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Purposes Acetabular fractures are more and more common in the elderly. Open reduction and internal fixation (ORIF) may lead to poor outcomes and high revision rates. Primary total hip arthroplasty (THA) combined with internal fixation, also known as the combined hip procedure (CHP), associated with dual mobility cup (DM-CHP) could be an efficient procedure in selected elderly patients. The aim of this study is to compare functional and radiological outcomes between ORIF and DM-CHP. Methods Between 2007 and 2018, 51 patients older than 65 years were surgically treated for acetabular fractures. Twenty-six patients were treated by DM-CHP and 25 by ORIF. Each group was divided into two subgroups regarding a single or combined approach. Hospital stay, surgical time, intraoperative blood loss, and complications were documented. The Harris Hip Score (HHS) was used for measuring the functional outcome. Radiological analysis was used to assess the centre of rotation in the DM-CHP group. Results Median surgery time and intra-operative blood loss were higher in DM-CHP than those in ORIF. Early medical complication rate was higher for a combined approach as compared with a single posterior approach in DM-CHP (p = 0.003). Dislocation rate was 7.7% in DM-CHP. Revision rate was higher in ORIF (20% versus 7.7%). HHS was similar in both groups. Conclusions DM-CHP leads to similar functional outcomes and less revision than ORIF. This study strengthens the practice of using only the posterior approach for primary THA in the elderly. Dual mobility is a valid therapeutic option for acetabular fractures in elderly patients.

A solution for challenging hip dysplasia surgery could be a patient-specific 3D-printed shelf implant that is positioned extra-articular and restores the dysplastic acetabular rim to normal anatomical dimensions. The anatomical correction and biomechanical stability of this concept were tested in a canine model that, like humans, also suffers from hip dysplasia. Using 3D reconstructed computed tomography images the 3D shelf implant was designed to restore the radiological dysplastic hip parameters to healthy parameters. It was tested ex-vivo on three dog cadavers (six hips) with hip dysplasia. Each hip was subjected to a biomechanical subluxation test, first without and then with the 3D shelf implant in place. Subsequently, an implant failure test was performed to test the primary implant fixation. At baseline, the dysplastic hips had an average Norberg angle of 88±3° and acetabular coverage of 47±2% and subluxated at an average of 83±2° of femoral adduction. After adding the patient-specific shelf implants the dysplastic hips had an average Norberg angle of 122±2° and acetabular coverage of 67±3% and subluxated at an average of 117±2° of femoral adduction. Implant failure after primary implant fixation occurred at an average of 1330±320 Newton. This showed that the patient-specific shelf implants significantly improved the coverage and stability of dysplastic hips in a canine model with naturally occurring hip dysplasia. The 3D shelf is a promising concept for treating residual hip dysplasia with a straightforward technology-driven approach, however, the clinical safety needs to be further investigated in an experimental proof-of-concept animal study. This article is protected by copyright. All rights reserved.

A cirurgia de osteotomia periacetabular (OPA) é o tratamento de escolha na displasia do desenvolvimento do quadril (DDQ) de pacientes esqueleticamente maduros sintomáticos e os resultados incluem a melhora da qualidade de vida, a modificação da história natural da doença e eventualmente a prevenção da coxartrose. Por isso é considerada uma cirurgia preservadora do quadril. No entanto, sendo uma cirurgia tecnicamente desafiadora, com longa curva de aprendizado e associada a algumas complicações graves, vislumbrou-se a possibilidade de aplicar a tecnologia da prototipagem rápida (PR), com planejamento cirúrgico tridimensional (3D) e impressão de guias customizados como auxiliares à essa cirurgia. Neste estudo, apresentamos todas as etapas do desenvolvimento de um processo original de custo acessível para produção de guias plásticos customizados para OPA e avaliamos a acurácia e custos destes guias em um estudo experimental em ossos de cadáveres. Dez ossos de cadáveres humanos foram submetidos à cirurgia experimental com auxílio do guia produzido em plástico ABS por PR, a partir de imagens tomográficas e um processo de planejamento 3D. Em nenhum caso houve quebra (falha mecânica) do guia ou a violação da superfície articular do acetábulo ou quebra da coluna posterior. Isso comprovou a eficácia do guia em orientar cortes cirúrgicos ao mesmo tempo em que preveniu essas complicações. Quanto à acurácia da impressão, a diferença absoluta média entre as espessuras das fendas impressas e as fendas planejadas foi de 0,28mm (desviopadrão=0,024mm; diferença mínima=0,01mm e máxima=0,75mm). Segundo o método assistido por computador (escaneamento óptico e medida linear no programa Cloudcompare) a acurácia do guia, considerando as diferenças entre os cortes planejados e obtidos, foi de 1,57mm em média (dp=2,15mm) ou 97,23%. A acurácia tridimensional dos cortes foi estimada pela inclinação entre retas A planejadas e A obtidas (ângulo θA) e entre retas B planejadas e B obtidas (ângulo θB) revelando um erro médio de inclinação de 5,49° e 4,64°, respectivamente. Segundo o método de comparação dos volumes planejados e obtidos (a partir melhor alinhamento automatizado no Cloudcompare), em média, a distância máxima foi de 7,21mm (dp=3,336mm), o erro-máximo=0,34mm (dp=0,03mm), a maior distância máxima=12,55mm e a menor distância máxima=3,74mm. O custo médio do filamento utilizado por guia foi de R$ 2,28 (dp= R$0,52). No modelo econômico de custos, o custo unitário médio estimado de um guia considerando todos os custos de capital, operação e perdas em um ambiente hospitalar foi de R$ 120,85 (mínimo R$ 82,57 e máximo R$ 684,56). Concluímos que é possível criar guias cirúrgicos para a OPA a um custo acessível e com boa acurácia utilizando a tecnologia da prototipagem rápida e o método descrito nessa tese. Periacetabular osteotomy (PAO) surgery is the treatment of choice for developmental dysplasia of the hip (DDH) in symptomatic skeletally mature patients and the results include improving quality of life, modifying the natural history of disease and eventually the preventing development of hip arthrosis. Therefore, it is considered a hip-preserving surgery. However, because PAO is technically challenging, has a long learning curve and is associated with some serious complications, we envision the possibility of applying rapid prototyping (RP) technology, with three-dimensional surgical planning (3D) and printing of customized guides for this surgery. In this study, we present all the steps in the development of an original low-cost Brazilian process to produce plastic guides customized for OPA and evaluated the accuracy and costs of these guides in an experimental study of cadaver bones. Ten hip bones from human cadavers underwent experimental surgery with assistance of a guide produced in ABS plastic by RP, using tomographic images and a 3D planning process. In no case was there a fracture of the guide (mechanical failure) or a violation of the articular surface or of the posterior column of the acetabulum. This proved the guide's effectiveness in guiding surgical cuts while preventing those complications. The average accuracy of the impression, comparing the absolute mean difference between the planned and obtained cutting slots was 0.28mm (standard deviation = 0.024mm; minimum difference =0.01mm and maximum =0.75mm). According to the computer assisted method (comprising optical scanning and linear measures in Cloudcompare software) the accuracy of the guide was 1.57mm in average (sd=2.15) or 97.23% (comparing the difference between the planned and obtained bone cuts). Tridimensional accuracy of the cuts was estimated comparing the inclination of planned and obtained line A (θA angle) and planned and obtained line B (θB angle) which measured 5,49° e 4,64°, respectively. According to the automated comparison between the planned and obtained volumes (using best alignment tool in Cloudcompare software), on average the maximum distance was 7.21 (sd=3.336), the maximum error=0.34 (sd=0.03), the greater maximum distance=12.55 mm and the smaller maximum distance=3.74mm. The average cost of the filament used per guide was BRA$ 2.28 (sd=BRA$ 0.52). In the economic cost model, the estimated average unit cost of a guide considering all the costs of capital, operation and losses in a hospital environment was BRA$=120.85 (minimum=BRA$ 82.57 and maximum BRA$=684.56). We conclude that it is possible to create inexpensive surgical guides for PAO and with good accuracy using the rapid prototyping technology and the method described in this thesis.

