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Purpose: The aim of study is to evaluate the accuracy of a navigation system during curved peri-acetabular osteotomy (CPO).Methods: Forty-seven patients (53 hips) with hip dysplasia were enrolled and underwent CPO with or without navigation during surgery. Clinical and radiographical evaluations were performed and compared between the navigation group and non-navigation group, post-operatively.Results: The clinical outcomes were not significantly different between the navigation and non-navigation groups. Furthermore, post-operative reorientation of the acetabular fragment was similar between the navigation and non-navigation groups. However, the discrepancy between the pre-operative planning line and post-operative osteotomy line was significantly improved in the navigation group compared with that in the non-navigation group (p < 0.05). Further, the complication rate was significantly improved in the navigation group (p < 0.001).Conclusion: The accuracy of the osteotomy's position was significantly improved by using the navigation. Therefore, the use of navigation during peri-acetabular osteotomy can avoid complications. [ABSTRACT FROM AUTHOR]

Purpose: Although the arthroscopic management of femoroacetabular impingement (FAI) is increasing, severe complications have been reported due to traction. We developed an arthroscopic technique based on an initial capsulotomy and a minimal traction approach. The main purpose of this study was to analyze the clinical outcomes of FAI treatment using this technique after at least two years of follow-up.Methods: Forty-seven consecutive patients underwent surgery for FAI. There were two initial portals: a proximal anterolateral portal and a distal anterior instrumental portal. An anterior working space was created and a T-shaped incision was made in the anterior capsule to relieve joint distraction. Short traction (less than 20 mn) made it possible to approach the central compartment. Acetabuloplasty was performed in the presence of pincer impingement. Traction was then released. A head-neck femoral osteochondroplasty was performed in case of bump impingement. All patients underwent a mean 3.3 ± one years of follow-up based on two self-administered questionnaires: the Harris hip score and the QOL Oxford score. None of the patients were lost to follow-up.Results: There were three complications: two ossifications and one case of injury to the femoral cutaneous nerve with good clinical outcomes at the final follow-up. Five patients (10%) underwent surgical revision after a mean 1.4 years of follow-up: three total hip arthroplasties, one peri-acetabular osteotomy, and one repeat arthroscopic hip debridement. The Harris score increased significantly from 60 ± 10 to 86 ± 15 (p < 0.0001) and the Oxford score improved from 34 ± 15 to 50 ± 11. Only 25% of patients had a "forgotten hip" at the final follow-up.Conclusion: Our clinical results were comparable to previously reported outcomes with other surgical techniques for the management of FAI. However, it should also be noted that despite these good clinical outcomes, the percentage of patients with a "forgotten hip" is low, and patients should be informed of this. [ABSTRACT FROM AUTHOR]

Introduction: Acetabular revision surgery poses a challenge due to the increased frequency of severe defects and poor quality of the remaining bone. We compare the clinical and radiological outcomes, complications, and survival of two systems commonly used in complex acetabular revisions (AAOS types II, III, and IV): trabecular metal system (TM) and Burch-Schneider antiprotrusion cages (BS).Methods: Eighty-four patients underwent acetabular revision surgery with TM or BS in our centre between 2008 and 2014. Comparison was made of demographic and clinical characteristics, satisfaction, radiographic parameters, complications, and survival of the implants. A BS was implanted in 30.9% of the patients, while 69.1% received a TM implant. The mean follow-up was 4.77 years.Results: The BS group required a significantly greater number of constrained implants (p = 0.001) and more walking aids (p = 0.04). The mean satisfaction (p = 0.02) and HHS scores at the end of the follow-up were higher in the TM group (p = 0.003). No differences were observed in the incidence of complications, though the only two cases of implant rupture corresponded to the BS group. The overall survival rate was 88.1% after 7.5 years.Conclusion: TM implants afforded better clinical outcomes and greater patient satisfaction than antiprotrusion cages in the treatment of severe acetabular defects. [ABSTRACT FROM AUTHOR]

