournel's extensive lateral approach for internal fixation of the fractures of the acetabulum involving the two columns. MATERIAL: This prospective study concerns 25 patients. Mean age was 38 years. Mean follow-up was 4 years and 6 months (with extremes of 1 year and 9 years 9 months). 13 cases had a minimum of 4 years of follow-up. There were 1 transversal fracture, 9 transversal fractures associated with a posterior wall fracture, 2 anterior column fractures associated with a hemitransversal posterior fracture, 6 "T" shaped fractures, 7 fractures of the two columns. During the procedure, a trochanterotomy was carried out. Not any of the patients was irradiated postoperatively and they did not take any indomethacin. The patients were operated on 10 days after the accident, on average (with the extremes of 2 and 60 days). The average time of the procedure was 4 H 20 and 1080 cc of globular sediment were used during the intervention on average. The same surgeons participated in each operation. METHODS: The anatomical results were analysed according to Matta's criteria and the congruence study head-roof and head-acetabulum of the SOFCOT symposium in 1981. The functional results were analysed using the quotation of Merle d'Aubigné. Complications were searched systematically. The appearance of heterotopic ossifications was analysed according to Brooker. RESULTS: 23 patients had a satisfactory anatomical reduction and 11 patients out of 13 did not present any arthrosis after a minimum of 4 years follow-up. 12 patients had very good or good functional results. 3 patients had no heterotopic ossifications, 7 were grade I, 5 grade II, 8 grade III, and 2 grade IV. The gluteus medius was quoted 4 in 18 patients and 5 in 5 patients. There were 2 cases of deep suppuration, one of them was a patient who died 6 months later of a pancreas cancer unrecognized at the time of the accident. There were 5 aseptic osteonecroses and 3 cases of regressive paralysis of the sciatic nerve. 4 total hip prosthesis were inserted secondarily. DISCUSSION: The Letournel extensive lateral approach was efficient to obtain an anatomical reduction but, functionally, it was only efficient in one case out of two. For the moment, the authors associate systematically a postoperative irradiation to reduce the ossifications (10 to 12 gray in 5 sessions). On the other hand, they try to obtain a more efficient reinsertion of the glutei muscles, thank to a bone fragment of the iliac crest. CONCLUSION: The authors limit their indications of the Letournel's extensive lateral approach to the fractures of the two columns, not older than 10 days or to the comminuted ones.

Acetabulum↗
PubMed1995

[Traumatic hip dislocation with "spontaneous" reposition and re-luxation].

A case of traumatic hip dislocation with spontaneous reduction of the hip joint is presented. The patient was involved in a car accident, and characterized as multitraumatized. On admission to the Emergency Department there were no clinical signs of traumatic hip-dislocation, but because of the severity of the trauma an X-ray of the pelvis was performed and a fracture of the acetabulum diagnosed. The patient was taken to the operating theatre for surgery of several fractures of both upper and lower extremities. This was followed by control X-rays including both anterior-posterior and lateral views of the right hip. This demonstrated that the right hip was now dislocated. The dislocation was reduced. CT showed a larger fracture of the acetabulum, and this was treated with osteosynthesis. Patients with an unstable hip due to trauma, should as a general rule have the hip X-rayed in two planes. It is further suggested that in cases of severely traumatized patients X-ray of the pelvis should be routinely performed.

Accidents, Traffic↗
PubMed1994

[Three-dimensional ultrasound image of the infant hip].

Ultrasound imaging of the infant hip has gained wide acceptance, especially in diagnosis and therapy of infant hip dysplasias. Problems are the prognosis with regard to normal and pathological alpha-angle and treatment using cast, harness, or pillow. The well-known two-dimensional ultrasound techniques are not able to reproduce the correct relationship between femoral head and acetabulum. The use of the new three-dimensional technique is independent of the position of the infant hip. Although a special view into the acetabulum is possible, at present this method is not suitable for screening programs.

Acetabulum↗
PubMed1993

[Treatment of acetabular fractures].