Objective: Correlate the postoperative radiographic evaluation with variables accompanying acetabular fractures in order to determine the predictive factors for segmental impaction of femoral head. Methods: Retrospective analysis of medial files of patients submitted to open reduction surgery with internal acetabular fixation. Within approximately 35 years, 596 patients were treated for acetabular fractures; 267 were followed up for at least two years. The others were excluded either because their follow up was shorter than the minimum time, or as a result of the lack of sufficient data reported on files, or because they had been submitted to non-surgical treatment. The patients were followed up by one of three surgeons of the group using the Merle d'Aubigné and Postel clinical scales as well as radiological studies. Results: Only tow studied variables-age and amount of postoperative reductionshowed statistically significant correlation with femoral head impaction. Conclusions: The quality of reduction-anatomical or with up to 2mm residual deviation-presents a good radiographic evolution, reducing the potential for segmental impaction of the femoral head, a statistically significant finding.

We conducted a longitudinal study including patients with the same type of primary hybrid total hip replacement and evaluated patient activity and femoral osteolysis at either five or ten years post-operatively. Activity was measured using the University of California, Los Angeles scale. The primary outcome was the radiological assessment of femoral osteolysis. Secondary outcomes were revision of the femoral component for aseptic loosening and the patients’ quality of life. Of 503 hip replacements in 433 patients with a mean age of 67.7 years (30 to 91), 241 (48%) were seen at five and 262 (52%) at ten years post-operatively. Osteolytic lesions were identified in nine of 166 total hip replacements (5.4%) in patients with low activity, 21 of 279 (7.5%) with moderate activity, and 14 of 58 (24.1%) patients with high activity. The risk of osteolysis increased with participation in a greater number of sporting activities. In multivariate logistic regression adjusting for age, gender, body mass index and the inclination angle of the acetabular component, the adjusted odds ratio for osteolysis comparing high vs moderate activity was 3.6 (95% confidence interval 1.6 to 8.3). Stratification for the cementing technique revealed that lower quality cementing increased the effect of high activity on osteolysis. Revision for aseptic loosening was most frequent with high activity. Patients with the highest activity had the best outcome and highest satisfaction. In conclusion, of patients engaged in high activity, 24% had developed femoral osteolysis five to ten years post-operatively.

IntroductionHip arthroscopy has become a standard procedure in the treatment of hip joint pain not related to osteoarthritis or dysplasia in the young and active patient. There has been increasing focus on the contribution of the hip capsule to function and on stability following hip arthroscopy. It has been suggested that capsular closure after hip arthroscopy may prevent microinstability and macroinstability of the hip joint and reduce revision rate. However, it remains unknown whether capsular closure should be performed as a standard procedure when performing hip arthroscopies, especially in patients without additional risk factors for instability such as hypermobility or dysplasia of the hip. We hypothesised that capsular closure will lead to a superior outcome in hip arthroscopy for femoroacetabular impingement syndrome (FAIS) compared with non-capsular closure.Methods and analysisIn this randomised controlled, multicentre trial, 200 patients scheduled for hip arthroscopy for FAIS will be cluster randomised into one of two groups (group I: hip arthroscopy without capsular closure, group II: hip arthroscopy combined with capsular closure). Inclusion criteria are: age between 18 years and 50 years and FAIS according to the Warwick agreement. Exclusion criteria are: previous hip surgery in either hip, previous conditions of Legg-Calvé-Perthes or slipped capital femoral epiphysis, malignant disease, recent hip or pelvic fractures, arthritis, Ehlers-Danlos or Marfan disease, recent (within 6 weeks) application of intra-articular corticosteroids, language problems of any kind, and radiological signs of osteoarthritis, acetabular dysplasia or acetabular retroversion. Surgery will be performed in Denmark at four centres by four surgeons, all performing an interportal capsulotomy and closure with at least two absorbable sutures. Patients in both groups, who are blinded for the intervention, will receive the same standardised rehabilitation programme. As primary outcome scores, HAGOS (sport) will be used with HAGOS (symptoms, pain, function in daily living, participation in physical activities and hip and/or groin-related quality of life), Hip Sports Activity Scale, short validated version of the International Hip Outcome Tool, EQ-5D, Visual Analogue Scale for pain, complications and reoperation rate as secondary outcome tools. Using HAGOS (sport) as primary outcome parameter the power analysis required a minimum of 84 individuals per group. Together with a clinical examination performed by the patient’s surgeon 1 year after surgery, patient reported outcome measures will be completed preoperatively, as well as at 3 months, 1 year, 2 years and 5 years postoperatively. In addition, adverse effects will be recorded.Ethics and disseminationThe study is approved by the Central Denmark Region Committee on Biomedical research ethics. The results of this study will be presented at national and international congresses and published in peer-reviewed journals.Trial registration numberNCT03158454; Pre-results.