Background: Pubic bone nonunion and delayed union are reported as post-operative complications after peri-acetabular osteotomy (PAO). However, few studies have determined the incidence of delayed union using computed tomography (CT) scans. This study aimed to determine the incidence of delayed union at one year after PAO using X-ray and CT scans.Methods: We performed a retrospective review of 150 hips in 132 consecutive patients with acetabular dysplasia who underwent PAO between January 2012 and June 2016 and evaluated 107 hips for which pelvic CT scans taken at one year after PAO were available. Clinical evaluations included age at surgery, weight, body mass index (BMI) and history. Radiographic evaluations were to assess pubic, ischial and iliac delayed union at one year post-operatively.Results: Based on X-ray analysis, the incidence of delayed union in the pubic, ischial and iliac bones was 11.2% (12 hips), 5.6% (6 hips) and 0% (0 hips), respectively, and20.6% (22 hips), 8.4% (9 hips) and 0% (0 hips), respectively, based on CT scans.Conclusion: The incidence of delayed union of the pubis and ischium at one year after PAO according to CT scans was higher than that based on X-ray imaging. CT scans are useful in patients with some symptoms at the osteotomy site.Level Of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: Acetabular cup positioning in extreme angles of vertical position affects both stability and long-term survivorship of total hip arthroplasty. The purpose of this study is to determine whether native Sharp's angle is associated with an increased abduction angle of the acetabular component.Methods: Consecutive patients who underwent primary total hip replacement between February 2012 and August 2015 were included. Vertical positioning of acetabular implant in the antero-posterior post-operative radiographs were measured. The proportion of implants positioned outside the safe zone (40° ± 10°) was calculated and through a multivariate analysis, Sharp's angle and other factors possibly associated with cup malpositioning were evaluated.Results: Five hundred twenty-eight hip arthroplasties were analyzed. Prevalence of cup malpositioning was 7.6% and 25 patients had an altered native acetabular angle. An altered pre-operative Sharp's angle was associated with a higher risk of vertical malpositioning of the acetabular component (OR 2.51 IC 95%: 1.17-5.39) (p = 0.02). Body mass index, surgeon's volume, size of the implant, gender, pre-operative diagnose and age, were not associated with the position of the cup.Conclusions: The alteration of the Sharp's angle as an indicator of hip dysplasia in native hips increases the odds of acetabular cup malpositioning. Other factors explored did not correlate with the position of the acetabular prosthesis. Systematic assessment of Sharp's angle should be included in the pre-operative planning of primary hip arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Elderly patients have more special medical needs when compared with young ones; thus, the results of open reduction and internal fixation (ORIF) for acetabular fractures should be stratified by age in these patients. This study seeks to determine whether the age of the patient influences the results of the ORIF for acetabular fractures.Methods: We performed a retrospective analysis of prospectively collected data on 53 elderly patients with displaced acetabular fractures who underwent ORIF between May 2004 and May 2011. Patients were divided into two groups by age: young-old group (60-74 years) and old-old group (75-90 years). The number of patients in each group was 28 and 25. The reduction quality and clinical function was evaluated using the Matta criteria and modified Postel Merle D'Aubigne Score, respectively. Operative time, bleeding amount, and complications were recorded.Results: Patients in old-old group had significantly lower anatomical reduction rate (p = 0.024), less operative time (p = 0.021), and less bleeding amount (p = 0.016) than those in the young-old group. The reduction quality in the young-old group was strongly associated with clinical function (p < 0.05). However, no difference in clinical function was detected among the different reduction qualities in the old-old group (p > 0.05). Moreover, no significant difference in clinical functions (p = 0.787) and complications (p = 0.728) was detected between the two groups.Conclusions: Old-old patients may expect comparable clinical functions and complications with young-old patients. The reduction quality in old-old patients may be not significantly associated with clinical function. Different treatment strategies may be applied for acetabular fractures with ORIF in different age groups. [ABSTRACT FROM AUTHOR]