The authors present an account of 85 patients with fractures of the acetabulum treated at the Orthopaedic Clinic, Faculty Hospital Plzen in 1985-1991. The fractures are classified according to Lettournel-Judet. The authors investigated associated injuries which prolong the interval between injury and operation as well as the correlation between the mechanism of injury and the patient's age and the incidence of injuries in different months of the year. For indication for operation the quality of reposition evaluated by computed tomography is essential. The authors analyze the length of the interval between injury and operation, administration of antibiotics and anticoagulants. As to early complications, they pay attention in particular to bronchopneumonia, infection and thromboembolic disease. The paper deals also with the most serious late complication--avascular necrosis--and the authors discuss the causes of its development as well as possibilities to influence it. The paper presents also results evaluating patients as regards their return to work, subjective evaluation of gait, pain of the joints and satisfaction with treatment. The case-history is followed by discussion concerned with the importance of computed tomography, the surgical approach, importance of treatment of the sacroiliac complex, the development of heterotopic and ectopic ossifications and the essential time of relief of the operated joint. In the conclusion the authors summarize the basic principles of fractures of the acetabulum.

Acetabulum↗
PubMed1993

The treatment of acetabular fractures through the ilioinguinal approach.

The ilioinguinal approach was developed in 1965 as an anterior approach to the pelvis and acetabulum. Before this date, the Smith-Petersen incision or a modification of it called the iliofemoral approach provided the only access to the upper part of the anterior column of the acetabulum. In the current study of 195 acetabular fractures, the ilioinguinal approach was used alone in 178 cases (90%) and in combination with the Kocker-Langenbeck as a double incision in 17 cases (10%). There were 39 simple and 156 complex associated fracture patterns. There were two large groups of associated fractures: anterior column posterior hemitransverse (39 fractures) and both column fractures (98 cases). Of these fracture patterns stabilized through the ilioinguinal approach, there was a rate of perfect reduction of 85% and 73%, respectively. Of 70 fractures involving the anterior column, anterior wall, and anterior column posterior hemitransverse, there were 61 perfect reductions (87%). The complication rate was extremely low, without any evidence of external iliac fossa heterotopic ossification. The ilioinguinal approach provides total and complete access to the anterior column from the sacroiliac joint to the pubic symphysis. An experienced acetabular surgeon may achieve excellent results even with complex fracture patterns.

Acetabulum↗
PubMed1996

[Murata-Chiba (MC) support ring for acetabular defect in rheumatoid hip].

Acetabular protrusion presents a particular challenge in rheumatoid arthritis. Our surgical plan is (1) to use autologous bone grafts for reconstruction of the acetabulum (2) to locate the correct anatomic position of the acetabulum, (3) to use a uncemented porous socket with rigid screw fixation. From 1991 we began to use MC (Murata-Chiba) support ring which was assembled with Harris-Galante porous socket for highly deformed hip such as acetabular protrusion. We evaluated the clinical and radiographic results of 10 cases. All cases had excellent or good results at follow-up with improved overall function in terms of standing, transfer activities and relief of pain. No apparent complications related to the device was noted. MC support ring is an useful device in rheumatoid hip with severe acetabular protrusion.

Acetabulum↗
PubMed1996

Prospective serial technetium diphosphonate and indium-111 white blood cell labeled imaging in primary uncemented total hip arthroplasty.

Although technetium diphosphonate (TcMP) and Indium-111 white blood cell labeled (Ind-WBC) imaging are reported useful in identifying aseptic and septic loosening in cemented hip arthroplasty, their usefulness has not been identified in uncemented porous coated hip arthroplasty. We attempted to define the natural history of TcMP and Ind-WBC imaging in primary P.C.A. uncemented total hip arthroplasty. Twenty-five hips in 21 patients were scanned immediately postoperatively, at 3 months, 6 months, 12 months, 18 months, and 24 months after surgery with both TcMP and Ind-WBC tracers. Clinical and radiographic follow-up were also obtained at each interval. Intensity and distribution of tracer activity were recorded as well as the time when stabilization occurred around the acetabulum, femoral porous surface areas, and femoral stem tip. Acetabular cup and femoral porous surface areas stabilized in the first year on both TcMP and Ind-WBC imaging. Focal femoral hip activity continued at 24 months in 72% of TcMP and 24% of Ind-WBC images. TcMP and Ind-WBC images used to assess uncemented total hip arthroplasty should not be over interpreted. Although persistent intense activity after one year around the acetabulum and porous surface femoral areas should be considered abnormal for both TcMP and Ind-WBC scans, femoral tip activity is present in the majority of patients, with or without thigh pain, at 24 months on TcMP scans. Tip activity can also persist at 24 months on Ind-WBC images and should be interpreted in conjunction with TcMP images.

Acetabulum↗
PubMed1998

Indications for intertrochanteric osteotomy after periacetabular osteotomy for adult hip dysplasia.