Objectives: We evaluated the effect of triple pelvic osteotomy on acetabular coverage and its clinical implications by clinical and radiographic parameters in patients with acetabular dysplasia.Methods: Triple pelvic osteotomy was performed in 21 hips of 19 patients (13 females, 6 males; mean age during operation 16.3 years; range 8 to 32 years). Acetabular dysplasia was bilateral in two, and unilateral in 17 patients. Etiology was developmental dysplasia of the hip in 12 patients, Legg-Calve-Perthes disease in five patients, and diplegic and quadriplegic cerebral palsy in two patients, respectively. The patients were clinically evaluated by the modified Merle d’Aubigne-Postel system, and radiographical assessments were made using nine parameters. The mean follow-up period was 27.7 months (range 14 to 60 months).Results: According to the modified Merle d’Aubigne-Postel system, preoperative and postoperative clinical scores were 13.14 and 15.29, respectively (p, Amaç: Asetabuler displazili hastalara uygulanan üçlü pelvik osteotomi ameliyatının asetabuler örtünme üzerine etkisi ve klinik yansıması klinik ve radyografik parametrelerle değerlendirildi.Çalışma planı: Asetabuler displazisi olan 19 hastanın (13 kadın, 6 erkek; ameliyat tarihinde ort. yaş 16.3; dağılım 8-32) 21 kalçasına üçlü pelvik osteotomi yapıldı. İki hastada iki taraflı, 17 hastada tek taraflı tutulum vardı. Etyoloji, 12 hastada gelişimsel kalça displazisi, beş hastada Legg-Calve-Perthes hastalığı, iki hastada ise biri diplejik diğeri kuadriplejik tutulumlu serebral felçti. Klinik değerlendirme modifiye Merle d’Aubigne-Postel sistemine göre yapıldı. Radyografik değerlendirmede dokuz parametre kullanıldı. Ameliyat sonrası takip süresi ortalama 27.7 ay (dağılım 14-60 ay) idi.Sonuçlar: Modifiye Merle d’Aubigne-Postel klinik değerlendirme toplam puanları ameliyat öncesi ve sonrasında sırasıyla 13.14 ve 15.29 bulundu (p

Objectives: We evaluated the functional and radiologic results of surgical treatment in patients with displaced acetabular fractures.Methods: The study included 21 patients (13 males, 8 females; mean age 35 years; range 21 to 63 years). Before surgery, all the patients were evaluated with anteroposterior, iliac, and obturator oblique views and computed tomography scans. According to the Letournel-Judet classification, the fractures were simple in 10 patients and complex in 11 patients. Twelve patients had posterior wall and/or the posterior column fractures. Four patients underwent closed reduction under emergency settings for accompanying posterior dislocations. The mean time to surgery was 4.8 days (range 1 to 13 days). Surgery was performed by the Kocher-Langenbeck approach (n=12), a triradiate approach (n=5), and a modified extended iliofemoral approach (n=4). Functional results were assessed by the D’Aubigne-Postel’s knee scoring system and radiologic results using anteroposterior, iliac, and obturator oblique views. The mean follow-up was 31 months (range 19 to 64 months).Results: Functional results were excellent in eight patients (38.1%), good in seven (33.3%), satisfactory in four (19.1%), and poor in two patients (9.5%). Radiologic examination showed posttraumatic arthrosis in four patients (19.1%), heterotopic ossification in three patients (14.3%), and avascular necrosis in two patients (9.5%). Radiologic results were excellent and good in 16 patients (76.2%), satisfactory in three patients (14.3%), and poor in two patients (9.5%).Conclusion: Clinical and radiologic results showed concordance. The presence of dislocations and inadequate reduction were associated with poor functional results., Amaç: Asetabulum kırığı nedeniyle cerrahi tedavi uyguladığımız hastalarda fonksiyonel ve radyolojik sonuçlar değerlendirildi.Çalışma planı: Asetabulum kırığı nedeniyle cerrahi tedaviden sonra yeterli takibi yapılan 21 hasta (13 erkek, 8 kadın; ort. yaş 35; dağılım 21-63) çalışmaya alındı. Ameliyat öncesinde tüm olgular ön-arka, iliak ve obturator oblik grafiler yanı sıra bilgisayarlı tomografi ile değerlendirildi. Letournel-Judet sınıflamasına göre 10 hastada basit, 11 hastada kompleks kırık vardı. En sık arka duvar ve/veya arka kolon kırığı (12 hasta) saptandı. Kırıkla birlikte arkaya çıkık olan dört hastaya acil kapalı redüksiyon yapıldı. Hastalar ortalama 4.8 günde (dağılım 1-13 gün) ameliyat edildi. On iki olguda Kocher-Langenbeck, beş olguya triradyat, dört olguya modifiye genişletilmiş iliofemoral yaklaşım uygulandı. Sonuçlar fonksiyonel olarak D’Aubigne ve Postel kalça puanlaması ile ve radyolojik olarak ön-arka, iliak ve obturator grafilerle değerlendirildi. Ortalama takip süresi 31 ay (dağılım 19-64 ay) idi.Sonuçlar: Fonksiyonel olarak sekiz hastada çok iyi (%38.1), yedi hastada iyi (%33.3), dört hastada yeterli (%19.1), iki hastada kötü (%.9.5) sonuç elde edildi. Radyolojik olarak dört hastada posttravmatik artroz (%19.1), üç hastada heterotopik ossifikasyon (%14.3), iki hastada avasküler nekroz (%9.5) saptandı. Radyolojik sonuçlar 16 olguda çok iyi ve iyi (%76.2), üç olguda yeterli (%14.3), iki olguda kötü (%9.5) idi. Çıkarımlar: Klinik ve radyografik sonuçların paralellik gösterdiği görüldü. Redüksiyonun yeterli olmadığı ve çıkıkla birlikte olan olgularda kötü fonksiyonel sonuç alındı.