Background: Hip dysplasia is a common cause of secondary osteoarthritis. To prevent the early onset of secondary osteoarthritis, rotational acetabular osteotomy has been proposed. Description: The approach combines the anterior iliofemoral and posterior approaches through a single skin incision. The pubic bone is cut independently, and the ilium and ischium are cut in continuity. The rotation of the acetabulum provides a more horizontal weight-bearing area and, at the same time, returns the superiorly subluxated femoral head to a more normal position. Alternatives: The Ganz periacetabular osteotomy involves the same concept as a rotational acetabular osteotomy with a different surgical approach. The rate of major complications, such as intra-articular osteotomy, nerve palsy, loss of fixation, malreduction, and symptomatic heterotopic ossification, is lower in rotational acetabular osteotomy (0% to 18%) than in periacetabular osteotomy (6% to 37%). Because of a wide surgical exposure, osteotomy can be performed under direct vision in rotational acetabular osteotomy. Rationale: Rotational acetabular osteotomy for osteoarthritis secondary to hip dysplasia can alter the position of the acetabulum en bloc and cover the femoral head with cartilage. For the unstable hip with dysplasia, the surgical procedure is needed for the prevention of osteoarthritis. [ABSTRACT FROM AUTHOR]

Introduction: Recent studies have reported short-term favourable results of tantalum-made components in acetabular revisions with bone loss. However, there is a lack of information regarding the mid to long-term results of such components.Objectives: The objective of this study was to analyse the outcome and survivorship of acetabular revision hip arthroplasty using tantalum components for loosening associated with bone loss at a minimum of five-year follow-up.Methods: We retrospectively reviewed 51 consecutive patients (51 hips) who had an acetabular revision using porous tantalum components at a minimum follow-up of five years. The mean age was 64 years (range, 31-87). There were 27 males and 24 females, 47 right hips and four left hips. Twenty-five (49 %) included a femoral revision. According to Paprosky's classification 18 hips were classified type 2A, 11 type 2B, ten type 2C, seven type 3A and five type 3B. No bone grafting was performed. Sixteen hips (31.3 %) required the use of additional tantalum-made augments stabilized by screws and cement at the cup-augment interface.Results: At a mean followup of 6.8 years (range, 5.1-10 years), the Harris hip score improved from 44 pre- operatively (range, 23-72) to 84 post-operatively (range, 33-98). The mean post-operative hip centre position in relation to the teardrop was 29 mm (range, 20-43 mm) horizontally and 21 mm (range, 8-36 mm) vertically. The mean acetabular inclination was 42° (range, 17-60°). Six hips (11.7 %) required a re-operation without component revision (two for chronic instability, one ossification removal, one haematoma, one deep infection and one periprosthetic femoral fracture). One patient required a cup re-revision for septic loosening. No aseptic loosening occurred. At last followup the radiological analysis showed one evolutive osteolysis and one screw breakage. The global survivorship was 92.3 % at 64 months. If only aseptic loosening was defined as the end-point the survivorship was 100 % at 64 months.Conclusions: When facing an acetabular revision with severe bone loss, tantalum-made components can provide a stable fixation. This study at a minimum five-year follow-up compares favourably with other reconstruction techniques, but longer follow-up is still required. [ABSTRACT FROM AUTHOR]