Residual hip dysplasia in the adult is characterized by deficient anterior and lateral acetabular coverage with subsequent hip joint incongruity and instability. The frequency of periacetabular osteotomy for the treatment of residual hip dysplasia is increasing. In certain morphologic conditions preoperative abduction or intraoperative radiographs reveal that congruency after a periacetabular osteotomy is not optimum; at this point the surgeon may consider the addition of an intertrochanteric osteotomy. In a retrospective study, the radiographs of 25 patients who had a femoral osteotomy with or after periacetabular osteotomy were analyzed and the results were compared with a control group of 34 patients who had periacetabular osteotomy without a femoral osteotomy. The analyzed parameters included: the femoral head extrusion index and the acetabular index, before and after periacetabular osteotomy; the femoral neck shaft angle; the presence of femoral head deformity; the presence of osteoarthrosis; the presence of a secondary acetabulum; the influence of previous ipsilateral hip surgery; the effect of hip adduction or abduction on joint congruency; and the age of the patient. The variables that had a statistically significant association with the performance of an intertrochanteric osteotomy included a femoral head extrusion index and an acetabular index after periacetabular osteotomy outside the normal limits, a neck shaft angle outside the limits of the control group, a deformed femoral head, an osteoarthritic hip, a secondary acetabulum, and a joint space height and congruency dependent on position of the proximal femur. When using statistically significant variables, a discriminant analysis predicted the correct group (periacetabular osteotomy with femoral osteotomy, or periacetabular osteotomy without femoral osteotomy) for 89% of the cases.

Acetabulum↗
PubMed1998

[Multiple fractures following seizures in a pregnant woman].

A 27-year-old woman, immigrated from Libanon, pregnant and at term was admitted with pain in the lower abdomen. The history was badly recognized because of the patient's inability to speak Danish. X-ray revealed a fracture of the left acetabulum with a minor central dislocation of the femoral head. During a new seizure she had another fracture of the right acetabulum also with a minor central dislocation of the femoral head and an undisplaced fracture of the proximal humerus on the left side. She was then delivered by a caesarean section. The seizures were later found to be due to grand mal type epileptic attacks. This case underlines the importance of a careful clinical and radiological investigation of patients with complaints of pain related to the central joints after seizures.

Accidental Falls↗
PubMed1997

-Arthrography of the hip-.

Painful hip with normal X-rays (including false-lateral view of both hips) is the main indication for hip arthrography, searching for focal chondropathy. In the presence of moderate hip degenerative arthritis contrasting with increasing disability, a labrum lesion must be investigated. Such lesions are of two kinds, mainly degenerative (of the superior labrum) or post-traumatic (of the posterior labrum). Arthrography allows the diagnosis of cystic changes located in the acetabulum. It also allows the diagnosis and evaluation of the extent of synovial osteochondromatosis or villonodular synovitis. In three indications, computed tomographies must be added to plain arthrography: posterior labrum lesions, osteochondromatosis (looking for foreign bodies in the acetabular fossa) and cystic changes in the acetabulum (with density measurements). In all cases, a complete conventional radiological assessment must be available. Strict asepsis must be ensured. When osteochondromatosis is suspected, evaluation of articular capacity must be systematic.

Acetabulum↗
PubMed1998

Acetabular reconstruction in revision total hip arthroplasty: a review of options.

Revision of the acetabular component in total hip arthroplasty occurs for reasons such as polyethylene wear and osteolysis, recurrent dislocation, and mechanical failure. The major problems in acetabular revision surgery are loss of bone stock, difficulty in achieving stability, and alteration of the hip center of rotation. The goal of reconstruction is to use or restore the supportive structural integrity of the acetabulum to create a situation similar to primary arthroplasty. There are several options for reconstruction in acetabular revision surgery. This paper reviews contemporary revision options and concepts relating to the acetabulum.

Acetabulum↗
PubMed1998

[The Donauspital-Stolzalpe concept (Danube Hospital, Vienna, Austria). Corrective osteotomy with selective labrum surgery following preoperative MRI arthrography].