Objectives: This study was designed to evaluate the results of single-stage bilateral Pemberton’s pericapsular osteotomy with or without open reduction and to demonstrate its advantages over two separate consecutive interventions in bilateral developmental dysplasia of the hip (DDH).Methods: This prospective study included 20 patients (14 girls, 6 boys; mean age 30 months; range 12 to 60 months) with bilateral DDH, who underwent single-stage bilateral Pemberton’s pericapsular osteotomy with (14 patients, group A1) or without (6 patients, group A2) open reduction. Twenty patients (16 girls, 4 boys; mean age 24 months; range 13 to 47 months) with unilateral DDH, who underwent Pemberton’s pericapsular osteotomy with (12 patients, group B1) or without (8 patients, group B2) open reduction were enrolled into the study as controls. Single- and two-stage procedures were compared with regard to improvement in the acetabular index, complications, mean duration of anesthesia, perioperative need for blood transfusion, length of hospital stay, initiation of walking, overall cost of antibiotic prophylaxis, and total hospital charge.Results: There were no significant differences between A1 and B1, A2 and B2 groups with respect to mean age, gender, pre- and postoperative acetabular indices, and recovery times. However, duration of anesthesia, length of hospital stay, cost of antibiotic prophylaxis, and total hospital charges differed significantly. The amount of blood transfusion differed significantly only between groups A1 and B1. The length of hospital stay and cost of antibiotic prophylaxis in group A2 was twice as much as that of group B2. Increases in other parameters ranged between 22% to 37%. No early or late complications were encountered.Conclusion: Single-stage bilateral Pemberton’s pericapsular osteotomy in patients with bilateral DDH seems to have significant advantages over two separate consecutive interventions. However, increased risks of bilateral osteotomies require that sufficiently equipped and experienced anesthesiologic and surgical teams be available., Amaç: Çift taraflı gelişimsel kalça displazisi (GKD) olan hastalarda, tek seansta açık redüksiyon ile birlikte ya da yalnız yapılan çift taraflı Pemberton perikapsüler osteotomisinin sonuçlarını ve iki ayrı seansta yapılan girişimlere olan üstünlüğünü değerlendirmek.Çalışma planı: Çift taraflı GKD nedeniyle tek seansta, açık redüksiyon ile birlikte (14 hasta, A1 grubu) ya da yalnızca (6 hasta, A2 grubu) çift taraflı Pemberton perikapsüler osteotomisi yapılan 20 hasta (14 kız, 6 erkek; ort. yaş 30 ay; dağılım 12-60 ay) prospektif olarak incelendi. Tek taraflı GKD nedeniyle açık redüksiyon ile birlikte (12 hasta, B1 grubu) ya da yalnızca (8 hasta, B2 grubu) Pemberton perikapsüler osteotomisi yapılan 20 hasta (16 kız, 4 erkek; ort. yaş 24 ay; dağılım 13-47 ay) kontrol grubunu oluşturdu. Çalışma grubu ile kontrol grubundaki hastalar asetabuler indekste elde edilen düzelme derecesi, komplikasyonlar, ortalama anestezi süresi, ameliyat sırasında gereken kan nakli miktarı, hastanede yatış süresi, yürümeye başlama süresi, antibiyotik profilaksisi tutarı ve toplam hastane harcaması bakımından karşılaştırıldı.Sonuçlar: A1 ile B1, A2 ile B2 grupları arasında yaş ortalaması, cinsiyet, ameliyat öncesi ve sonrası asetabuler indeks ölçümleri, iyileşme süresi bakımından anlamlı farklılık görülmedi. Anestezi süresi, hastanede yatış süresi, antibiyotik profilaksisi tutarları ve toplam hastane harcaması bakımından anlamlı fark belirlendi. Kan nakli miktarı açısından yalnızca A1 ile B1 grupları arasında anlamlı fark saptandı. Hastanede yatış süresi ve antibiyotik profilaksisi tutarı A2 grubunda B2 grubuna göre iki kat fazla idi. Diğer parametrelerdeki artışlar %22 ile %37 arasında değişmekteydi. Hiçbir hastada erken ya da geç komplikasyonla karşılaşılmadı.Çıkarımlar: Gelişimsel kalça displazisinde tek seansta yapılan çift taraflı Pemberton perikapsüler osteotomisinin, iki ayrı seansta yapılan ardışık ameliyatlara göre belirgin üstünlükleri vardır. Bununla birlikte, büyük bir cerrahi girişim olan çift taraflı osteotomiler için cerrahi ekibin olduğu kadar anestezi ekibinin de yeterince donanımlı ve deneyimli olması gerekir.

Objectives: This study was designed to evaluate long term results and to determine prognostic factors in patients who underwent surgery for acetabular fractures.Methods: Of three hundred and thirty-two patients who underwent surgery for acetabular fractures between January 1970 and January 1998, 240 patients (186 males, 54 females; mean age 17 years; range 15-81 years) with adequate follow-up data were included. The mean period between the traumatic event and the last follow-up examination was 11.2 years (range 2-26 years). According to the classification of Letournel and Judet, 163 fractures (68%) were simple and 77 (32%) were of compound type. Central, posterior, and anterior dislocations occurred in 45.8%, 38.4%, and 15.8% of fractures, respectively.Results: At the last follow-up examination, excellent, good, fair, and poor functional results were obtained in 96 (40%), 96 (40%), 12 (5%), and 36 (15%) patients, respectively. Radiologic results were excellent in 45%, good in 21.7%, fair in 18.3%, and poor in 15%. Statistical analyses revealed that significant prognostic factors included mean period between the trauma and operation (p=0.05), damage to the femoral head (p=0.01), and the quality of anatomic reduction (p=0.009).Conclusion: We obtained satisfactory results in 192 of 240 hips (80%) by surgical therapy, aiming an excellent anatomic reduction in order to prevent late secondary osteoarthrosis. Similar results are reported in the literature by experienced surgical teams after long follow-up periods. Both in our series and in some other in the literature, no statistical significance between clinical and radiologic results have been found., Amaç: Kliniğimizde cerrahi yöntemle tedavi edilen asetabulum kınklı olguların uzun dönem tedavi sonuçlarım değerlendirmek ve prognoza etkili kriterleri belirlemek.Çalışma planı: Ocak 1970-Ocak 1998 döneminde, kliniğimizde cerrahi olarak tedavi edilen asetabulum kınklı 332 olgu içinden yeterli takipleri yapılan 240 hasta (186 erkek, 54 kadın; yaş ort. 17; yaş dağılımı 15-81) çalişmaya alındı. Kaza ile son kontrol muayenesi arasnda geçen ortalama süre 11.2 yıl (dağılım 2;26 yıl) idi. Letoumel ve Judet sınıflama sistemine göre 240 kırığın 163'ü (%68) basit kırık, 77'si (%32) bileşik kınktı. Tile sınıflama sistemine göre 110 kalçada (%45.8) travma anında santral çıkık, 92 hastada (%38.4) arkaya çıkık, 38 hastada (%15.8) öne çıkık oluşmuştu.Sonuçlar: Son kontrol muayenesinde 96 hastada (%40) mükemmel, 96 hastada (%40) iyi, 12 hastada (%5) orta ve 36 hastada (%15) kötü sonuç elde edildi. Radyolojik sonuçlar 108 hastada (%45) mükemmel, 52 hastada (%21.7) iyi, 44 hastada (%18.3) orta ve 36 hastada (%15) kötü şeklindeydi. Kaza anı ve cerrahi girişim arasinda geçen sürenin (p=0.05), femur başnda hasar varlığınn (p=0.01)ve redüksiyon kalitesinin (p=0.009) klinik sonuca etkili, prognostik değer taşıyan kriterler oldukları saptandı.Çıkarımlar: Geç osteoartrozu önleme prensibinden yola çıkarak ve tam anatomik redüksiyonu amaçlayarak yapılan cerrahi tedaviyle 240 olgunun 192'sinde (%80) tatminkar (mükemmel ve iyi) klinik sonuç elde ettik. Literatürde tecrübeli ekiplerin büyük serilerinde uzun dönem takipler sonucunda benzer değerler bildirilmiştr. Hasta grubumuzda ve literatürdeki bazı serilerde radyolojik ve klinik sonuçlar arasinda anlamlı fark bulunamamıştır.Anahtar sözcükler: Asetabulum/cerrahi/yaralanma/radyografiq kınk/cerrahi/komplikasyonq kırık fıksasyonu, intemal/yöntem.