Background: Pelvic discontinuity is uncommon and presents the surgeon with complex reconstructive challenges. The objective of this study is to report the results of current strategies used in the treatment of pelvic discontinuity.Methods: We retrospectively analyzed prospectively collected data on 113 consecutive revision total hip arthroplasties performed for the treatment of unilateral pelvic discontinuity at a single institution. The study included 18 male and 95 female patients with a mean age of 63 years at the time of revision surgery. Preoperative, immediate postoperative, and latest follow-up radiographs were reviewed to assess healing of the discontinuity as well as acetabular component stability. Treatment modalities included an uncemented cup with a posterior column plate (50 hips; 44%), a cup-cage construct (27 hips; 24%), an antiprotrusio cage with or without a posterior column plate (26 hips; 23%), and an uncemented cup alone (10 hips; 9%). The average duration of follow-up for each of these types of surgical reconstruction was similar (range, 3.9 to 7.2 years).Results: Five-year revision-free survivorship of the implant was best with a cup-cage construct (100%) and worst with an uncemented cup with a posterior column plate (80%) and a cup alone (80%). Healing of the discontinuity was achieved in 50% of the hips with an uncemented cup alone, 74% of the hips with an uncemented cup and a posterior column plate, 74% of the hips with a cup-cage construct, and 88% of the hips with an antiprotrusio cage construct (91% of these hips when structural allograft was used). The overall complication rate was 26.5%. The average Harris hip score improved from 54 preoperatively to 69 postoperatively (95% confidence interval: 50 to 57 preoperatively and 65 to 72 postoperatively; p = 0.017).Conclusions: Improved survivorship and healing rates were seen in this series when a reconstruction cage was used as an adjunct to an uncemented cup (cup-cage) or in combination with structural allograft bone that bridged the discontinuity.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Misplaced screw during the internal fixation of acetabular fractures may penetrate the hip joint which might cause chondrolysis and traumatic osteoarthritis in the future. This study aims to acquire the safe path for screw insertion along inferior border of the arcuate line fixation route at acetabular area.Methods: Computed tomography (CT) scans of 98 patients without pelvic trauma were rebuilt for three-dimensional models of pelvis. After depicting the fixation route curve, five cross-sections perpendicularly to the curve were established from the anterior of pelvis to the posterior along inferior border of the arcuate line. The safe screw lengths for section 1 and 5 were measured from the computer models. In section 2, 3 and 4, a line from the screw entry point tangent to the inferior edge of the acetabulum was depicted and the measurements of minimum safe direction of screw insertion were performed then marked with angle θ.Results: The safe screw lengths for section 1 and 5 were 22.29 ± 4.41 mm and 32.64 ± 4.70 mm (n = 98). The minimum safe angles of screw insertion for the middle three sections 2, 3, and 4 were 65.38 ± 10.23°, 74.20 ± 10.20°, and 57.88 ± 11.11°(n = 98), respectively. The results for the male group (n = 98) indicated smaller minimum safe angles in these three sections compared with the female (n = 98).Conclusions: Compared to male, the minimum safe angles of screw placement at acetabular area for female should be more away from inferior edge of acetabulum and tilt to the bottom of pelvis along inferior border fixation route in surgical management of acetabular fractures. [ABSTRACT FROM AUTHOR]

Introduction: Anatomical reduction of displaced acetabular fracture is not without its' limitations and complications. This study is conducted to assess clinical and radiological outcomes as well as complications of treating displaced acetabular fractures with emphasis on anatomical reduction in weight-bearing area, mainly the posterior column, and imperfect reduction of the anterior column is acceptable. However, stability of both columns is mandatory.Methods: It was a retrospective study carried out in a Level 1 arthroplasty and trauma centre. 23 patients (17 males, 6 females) with average age of 50.1 years (range, 36-68 years) with displaced acetabular fracture treated with combined incisions and plate-cable systems were included. There were 3 elementary and 18 associated fractures according to Letournel classification. Average follow-up was 23.5 months (range, 12-38.7 months). Mean operation time was 160min (range: 75-320min). Functional scores were evaluated using Harris Hip Score (HHS) whilst reduction was assessed by Matta criteria. Any displacement of reduction, osteoarthritis, heterotopic ossification, and other complications was recorded.Result: 65.2% (15/23) of the patients obtained excellent HHS and 21.7% (5/23) had good HHS. There were 12 anatomical, 6 imperfect, and 5 poor reductions. No displacement was recorded in final follow-up. Complications documented: three lateral femoral cutaneous nerve injuries, two conversions to total hip arthroplasty, three Brooker stage 1 heterotrophic ossification, one pulmonary embolism and one screw irritation. No incidence of wound breakdown, infection and radiological osteoarthritis was reported.Conclusions: Imperfect reduction of the anterior column provided clinical outcomes that are as good as total anatomical reduction. This approach minimizes soft tissue damage and reduces perioperative morbidities. [ABSTRACT FROM AUTHOR]

