ABSTRACT
Recent in vitro work has shown that sealing the acetabular notch with bone graft in bovine acetabulum samples results in improved cement penetration in the acetabular bone during total hip arthroplasty. Successful sealing of the notch may be identified on postoperative films by a lack of cement extrusion. This study aimed to assess the clinical effectiveness of this technique in preventing cement escape and early radiolucent lines by review of early postoperative radiographs. We reviewed the post-operative radiographs of 380 consecutive patients who underwent primary total hip arthroplasty with implantation of the same flanged cemented polyethylene cup. The incidence, site and extent of cement extrusion and the incidence of any early postoperative radiolucent lines at the cement bone interface were measured. We found the rate of inferior cement escape in our series was 9.2%, compared to 36.4% in a previous study. We also found a lower rate of early radiolucent lines compared to historical controls. We believe placing bone graft on the medial/inferior wall prior to cementing helps to increase cement pressurisation by sealing the acetabular notch, as identified by reduced cement escape and early radiolucent lines.
Subject(s)
Arthroplasty, Replacement, Hip/methods , Cementation/methods , Adult , Aged , Aged, 80 and over , Bone Transplantation , Female , Humans , Male , Middle Aged , Pressure , Retrospective StudiesABSTRACT
Osteoporosis is a major problem world-wide. In the UK, it costs the NHS about pound 1.7 billion per annum. Admission to orthopaedic units for treatment and rehabilitation with fractured necks of femur makes up a large proportion of the cost. The evidence suggests simple, cost-effective treatments can reduce fractures and re-fractures attributable to osteoporosis by up to 50%, and easy to follow guidelines exist. Our study, of a typical large district general hospital suggests that ideally placed orthopaedic surgeons are however not taking the opportunity to start these treatments or offer advice about this common condition. Commencing these treatments could prevent more than 7000 fractures per year in the UK.