Objectives: To evaluate early results of the ilioinguinal approach in the surgical treatment of displaced acetabular fractures and to report our experience with this technique.Methods: Using a standardized prospective protocol, 20 consecutive patients with displaced acetabular fractures were treated with open reduction and internal fixation via the ilioinguinal approach. There were 17 men and three women with ages ranging from 19 to 70 years (mean age 41 years). Surgery was performed within the first three weeks of admission. According to the Judet and Letournel classification, there were 14 complex (70%) and six elementary (30%) fractures. Radiologic and clinical evaluations were made using the criteria described by Matta. The mean follow-up was 14 months (range 6 to 32 months).Results: Postoperative reduction was regarded as anatomic or satisfactory in 80%. Postoperative complications included deep wound infection (n=1), iatrogenic sciatic nerve palsy (n=2), and, according to the classification by Ghalambor et al., grade I heterotopic ossification (n=1). During follow-up, posttraumatic osteoarthrosis developed in one patient, and moderate narrowing of the hip joint (, Amaç: Ayrılmış asetabulum kırıklarının cerrahi tedavisinde ilioinguinal yaklaşımın erken sonuçlarının ve uygulamayla ilgili tecrübelerimizin bildirilmesi.Çalışma planı: Prospektif bir çalışma protokolü çerçevesinde, 20 hastanın ayrılmış asetabulum kırığı ilioinguinal yaklaşımla cerrahi olarak tedavi edildi. Hastaların 17’si erkek, üçü kadın idi (yaş ort. 41; dağılım 19-70). Tüm hastalar başvurudan sonraki ilk üç hafta içerisinde ameliyat edildi. Judet ve Letournel sınıflamasına göre, kırıkların 14’ü (%70) kompleks tipte, altısı (%30) elementer tipteydi. Son kontrolde hastaların klinik ve radyolojik değerlendirilmeleri, Matta’nın tanımladığı kriterler kullanılarak yapıldı. Ortalama izlem süresi 14 ay (dağılım 6-32 ay) idi.Sonuçlar: Hastaların %80’inde ameliyat sonrası redüksiyon, anatomik ya da başarılı olarak değerlendirildi. Bir hastada derin yara enfeksiyonu, iki hastada siyatik sinirin peroneal komponentini etkileyen iatrojenik sinir arazı, bir hastada Ghalambor ve ark.nın sınıflamasına göre I. derece heterotopik ossifikasyon gelişti. İzlem süresi içinde bir hastada belirgin posttravmatik artrit, iki hastada ise eklem aralığında orta derecede (%50’den az) daralma saptandı. Son kontrolde hastaların radyolojik değerlendirmelerinin klinik bulguları ile uyumlu olduğu gözlendi.Çıkarımlar: Çalışmamız, asetabulumun ayrılmış kırıklarında ilioinguinal yaklaşımla cerrahi tedavinin etkili bir seçenek olduğunu gösterdi. İlioinguinal yaklaşımla, düşük komplikasyon oranı, hızlı yara iyileşmesi ve çok sayıda kırık tipinde yeterli görünüm sağlanmaktadır.

Objectives: We evaluated the results of acetabular shelf procedures performed for the treatment of Legg-Calve-Perthes (LCP) disease.Methods: The study included 14 patients (17 hips) with LCP disease, who were treated with acetabular shelf operation. The mean ages at the time of diagnosis, operations, and final examinations were 7 years (range 5 to 9 years), 8 years (range 6 to 10 years), and 12 years (range 10 to 16 years), respectively. The mean follow-up was five years (range 3 to 9 years). Before surgery, all patients had Catterall 3-4 hips, and at least two risk factors were identified. On pre- and postoperative anteroposterior and lateral radiograms, the Mose sphericity indices and CE angles were measured. In addition, the presence of hinge abduction was evaluated by dynamic arthrography preoperatively, and on direct radiograms and clinically during final examinations. The hips were graded according to a modified Stulberg classification on final direct radiograms. Clinical evaluation was made with the use of the Iowa hip scores.Results: The Mose measurements did not yield significant improvement on anteroposterior radiograms (p>0.05), whereas postoperative improvement was significant on lateral views (p, Amaç: Legg-Calve-Perthes (LCP) hastalığı nedeniyle asetabuler çatı girişimi uygulanmış olan hastaların sonuçlarını değerlendirdik.Çalışma planı: Kliniğimizde LCP hastalığı tanısı ile takip edilen ve çatı ameliyatı uygulanan 14 hastanın 17 kalçası çalışmaya alındı. Hastaların ortalama yaşı, tanı konduğunda 7 (dağılım 5-9), ameliyatlar sırasında 8 (dağılım 6-10) ve son takip muayenesinde 12 (dağılım 10-16) idi. Hastalar ortalama beş yıl (dağılım 3-9 yıl) süreyle izlendi. Ameliyat öncesinde kalçaların tamamı Catterall 3-4 grubunda idi. Tüm hastalarda en az iki risk faktörü vardı. Ameliyat öncesi ve son takip radyografilerinde ön-arka ve yan Mose küresellik ölçümleri, merkez kenar (CE) açı ölçümleri yapıldı ve istatistiksel olarak karşılaştırıldı. Hastalar ameliyat öncesinde dinamik artrografi ve son takiplerinde ise radyografik ve klinik olarak menteşeli abduksiyon açısından değerlendirildi. Son takip radyografisinde Stulberg sınıflaması modifiye edilerek kalçalar sınıflandırıldı. Klinik olarak Iowa kalça skoru ile değerlendirme yapıldı.Sonuçlar: Mose küresellik ölçümlerinde, ön-arka radyografilerde görülen düzelme istatistiksel bakımdan anlamlı bulunmadı (p>0.05). Yan radyografilerdeki düzelme ise anlamlı idi (p