The article focuses on the procedure of reducing and fixing comminuted posterior acetabular wall fractures. It is noted that each intraarticular fragment is carefully delineated after the surgical approach is completed, which exposes the posterior wall and column. It is mentioned that the accuracy of the fracture reduction is the most-crucial determinant of clinical success.

Background: Wide variability in cup orientation has been reported. The aims of this study were to determine how accurate surgeons are at orientating the acetabular component and whether factors such as visual cues and the side of operating table improved accuracy.Methods: A pelvic model was positioned in neutral alignment on an operating table and was prepared as in a posterior approach. Twenty-one surgeons (9 trainers and 12 trainees) were tasked with positioning an acetabular component in a series of target orientations. The orientation of the component was measured using stereophotogrammetry, and the difference between the achieved orientation and the target orientation was calculated. Tasks included stating the surgeon's preferred orientation and thereafter placing the cup in that orientation, reproducing visual cues (transverse acetabular ligament and alignment guide), altering orientation by 10°, and estimating orientation while on the assistant's side.Results: The preferred inclination was 42° and the preferred anteversion was 21°. On average, surgeons decreased the inclination by 4° and increased the anteversion by 11° when tasked with replicating their desired orientation. The variability (defined as 2 standard deviations) in achieving a target orientation was 14°. The use of visual cues, such as the transverse acetabular ligament or the alignment guide, significantly improved accuracy to 1° for anteversion (p < 0.001) and -3° for inclination (p = 0.003). In addition, the use of an alignment guide reduced the variability by one-third. Trainees and trainers had similar accuracy and variability. There was greater variability in assessing cup inclination when standing on the assistant's side compared with the surgeon's side of the table, which has implications for training.Conclusions: Surgeons overestimate operative inclination and underestimate anteversion, which is of benefit, as this, on average, helps to achieve the desired radiographic cup orientation. Although the use of visual cues helps, conventional techniques result in a large variability in acetabular component orientation. New and better guides and methods for training need to be developed. [ABSTRACT FROM AUTHOR]

Purpose: The potential influence of acetabular component orientation on iliopsoas impingement in total hip arthroplasty (THA) has not been previously quantified. The aim of the present study was to utilize pre- and post-operative CT-based 3D models to quantify iliopsoas impingement on acetabular components, and to identify any potential factors associated with iliopsoas impingement.Methods: Iliopsoas muscle was modelled from pre-operative CT scans and transferred to the post-operative 3D models in 19 THAs. The volume and the area of the overlap between iliopsoas muscle and acetabular cup (iliopsoas volume & area) was measured on axial and sagittal images. Most protruded lengths of cup uncovered by acetabular bone were measured on axial sagittal scan of CT scans. Version of acetabulum, acetabular cup, and the difference between the two (version difference) were also measured with cup inclination and size. Linear regression analysis was performed to identify any factor influencing iliopsoas impingement.Results: Iliopsoas impingement volume and area were 100.6 ± 226.1 (range, 0.0-663.9) mm³ and 52.6 ± 102.0 (0.0-342.3) mm³, respectively. The protruded lengths on axial and sagittal view were 6.9 ± 5.3 (0.0-16.0) and 2.1 ± 2.7 (0.0-8.0). Linear regression model showed that version difference was significantly related to the iliopsoas impingement volume and area (beta = -0.709, p = 0.041 for volume, and beta = -0.684, p = 0.047 for area).Conclusions: The results of this study demonstrate that iliopsoas impingement on acetabular components was influenced by the version difference between pre-operative acetabular bone and acetabular component rather than the magnitude of post-operative cup version alone. [ABSTRACT FROM AUTHOR]