Concomitant pathologies (labral lesions, intra-/extra-osseous ganglia and stress bone marrow edema) in adult residual hip dysplasia (RHD) might influence the outcome of conservative hip surgery. The aim of our prospective clinical study was to assess the value of preoperative MR arthrography in diagnosing concomitant lesions and in making surgical decisions in RHD. The first 37 consecutive patients with a minimum follow-up of 18 months have been analysed. All 37 patients presented RHD with the clinical symptomatology of labral lesions and underwent routine preoperative MRA. According to clinical, radiological and MR arthrographical criteria, these 37 patients were subdivided into four therapeutic subgroups: (1) reorientation of the acetabulum using the Tönnis triple pelvic osteotomy (TPO); (2) intertrochanteric varisation osteotomy (IVO); (3) palliative decompression with only symptomatic partial resection of the torn labrum (PALL); (4) primary total hip replacement (TEP). Based on the preliminary clinical and radiological outcomes of these four subgroups, the following conclusions can be drawn: labral lesions are considered to be a sign of chronic joint instability. Therefore, acetabular malorientation should be corrected by redirectional osteotomy of the acetabulum (TPO-subgroup) even in low grades of RHD if labral lesions are present. "Palliative" labral resections without corrective osteotomy (PALL subgroup) in secondary osteoarthritis due to RHD are definitively obsolete, because they rapidly progress to severe osteoarthritis due to surgically accelerated joint instability. In RHD with highly osteoarthritic hip joints and concomitant lesions, one should not hesitate to perform primary THR even in young patients.

Acetabulum↗
PubMedDate not supplied

Radiological demarcation of cemented sockets in total hip replacement.

The frequency of radiological demarcation of the cement-bone junction in the acetabulum after total hip replacement has been examined in 141 Charnley low-friction arthroplasties followed for an average of 10.1 years. Sixty-nine per cent showed demarcation of various degrees and 9.2 per cent of the series showed evidence of progressive migration of the socket. The vast majority of cases with demarcation were symptomless. In most cases where demarcation was accompanied by migration the operation notes suggested a technical explanation and in three cases low-grade sepsis was responsible. The fact that nearly 30 per cent of cases showed no demarcation even after 10 years supports the idea that there is no fundamental defect in the principle of employing cement in the acetabulum. Better surgical technique may increase the number of cases showing no demarcation.

Acetabulum↗
PubMedDate not supplied

Quantifying trabecular orientation in the pelvic cancellous bone of modern humans, chimpanzees, and the Kebara 2 Neanderthal.

The adaptive nature of bone lies in its ability to respond to the environment by conforming and reshaping itself constantly to accommodate life-time stresses experienced throughout daily activities. In order to keep strains within the bone as uniform and isotropic as possible, the trabecular orientation is determined by forces acting on the bone through adaptive remodeling. Hence, the preserved structure of bones may contain direct information about the forces they may have undergone. Some authors (Correnti [1952], Atti Acc Naz Lincei 12:518-523, [1955] Riv Antrop 42:289-336; Macchiarelli et al. [1999] J Hum Evol 36:211-232, [2001] Cambridge, UK: Cambridge University Press) have described in detail the trabecular systems of the hip bone in different primate species and have identified a gait-related system above the acetabulum with substantial differences across species (Macchiarelli et al. [1999]; Rook et al. [1999] Proc Natl Acad Sci USA 96:8875-8879). The aim of this study was to quantify trabecular orientation above the acetabulum to test the hypothesis that hominoid biomechanical behavior is recorded in the cancellous bone. The pelvic bones of 23 archaeological adult modern humans (12 females, 11 males), 20 adult Pan troglodytes (10 females, 10 males), and one adult male Neanderthal were radiographed and digitized. Fast Fourier transforms (FFTs) of the regions of interest in the corpus of the ilium were performed, with the angular distribution of the trabeculae quantified. All species displayed a constant and periodic orthogonal arrangement in the trabeculae with differences in the pattern of dominance between the arcades oriented along the 0 degrees or the 90 degrees axes. The variation in the FFT spectrum between species is discussed in the light of distinctive biomechanical features.

Animals↗
PubMed1997

Course of bone mineral content changes around cementless Zweymueller total hip arthroplasty. A 4-year follow-up study.