Objectives: We evaluated clinical and radiologic results of uncemented total hip arthroplasty for secondary osteoarthritis in patients with congenital hip dislocation and dysplasia.Methods: Total hip arthroplasty was performed in 23 hips of 20 patients (18 females, 2 males; mean age 46 years; range 31 to 65 years). Seven (30.4%), eight (34.8%), and eight hips were Crowe type-II, III, and IV, respectively. Femoral head autografting was used in six patients with acetabular deficiency. Eight hips (34.8%) underwent subtrochanteric femoral osteotomy. Clinical evaluation was made using the Harris hip scores and Merle d’Aubigné’s criteria, and radiological evaluations with pre- and postoperative, and control A-P radiographs. The mean follow-up was 35.1 months (range 12 to 85 months).Results: Pre- and postoperative mean Harris hip scores were 38.6 and 91.1, respectively. The mean Merle d’Aubigné scores were 1.66 and 5.7 for pain, 3.1 and 5.4 for mobility, and 3.2 and 5.3 for walking, respectively. Radiologically, graft coverage was 32%. In seven hips (30.4%) the acetabular component was fully covered by the acetabular bone. In 10 hips (43.4%), 18% of the acetabular component was uncovered. The location of the acetabular component was almost in the desired place in 10 hips (43.4%), lower in eight hips (34.8%), and above in five hips (21.7%). No sciatic or femoral nerve injuries were observed. One patient (4.4%) with Crowe type-IV hip required acetabular revision for dislocation due to acetabular malposition. No recurrences occurred.Conclusion: Correct placement of the uncemented small acetabular component, graft usage in cases with inadequate coverage of the acetabular component, and femoral shortening osteotomy where necessary should be considered in congenital hip dislocation or dysplasia., Amaç: Doğumsal kalça çıkığı ve dizplazisine bağlı sekonder osteoartrit nedeniyle çimentosuz total kalça protezi uygulamasının klinik ve radyolojik sonuçları değerlendirildi.Çalışma planı: Yirmi hastanın (18 kadın, 2 erkek; ort. yaş 46; dağılım 31-65) 23 kalçasına total kalça protezi uygulandı. Yedi kalça (%30.4) Crowe tip II, sekizi (%34.8) tip III, sekizi (%34.8) tip IV idi. Asetabulumun yetersiz olduğu altı kalçada (%26) femur başı greft olarak kullanıldı. Sekiz kalçada (%34.8) subtrokanterik femoral kısaltma osteotomisi uygulandı. Klinik değerlendirme Harris ve d’Aubigné’nin kalça değerlendirme kriterleri ile yapıldı. Radyolojik değerlendirme ameliyat öncesi ve sonrası ve kontrollerde çekilen ön-arka grafilerle yapıldı. Ortalama takip süresi 35.1 ay (dağılım 12-85 ay) idi. Sonuçlar: Ameliyat öncesi ve sonrası Harris kalça puanları 38.6 ve 91.1; d’Aubigné kalça değerlendirme puanları ağrı için 1.66 ve 5.7, hareket açıklığı için 3.1 ve 5.4, yürüme için 3.2 ve 5.3 bulundu. Radyolojik incelemede ortalama greft örtümü %32 idi. Yedi kalçada (%30.4) asetabuler komponentin tamamı asetabular kemik tarafından örtüldü. On kalçada (%43.4) asetabular komponentin desteksiz kalan bölümü ortalama %18 (%6.5-%22) bulundu. Asetabular komponent 10 kalçada (%43.4) hemen hemen yerinde, sekiz kalçada (%34.8) aşağıda, beş kalçada (%21.7) yukarıda yerleşimliydi. Olgularda siyatik ve femoral sinir hasarı gelişmedi. Crowe tip IV’lü bir olguda (%4.4) asetabuler malpozisyon nedeniyle disloke olan kalçaya asetabuler revizyon uygulandı. Yeniden çıkık gelişmedi.Çıkarımlar: Doğumsal kalça çıkığı veya displazili olgularda, çimentosuz küçük asetabuler komponentin gerçek asetabuluma yerleştirilmesi, kemik örtümü yetersiz olgularda greft kullanılması, gereken olgularda femoral kısaltma osteotomisi yapılması gerektiği sonucuna varıldı.