Background: The purposes of this study were to evaluate acetabular remodeling after closed reduction of developmental dysplasia of the hip (DDH) and to delineate the role of osteotomy.Methods: Eighty-four hips with DDH treated with closed reduction and followed until the patient was 8 years of age or older were included in this study. The mean age at closed reduction was 14.0 months (range, 3 to 30 months) and that at the latest follow-up visit was 12.7 years (range, 8.0 to 24.7 years). Osteotomy was performed in 26 hips (31%) during the follow-up period, at an average age of 2.8 years (range, 2.0 to 5.8 years). The acetabular index (AI) and center-edge angle (CEA) were measured, and osteonecrosis was graded. The treatment outcome was evaluated as satisfactory (Severin grade I or II) or unsatisfactory (III or IV). We retrospectively analyzed the associations among radiographic parameters, performance of osteotomy, grade of osteonecrosis, and final outcome.Results: A satisfactory outcome was observed in 67 (80%) of the 84 hips. An osteotomy was not performed in 30 of 34 hips with an AI of <32° and a CEA of >14° at the age of 3 years, and 28 (93%) of these 30 hips showed a satisfactory outcome. Of the 33 hips with an AI of ≥32° and a CEA of ≤14° at the age of 3 years, the 20 that had undergone an osteotomy showed a higher proportion of satisfactory outcomes than the 13 hips that had not (p = 0.01). Three of the 4 hips that showed an unsatisfactory outcome following an osteotomy had an AI of ≥34° at 1 year post-osteotomy. Grade-II, III, or IV osteonecrosis, according to the Bucholz-Ogden classification, developed in 10 of the 84 hips, and these 10 hips had a higher proportion of unsatisfactory outcomes than did those that developed no or grade-I osteonecrosis (p = 0.004).Conclusions: Hips with DDH showing poor acetabular remodeling after closed reduction may benefit from osteotomy. The AI and CEA at the age of 3 years can serve as one of the guidelines for osteotomy. Continued surveillance for acetabular remodeling is required even after osteotomy.Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Better understanding of three-dimensional (3D) morphology of the pelvis at the area of inferior border of the arcuate line is very important, which could guide the surgeons to treat pelvic and acetabular fractures more efficiently. The objective of this study is to provide references for screw placement and design of anatomical internal fixators for the fixation route along the pelvic inferior border of the arcuate line.Methods: Seventy five cases of computed tomography (CT) scan data were collected using Medical Image Database in Shanghai General Hospital between December 2009 and November 2010. 44 males and 31 females, aging from 21 to 91 years (average: 57.8 years) were enrolled. Using MIMICS 13.0, these data were used for three dimensional (3D) reconstructions of pelvic model. A curve from the pubic tubercle, along the inferior border of the arcuate line, to the sacroiliac joint was depicted and then divided into 11 equal parts. The measurements of whole length of the curve, the radius of the curvature and the thickness of bone at each decile point were performed, respectively.Results: The thinnest bone thickness at acetabular area was 17.24 ± 2.90 mm and 9.94 ± 2.69 mm for male and female, respectively. The radius of curvature at the decile points 1, 8 and 10 were smaller compared with the surrounding points.Conclusions: Using a screw shorter than 10 mm perpendicular to the bone surface along the inferior border of the arcuate line can avoid intra-articular screw penetration. There should be more recontouring of the plate at the areas of pubic tubercle and posterior edge of the acetabulum when placing a fixator along this fixation route. This study provides solid guidance for pelvic and acetabular surgeries as well as designing of anatomical fixators along inferior border fixation route at this area. [ABSTRACT FROM AUTHOR]