In this prospective study we followed the bone mineral content (BMC) changes over time in seven zones of interest around uncemented Zweymueller total hip arthroplasty (THA) components, using dual-energy X-ray absorptiometry (DEXA) combined with a radiographical analysis of the distal femoral cortices, close to the tip of the stem. In 36 women (average age 55 years) operated on for primary hip osteoarthritis, BMC of the hips was measured preoperatively and 2 weeks, 1 year and 4 years postoperatively. In particular, a significant decrease of the preoperative values (ranging from 35% to 42.53%; P = 0.05 to 0.01) was noted immediately postoperatively in zones 2-7. Thereafter, an additional significant increase of BMC was observed between the first and last observations at the greater (30%, P < 0.05) and lesser (35.48%, P < 0.01) trochanter. The BMC changes over time were not related to the age of the patients. The BMC reduction observed immediately after implantation of the Zweymueller THA is probably related to the intraoperatively removed bone from (1) the medial and distal inner surface of the acetabulum and (2) the inner femoral cortex. Thereafter, the BMC in zones 2, 6 and 7 remained practically unchanged. The fact that a significantly delayed BMC increase was found in the region of the greater and minor trochanter 4 years later may be due to an increasing, continuous bone turnover in the intertrochanteric area. Thus, the Zweymueller screw socket becomes definitively anchored immediately postoperatively in the medial and distal thirds of the acetabulum and remains stable over time, whereas the Zweymueller stem is mainly anchored within the distal femoral cortex as well as within the mass of the greater and minor trochanter, and was still stable at the 4-year follow-up.

Absorptiometry, Photon↗
PubMed1984

Histological results with cement-free implanted hip joint sockets of polyethylene.

The histological appearance of the implant-bone boundary in eight preparations from seven deceased patients in whom a polyethylene acetabulum socket had been inserted without cement between 3 weeks and 3 years previously is described. In all cases, a good or excellent clinical result had been present up to death. All sockets were firmly anchored macroscopically in the bone of the acetabulum. Three zones were defined in accordance with the mechanical strain on the surface of the cup: (a) zone of compression; (b) zone of transition in which mainly shear forces act; and (c) zone of decompression, which corresponds to the region below the "equator." It was noticeable that a layer of connective tissue separated the implant from the bone over almost the entire surface. This layer was very thin in the region of the pressure transfer layer, and thicker in the decompression zone. At sites at which pressure and shear forces act a fibrocartilaginous tissue was found, and the "subchondral" bone was only occasionally in direct contact with the polyethylene surface. At some sites, but above all in the region of the compression zone, very tiny particles that were birefringent in polarized light were found. Either these derive from very fine grindings from the prosthesis surface or they are to be interpreted as a result of "biodegradation" of the polyethylene. This observation permits the conclusion that the biocompatibility of the implant can be improved further by coating the polyethylene surface.

Aged↗
PubMed1979

Psoas transfer for the treatment of congenital dislocation of the hip.

Since 1965, anterolateral transfer of the psoas muscle has been employed by us as a routine surgical treatment for congenital dislocation of the hip joint. The transfer was carried out in association with open reduction in those patients in whom an intracapsular obstruction was evident, but corrective measures for acetabular dysplasia or cervicocapital deformity of the femur were not performed in this series. We treated 87 hip joints with this procedure from 1965 to 1973. In 38 hip joints, both open reduction and the psoas transfer were followed up for an average of 8 years. Thirteen hip joints with open reduction alone were included as controls. Position of the femoral head and development of the acetabulum and proximal end of the femur were assessed on X-rays, mainly after Severin's criteria. Redislocation was not encountered. Fifty percent of the hip joints with open reduction and the psoas transfer were classed as grade I or II. This figure is higher than that of controls, to which 23% were classed as grade I or II. Better concentricity of the head was achieved as determined by the CE angle (Wiberg). Development of acetabulum occurred when the transfer had been carried out in children under 1 year of age and was less likely in the older children. The detorsional effect of the psoas transfer remained questionable since detorsion in the transferred group did not exceed that of the controls.

Anthropometry↗
PubMed1978

[Sciatic nerve: special topography and possibility of injuries in surgery of the hip joint (author's transl)].

The minimal distance between the dorsal acetabulum and the sciatic nerve can be 1.5 cm. This topographic situation is extremely important for surgery of the hip and dorsal pelvis (for e.g.: total hip prothesis, osteosynthesis of dorsal acetabulum-fractures). Various operative approaches to the hip joint lead to different intraoperative aspects including the danger of iatrogen sciatic nerve-lesions. In most cases the nerve cannot be seen but only be palpated during operation. If the stem of the sciatic nerve is injured intraoperatively, lesions can be found in the whole field of its innervation. For this reason specimen operations were performed in human cadavers using various approaches to the hip joint. We systematically investigated the topography of this region--layer by layer--cutting sections in horizontal and sagittal plains. Based on our findings the course of the sciatic nerve is described with special emphasis on the danger of lesions during surgery of the hip joint and dorsal pelvis.

Hip Joint↗