TOTAL HIP REPLACEMENT USING ACETABULAR METAL AUGMENT AND BONE GRAFT IN PAPROSKY TYPE 3B ACETABULAR DEFECT: A CASE REPORT

Old unreduced and untreated fracture of the acetabulum is seen more commonly in developing countries and can be due to various reasons. Various methods can be used in the management of such cases which in general includes arthrodesis in young and total hip replacement in elderly patients. Acetabular fractures associated with acetabular defect pose challenge to the treating surgeon and the management of such defects plays an important role in the ?nal outcome of the surgery. We are here reporting a case of a 36 years old male patient who presented with 1 year 6 months old fracture of posterior wall of the acetabulum who is treated with THR with acetabular reconstruction using bone graft and acetabular augment. The patient was under regular follow up and now after 6 months of surgery patient is having good functional improvements with painless range of motions at index hip

Conservación de injerto autólogo de cabeza femoral en colgajo óseo para tratamiento de los defectos acetabulares / Conservation of autologous graft of femoral head in bone flap for treatment of acetabular defects

Resumen: Objetivo: Describir una técnica de conservación ósea de uso común en neurocirugía en un procedimiento ortopédico. Material y métodos: Se describe el caso de una paciente que se somete a artroplastía primaria de cadera con un resultado no satisfactorio inicial, planteándose previo al cierre la necesidad de una revisión con reconstrucción acetabular. Conservando cabeza femoral de paciente en tejidos blandos para realizar reconstrucción en segundo tiempo. Resultados: Tras seguimiento por seis meses se encuentra completa osteointegración de injerto de cabeza femoral, con buena evolución clínica y radiológica de la paciente. Las técnicas de conservación ósea en colgajos óseos han demostrado buenos resultados en la osteointegración de los injertos en otras áreas como neurocirugía. Conclusiones: La conservación de colgajos óseos en tejido celular subcutáneo para posterior uso como injerto es una opción viable de tratamiento también en la cirugía ortopédica.

Abstract: Objective: To describe a bone preservation technique commonly used in neurosurgery in an orthopedic procedure. Material and methods: We describe the case of a patient who undergoes primary hip arthroplasty with an initial unsatisfactory result, the need for a revision with acetabular reconstruction is considered before the wound closure. Keeping the patient's femoral head in soft tissues for second-time reconstruction. Results: After six months of follow-up, complete osseointegration of the femoral head graft was found, with a good clinical and radiological evolution of the patient. Bone conservation techniques in bone flaps have shown good results in the grafts osseointegration in other areas such as neurosurgery. Conclusions: The conservation of bone flaps in subcutaneous tissue for later use as a graft is a viable treatment option also in orthopedic surgery.

Acetabular Reconstruction in Total Hip Arthroplasty / 대한고관절학회지

The difficulties encountered in dealing with the bone deficient acetabulum are amongst the greatest challenges in hip surgery. Acetabular reconstruction in revision total hip arthroplasty can successfully be achieved with hemispherical components featuring a porous or roughened ingrowth surface and options for placement of multiple screws for minor acetabular defect. Acetabular component selection is mostly based on the amount of bone loss present. In the presence of combined cavitary and segmental defects without superior acetabular coverage, reconstructions with a structural acetabular allograft protected by a cage or a custom-made triflange cage have been one of preferred surgical options. The use of a cage or ring over structural allograft bone for massive uncontained defects in acetabular revision can restore host bone stock and facilitate subsequent rerevision surgery to a certain extent. But high complication rates have been reported including aseptic loosening, infection, dislocation and metal failure. On the other hand, recent literature is reporting satisfactory outcomes with the use of modular augments combined with a hemispherical shell for major acetabular defect. Highly porous metals have been introduced for clinical use in arthroplasty surgery over the last decade. Their higher porosity and surface friction are ideal for acetabular revision, optimizing biological fixation. The use of trabecular metal cups in acetabular revision has yielded excellent clinical results. This article summarizes author's experience regarding revision acetabular reconstruction options following failed hip surgery including arthroplasty.

Periacetabular stress distributions during normal gait cycle and its guiding function in acetabular reconstruction of THA / 医用生物力学

Objective To study the basic regular patterns of stress distributions inside and outside periacetabular districts during normal gait cycle of healthy adults, so as to provide clinical guidance for acetabular reconstruction of total hip arthroplasty (THA). Methods Based on CT scans of a male and a female healthy adult volunteer, The three-dimensional model including pelvis and proximal femur was reconstructed. By using an inhomogeneous material distribution scheme which was based on CT data to calculate elastic modulus and convergence analysis, each element was given a corresponding material attribute. The dynamic change of hip contact force during a normal gait cycle was used as the load condition to the model. Von Mises stress of the nodes inside and outside the model was considered as the criterion to assess the results. Results During normal gait, the stress on the hip surface of two volunteers was mainly transmitted from postersuperior part of acetabulum to auricular surface along posterolateral of iliac wing, and the maximum stress was at the district near greater sciatic. As for the superior, middle and inferior section of two volunteers' acetabulum, the stress was distributed both on cortical and cancellous bone of postersuperior part. However, in terms of acetabular anterior and posterior column, the stress distribution was mainly found on cortical bone. Conclusions According to the observed acetabular stress distribution pattern of health adults during normal gait cycle, choosing acetabular component with more suitable size and controlling the placement of acetabular component with more accuracy could obtain some acetabular reconstruction plan better in accordance with stress distributions during normal gait.