Introduction: Pelvic fractures requiring surgical fixation are rare injuries but present a great societal impact in terms of disability, as well as economic resources. In the literature, there is no description of these costs. Main aim of this study is to describe the direct and indirect costs of these fractures. Secondary aims were to test if the type of fracture (pelvic ring injury or acetabular fracture) influences these costs (hospitalization, consultation, medication, physiotherapy sessions, job absenteeism).Materials and Methods: We performed a retrospective study on patients with surgically treated acetabular fractures or pelvic ring injuries. Medical records were reviewed in terms of demographic data, follow-up, diagnosis (according to Letournel and Tile classifications for acetabular and pelvic fractures, respectively) and type of surgical treatment. Patients were interviewed about hospitalization length, consultations after discharge, medications, physiotherapy sessions and absenteeism.Results: The study comprised 203 patients, with a mean age of 49.1 ± 15.6 years, who had undergone surgery for an acetabular fracture or pelvic ring injury. The median treatment costs were 29.425 Euros per patient. Sixty percent of the total costs were attributed to health-related work absence. Median costs (in Euros) were 2.767 for hospitalization from trauma to definitive surgery, 4.530 for surgery, 3.018 for hospitalization in the surgical unit, 1.693 for hospitalization in the rehabilitation unit, 1.920 for physiotherapy after discharge and 402 for consultations after discharge. Total costs for treating pelvic ring injuries were higher than for acetabular fractures, mainly due to the significant higher costs of pelvic injuries regarding hospitalization from trauma to definitive surgery (p < 0.001) and hospitalization in the surgical unit (p = 0.008).Conclusions: Pelvic fractures are associated with both high direct costs and substantial productivity loss. [ABSTRACT FROM AUTHOR]

Introduction: Hip resurfacing (HR) is intended to preserve the femoral bone stock during primary arthroplasty. On the other hand, little has been reported regarding the intraoperative need of bone reconstruction for extended acetabular defects during hip resurfacing revision. Thus, the aim of the presented study was to identify whether there is an increased need for acetabular bone reconstruction in HR revision surgery.Materials and Methods: We analyzed the data of 38 patients who underwent 39 conversions from a HR to a total hip arthroplasty (THA). Acetabular bone defects and the respective revision technique were compared against a temporary cohort of patients undergoing revision surgery of a conventional THA.Results: In 29 HR patients revision required either autogenous or allogenous impaction bone grafting to adequately manage acetabular host bone degradation. In 10 cases additional implantation of a reinforcement device was necessary. Compared to the THA cohort revision of failed HR is associated with a significantly increased risk of higher grade bone defects (Paprosky classification) and extended acetabular reconstruction (p < 0.05).Conclusions: This study provides evidence that revision of failed HR devices is associated with an increased risk for extensive acetabular defects. Furthermore, the preoperative radiographic assessment of HR devices often underestimates the intraoperative acetabular defect. Surgeons should be aware of this fact not to technically underestimate HR revision procedures. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic anterior dislocation of the hip joint is rare. Additional injuries to the hip due to dislocation are even more infrequent. Outcome is limited by osteoarthritic joint degeneration or the occurrence of avascular necrosis of the femoral head. Method: Anterior hip dislocation occurred in ten of 100 patients with traumatic hip dislocations (8 men, mean age: 43, 22-62years) at two major trauma centres, between January 2001 and December 2008. Four patients had impaction fractures of the femoral head and three patients had fractures of the anterior acetabular wall. One patient presented with an open dislocation. In three of the ten patients surgical treatment was necessary. Results: Nine patients were evaluated retrospectively at a follow-up of 4.8 ± 2.3 years (mean ± SD). The mean scores were 88 ± 19 (Harris Hip-Score), 15 ± 23 (WOMAC-Score), level 6 (UCLA-Score). Four cases presented with only fair clinical or radiological results according to Epstein. AVN with collapse of the femoral head was observed in one. Conclusion: Traumatic anterior hip dislocations presented in six of the ten cases with additional injuries to the hip. Surgical treatment in cases with deep impaction fractures of the femoral head or with large fragments of the acetabulum may improve the outcome. [ABSTRACT FROM AUTHOR]