Objectives: We evaluated the results of non-cemented revision arthroplasty in patients who had undergone cemented total hip arthroplasty.Methods: Twenty patients (12 women, 8 men; mean age 72 years; range 61 to 84 years) underwent non-cemented revision arthroplasty after a mean of 9.4 years (range 3 to 16 years) following primary surgery. The mean follow-up period was 4.5 years (range 3 months to 6.3 years). Results: During revision arthroplasty, femur fractures were observed in three patients (15%). Three patients (15%) had femoral cortex perforations. Trochanteric osteotomy was performed in five patients (25%). The mean Harris hip score after the operation was 76.7 (range 50 to 90). The results were excellent in three patients (15%), good in seven (35%), fair in seven (35%), and poor in three patients (15%).Conclusion: Despite a high intraoperative complication rate during non-cemented revision total hip arthroplasty, we believe that non-cemented revision should be the preferred method because of low infection and low aseptic loosening rates., Amaç: Çimentolu total kalça artroplastisi yapılan olgularda uyguladığımız çimentosuz revizyon artroplastisi sonuçlarını değerlendirdik. Çalışma planı: Yirmi olguda (12 kadın, 8 erkek; ort. yaş 72; dağılım 61-84) çimentosuz total kalça revizyonu uygulandı. Primer protez uygulamasından sonra geçen ortalama süre 9.4 yıl (dağılım 3-16 yıl), ortalama izlem süresi 4.5 yıl (dağılım 3 ay-6.3 yıl) idi.Sonuçlar: Revizyon artroplastisi sırasında üç olguda (%15) femoral kırık, üç olguda (%15) femoral korteks perforasyonu görüldü. Beş olguda (%25) trokanterik osteotomi yapıldı. Ameliyat sonrası Harris kalça skoru ortalaması 76.7 (dağılım 50-90) bulundu. Sonuçlar üç olguda (%15) mükemmel, yedi olguda (%35) iyi, yedi olguda (%35) orta, üç olguda (%15) kötü idi. Çıkarımlar: Çimentosuz total kalça revizyon artroplastileri sırasında, önemli oranda ameliyat içi komplikasyon oluşmaktadır. Buna karşın, enfeksiyon oranlarının düşük olması ve aseptik gevşemenin daha az görülmesi nedeniyle, çimentosuz revizyonların tercih edilmesi gerektiğini düşünüyoruz.

Objectives: To evaluate early and mid-term results of open reduction and internal fixation for acetabular fractures.Patients: The study included 39 patients (29 males, 10 females; mean age 35 years) who underwent surgery for acetabular fractures between January 1991 and August 1997. Most of the fractures were caused by high-energy trauma, resulting in a displacement of more than 3 mm and instability. According to the classification of Letournel and Judet, the fractures were simple in 15 cases and complex in 24 cases. Three patients had sciatic nerve palsy on admission. Posterior and central dislocations of the hip occurred in six patients and one patient, respectively. The period from injury to operation ranged from two to fifteen days with a mean of nine days. Mean follow-up period was 52 months (range 27 to 90 months).Results: The mean postoperative displacement was one millimeter (range 0 to 7 mm). Postoperative reduction was graded as excellent in 64.1% (n=25), imperfect in 23.0% (n=9), and poor in 12.8% (n=5). We encountered two superficial and one deep infections, three avascular necroses, no iatrogenic nerve injuries and no disabling heterotopic ossification. At the most recent follow-up, thirty patients had no pain at all (76.9%); six patients (15.3%) complained of intermittent pain that did not require medication. Conclusion: Open reduction and internal fixation of the displaced high energy acetabular fractures should be performed to avoid post-traumatic osteoarthritis and to achieve a pain-free functional joint., Amaç: Deplase asetabulum kırıklarının cerrahi tedavisinin kısa ve orta dönem sonuçları değerlendirildi.Çalışma planı: Çalışmaya, Ocak 1991-Ağustos 1997 yılları arasında, cerrahi olarak tedavi edilen deplase asetabulum kırıklı 39 hasta (29 erkek, 10 kadın; ort. yaş 35) alındı. Kırıkların hemen hepsi yüksek enerjili travma ile oluşmuş, 3 mm’den fazla deplasmanı olan, instabilite veya uyumsuzluk yaratan kırıklar idi. Kırıklar Judet ve Letournel sınıflamasına göre 15’i basit ve 24’ü kompleks olarak gruplandırıldı. Üç hastada kırık sonrası sinir hasarı, altı hastada eşlik eden posterior luksasyon, bir hastada ise santral luksasyon mevcut idi. Yaralanma ile ameliyat arasında geçen süre 2-15 gün (ort. 9 gün) arasında değişmekteydi. Hastalar ortalama 52 ay süreyle (dağılım 27-90 ay) izlendi.Bulgular: Takip süresi sonunda postoperatif kırık deplasmanı 1 mm bulundu (0-7 mm). Redüksiyon olguların %64.1’inde (n=25) mükemmel, %23’ünde (n=9) iyi olarak değerlendirildi. Beş kalçada ise (%12.8) kötü redüksiyon elde edildi. İki hastada yüzeyel, bir hastada derin enfeksiyon, üç hastada avasküler nekroz, dokuz hastada eklem hareketini etkilemeyecek oranda heterotopik osifikasyon gözlendi. Son takiplerinde hastaların %76.9’unda hiç ağrı yoktu; %15.3’ünde ise analjezik gerektirmeyen ağrı mevcut idi. Çıkarımlar: Bu sonuçlar ışığında, posttravmatik artriti önlemek ve kalça eklem fonksiyonlarının devamlılığını sağlamak için deplase asetabulum kırıklarının cerrahi tedavisini önermekteyiz.

Objectives: We evaluated total hip arthroplasty in patients with high-riding developmental dysplasia of the hip with regard to surgical method and modifications, problems encountered during surgery, and follow-up results.Methods: A total of 42 hips (22 Crowe type III, 20 type IV) of 31 patients (29 women, 2 men; mean age 45.7 years; range 26-70 years) who underwent total hip arthroplasty were clinically and radiologically evaluated. In all cases, cementless acetabular components were placed in the true acetabulum. Fifteen acetabula required structural autografts. Cementless stems were used on the femoral side. Proximal metaphyseal step-cut osteotomy was performed in patients with high-riding hips of more than 4 cm. The mean follow-up period was 54.7 months (range 11 to 127 months).Results: The mean Harris hip score increased from 37.6 preoperatively to 91.02 at the end of follow-up. No acetabular autograft resorption or non-union were observed. Non-union and delayed union in the femoral osteotomy site were encountered in two patients, respectively. Two components (1 acetabular, 1 femoral) were revised during the follow up period. Two sciatic and two femoral temporary nerve palsies occurred. One patient developed superficial infection and was treated by debridement and antibiotics. Brooker type I heterotopic ossification was observed in seven patients.Conclusion: Total hip arthroplasty proved successful in high riding developmental dysplasia of the hip, Amaç: Yüksekte doğuştan kalça çıkığı nedeniyle total kalça artroplastisi uygulanan olgularda yöntem ve modifikasyonlar, karşılaşılan sorunlar ve klinik sonuçlar değerlendirildi.Çalışma planı: Otuz bir hastanın (29 kadın, 2 erkek; ort yaş 45.7; dağılım 26-70) toplam 42 kalçasına (22 Crowe tip III, 20 tip IV) uygulanan total kalça artroplastileri, klinik ve radyolojik olarak değerlendirildi. Tüm hastalarda gerçek asetabuluma yerleştirilen çimentosuz asetabuler komponent kullanıldı. On beş kalçada asetabulum, otojen yapısal allogreft ile desteklendi. Femoral tarafta da çimentosuz protez uygulandı; femurun 4 cm’den fazla distale indirilmesini gerektiren olgularda, femur proksimal metafiz basamaklı kısaltma osteotomisi uygulandı. Olgular ortalama 54.7 ay (dağılım 11-127 ay) süreyle izlendi.Sonuçlar: Ameliyat öncesinde 37.6 olan Harris kalça skoru, izlem sonunda 91.02’ye yükseldi. Kullanılan otogreftlerin tümünde kaynama sağlandı, greft rezorbsiyonu görülmedi. Femoral kısaltma osteotomisi bölgesinde bir hastada kaynamama, bir hastada geç kaynama gözlendi. Bir hastada asetabuler komponent, bir hastada ise femoral komponent revizyonuna gerek duyuldu. İki hastada geçici siyatik sinir, iki hastada geçici femoral sinir paralizisi gözlendi. Bir hastadaki yüzeyel enfeksiyon, yara debridmanı ve antibiyoterapi ile kontrol altına alındı. Yedi hastada Brooker tip I heterotopik ossifikasyon saptandı.Çıkarımlar: Yüksekte kalça çıkığı zemininde total kalça artroplastisi klinik olarak başarılı bir cerrahi girişimdir.