Influence from acetabular component orientation on stress distributions of periacetabulum / 医用生物力学

Abstract： Objective To study the influence from different placement angles of acetabular component on inner and outer stress distributions of periacetabulum in acetabular reconstruction of total hip arthroplasty (THA), so as to explore proper orientation for improving stability of acetabular component after THA. Methods Based on model with inhomogeneous material property assignment, nine THA models with acetabular component at different anteversion angles(15°, 20°, 25°) and abduction angles(40°, 45°, 50°) as well as one normal hip model were constructed. The maximal hip contact force in phase of single leg stance during normal gait cycle was chosen as the loading condition. In addition, according to the qualitative and quantitative principle, inner and outer stress distributions on 9 THA models were analyzed and compared with the normal hip model as control. Results When abduction angle of acetabular component was the nearest to anatomic angle (19° anteversion, 46° abduction) of acetabulum, the phenomenon of stress shielding on periacetabulum was the most obvious. When abduction angle of acetabular component was placed at 45° and anteversion angle changed from 15° to 25°, no significant influence was exerted on the whole stress distributions of THA models. Meanwhile, when anteversion angle of acetabular component was 15°, the THA model had good stability in stress distributions, and the phenomenon of stress shielding on cortical and cancellous bone was obviously improved. Conclusions For patients who have normal anatomic acetabulum and need to be treated with THA, the abduction angle of acetabular component should be placed at 45°, as that of normal acetabulum; the anteversion angle should be 5° smaller than that of normal acetabulum and between 15° and 20°.

Morsellized Allograft and Acetabular Reconstruction Cage: Follow up of 2 to 9 years

We report the outcome of 32 patients who underwent total hip replacement (THR) augmented with morsellized fresh frozen femoral head allografts and acetabular reconstruction cages. Nine patients underwent primary THR and 23 patients underwent revision THR. Follow up ranged from two to 9 years. Two most common indications for the procedures as reported in literature were rheumatoid arthritis and aseptic loosening of the hip. All but one patient achieved good outcome with radiographs showing full incorporatio

Total hip arthroplasty for severe congenital dislocation of adult hip mellitus / 中国矫形外科杂志

[Objective]To discuss the methods and results of total hip arthroplasty for the adult hip of severe congenital dislocation.[Method]Thirteen patients with unilateral Crowe type-Ⅳ dislocation underwent total hip replacement.All patients were distracted for two weeks preoperatively,and in the operation procedure,the acetabulat rotation center and abductor function were reconstructed on the basis of soft tissue release.The evaluations after surgery included the leg-length and Harris scores.[Result]According to the follow-up with an average of 18 months,the Harris hip score averaged 90 points.The leg-length extended 3.1 cm on average.One patient appeared sciatic nerve palsy.[Conclusion]Total hip arthroplasty could effectively treat server congenital dislocation of adult hip by the methods of tissue release,reconstruction of acetabular,proper selection of prosthetic and protection of nerve.

Treatment of adult developmental dysplasia of hip (DDH) through total hip replacement / 中华创伤骨科杂志

When adult developmental dysplasia of hip (DDH) patients have developed secondary os- teoarthritis of hip (OAH) with serious clinical symptoms,total hip replacement (THR) is their first choice of treatment.The anatomic structures of the acetabulum and femur in these patients are ahnormal and special,such as small and shallow cup,small femoral head,and narrow medullary cavity at proximal femoral shaft.As a result,the THR for DDH patients is quite different from the conventional ones and is thus highly difficult.We review in this paper the clinical classification of DDH,which is important for its treatment,the difficulties we will have in THR, especially in acetabular reconstruction and femoral prosthesis placement,and also strategies to resolve them.

Acetabular Reconstruction using Acetabular Roof Reinforcement Ring / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiographic results of acetabular reconstruction in severe acetabular bony defect using acetabular roof reinforcement ring with hook. MATERIALS AND METHODS: Thirty-five acetabular reconstructions using acetabular roof reinforcement ring with hook were performed between 1993 and 1997 and were followed up for more than two years. Bony defect was classified according to AAOS classification system. The clinical function was evaluated by Harris hip score and radiographical evaluation was focused on the osseous union of the grafted bone, reconstruction of center of rotation and any signs of socket loosening. RESULTS: The mean Harris hip score improved from 49 points preoperatively to 85 points at the final follow up. The bone graft was incorporated in 33 cases as shown by radiographic remodelling and had a homogenous trabecular appearance. In all cases, the center of rotation was repositioned within three milimeters from the anatomical position. One case was rerevised due to hook failure and postoperative deep infection. Another hook failure without infection was found in one case, but this patient had no radiographic or clinical instability because of bony consolidation after the grafted bone initially settled down at final follow up. Postoperative complications were hip dislocation in 3 hips, nonunion of the greater trochanter in one hip and discomfort at autograft donor site in 3 hips. CONCLUSION: Acetabular reconstruction using acetabular roof reinforcement ring with hook combined with morcellised bone graft was considered to be an useful methods especially in severe acetabular bone deficiency.