Background/purpose: This study retrospectively evaluated the benefits and prognostic factors of slotted acetabular augmentation (SAA) used for treating painful residual or neglected dysplastic hips in adolescents and young adults.Methods: Sixteen hips in 15 patients underwent SAA at an average age of 14.4 years. The radiologic and functional outcomes were reviewed after an average follow-up of 6.6 years.Results: All the patients obtained marked alleviation of pain (p<0.05). Harris hip score (HHS) was improved from 74.7 to 92.7 on average (p<0.05). Postoperative center-edge angle, Sharp's angle, c/b ratio and femoral head coverage showed significant improvement (p<0.01). Among the radiographic parameters, only the postoperative measurement of the femoral head coverage was significantly correlated with improvement of HHS (p<0.05). Detectable progression of osteoarthritis, from grade III to IV, was found in one patient 12 years after surgery. None of the hips required conversion to joint replacement. There were no surgical complications. Three-dimensional computed tomography showed that the grafts remained intact and provided congruent coverage at the latest follow-up, and none of them required arthroplasty.Conclusion: The major benefit of SAA was to alleviate hip pain by increasing load-bearing area. This benefit was not sensitive to preoperative radiographic parameters. There were no postoperative complications. Compared with other complex reconstructive acetabuloplasty procedures, SAA is a simple, safe and effective pain-reducing procedure for symptomatic dysplastic hips in adolescents and young adults. [ABSTRACT FROM AUTHOR]

Dislocation is the second most common complication in total hip arthroplasty, with reported incidences of up to 8 per cent. The authors' hypothesis is that, by modifying the rim of an acetabular component in order to shift the femoral neck contact position towards the periphery of the acetabulum, the torque required to dislocate the hip joint can be increased without reducing the range of motion. Three liners were designed and their dislocation characteristics mechanically evaluated using a custom experimental test jig designed to simulate the seated leg-cross. On the basis of torque and energy to dislocate and angle at dislocation, the hypothesis was accepted; geometrically varying the contact area between the femoral neck and the acetabular rim appear to be a powerful way to modify hip dislocation characteristics. [ABSTRACT FROM AUTHOR]

Background: Eccentric rotational acetabular osteotomy for the operative treatment of acetabular dysplasia consists of a spherical but eccentric osteotomy and rotation of the acetabulum that moves the center of rotation of the head of the femur medially and distally. No bone graft is needed. The reorientation of the acetabular fragment not only improves acetabular coverage but also restores the center of rotation of the subluxated hip. The purpose of this paper was to describe eccentric rotational acetabular osteotomy for the treatment of acetabular dysplasia and to evaluate its clinical and radiographic outcomes.Methods: We performed this procedure consecutively in 132 hips in 126 patients with dysplasia of the hip. Eighteen hips had no osteoarthritis, fifty-three had early osteoarthritis, and sixty-one had advanced osteoarthritis. Seven patients were male, and 119 were female. The average age was 36.5 years at the time of the index operation, and the average duration of follow-up was 7.5 years. Twenty-three hips in twenty-two patients were also treated with intertrochanteric valgus osteotomy to further improve joint congruency at the time of the acetabular osteotomy.Results: The average preoperative Harris hip score of 71 points improved to an average score of 89 points at the time of the latest follow-up. The average center-edge angle improved from 0 to 36 . An apparent change in the stage of the arthritis was observed in seven hips (5%), one of which had had early-stage disease and six of which had had advanced disease preoperatively.Conclusions: Eccentric rotational acetabular osteotomy appears to be a good treatment option for young patients with either early or advanced hip osteoarthritis secondary to dysplasia. [ABSTRACT FROM AUTHOR]