Objectives: We evaluated femoral head coverage by three-dimensional computed tomographic reconstruction after Pemberton’s pericapsular osteotomy with open reduction in cases with developmental dysplasia of the hip.Methods: In a prospective design, routine radiographs of 15 consecutive patients were obtained and three-dimensional computed tomographic reconstruction was performed preoperatively and six months after surgery. The mean age at the time of surgery was 26 months (range 18 to 34 months). Twelve patients were girls and three were boys.Results: The mean acetabular index was 38° (range 33-52°) preoperatively, and 19° (range 16-23°) postoperatively. Comparison between pre- and postoperative three-dimensional computed tomographic reconstruction images revealed increased acetabular adduction and extension, and decreased acetabular anteversion in all cases. Sufficient coverage of the femoral head was documented in all patients.Conclusion: Pemberton’s pericapsular osteotomy provides successful results in appropriate cases, with sufficient coverage of the femoral head. However, if there is any doubt, utilization of three-dimensional computed tomographic reconstruction images may contribute to a more precise evaluation of the outcome., Amaç: Açık redüksiyonla birlikte Pemberton perikapsüler osteotomisi yapılan gelişimsel kalça displazili olgularda, ameliyat sonrasında femur başının örtünmesinin yeterli olup olmadığı üç boyutlu bilgisayarlı tomografi rekonstrüksiyonu ile değerlendirildi.Çalışma planı: Prospektif bir çalışma düzeneğinde, 15 ardışık hastanın (12 kız, 3 erkek; ort. yaş 26 ay; dağılım 18-34 ay) ameliyat öncesi ve altı ay sonrası rutin radyografileri çekildi. Üç boyutlu bilgisayarlı tomografi rekonstrüksiyonu yapıldı ve femur başının örtünmesi değerlendirildi.Sonuçlar: Ameliyat öncesi dönemde 38° (dağılım 33-52°) olan asetabuler indeks ortalaması, sonraki dönemde 19 dereceye (dağılım 16-23°) indi. Üç boyutlu bilgisayarlı tomografilerin karşılaştırılması sonucunda, ameliyat sonrasında asetabulumların hepsinde addüksiyon ile ekstansiyon derecelerinde artış, asetabuler anteversiyon derecesinde ise azalma saptandı. Tüm hastalarda femur başının örtünmesi yeterli bulundu.Çıkarımlar: Uygun olgularda, Pemberton perikapsüler osteotomisinin çok iyi sonuçlar verdiğini, osteotomi sonrası femur başı örtünmesinin yeterli olduğunu düşünüyoruz; ancak bu konuda kuşku var ise, konvansiyonel yöntemler yerine üç boyutlu rekonstrüksiyonu yapılan bilgisayarlı tomografi görüntülerini kullanmanın daha doğru olacağı görüşündeyiz.

INTRODUCTION: We report the results of a titanium acetabular reinforcement ring with a hook (ARRH) in primary total hip arthroplasty (THA), which was introduced in 1987 and continues to be used routinely in our center. The favorable results of this device in arthroplasty for developmental dysplasia and difficult revisions motivated its use in primary THA. With this implant only minimal acetabular reaming is necessary, anatomic positioning is achieved by placing the hook around the teardrop and a homogenous base for cementing the polyethylene cup is provided. MATERIALS AND METHODS: Between April 1987 and December 1991, 241 THAs with insertion of an ARRH were performed in 178 unselected, consecutive patients (average age 58 years; range 30-84 years) with a secondary osteoarthrosis in 41% of the cases. RESULTS: At the time of the latest follow-up, 33 patients (39 hips) had died and 17 cases had been lost to follow-up. The median follow-up was 122 months with a minimum of 10 years. Eight hips had been revised, leaving 177 hips in 120 living patients without revision. Six cups were revised because of aseptic loosening. Two hips were revised for sepsis. The mean Merle d'Aubigné score for the remaining hips was 16 (range 7-18) at the latest follow-up. For aseptic loosening, the probability of survival of the cup was 0.97 (95% confidence interval, 0.94-0.99). However, analysis of radiographs implied loosening in seven other cups without clinical symptoms. CONCLUSIONS: The results of primary THA using an acetabular reinforcement ring parallel the excellent results of these implants often observed in difficult primary and revision arthroplasty at a minimum of 10 years. Survivorship is comparable to modern cementless implants. Medial migration that occurs with loosening of the acetabular component seems to be prevented with this implant. Radiographic loosening signs can exist without clinical symptoms.

Objectives: We evaluated the results of femoral shortening by subtrochanteric segmental resection in patients who underwent total hip replacement (THR) for high total dislocation of the hip.Methods: We performed THR in 19 hips of 16 patients (15 females, 1 male; mean age 41 years; range 22 to 55 years) with high total dislocation of the hip. All the patients had severe hip pain. In all cases, femoral shortening by subtrochanteric segmental resection and an anatomical reconstruction of the acetabulum were performed with the use of cementless femoral components and cementless acetabular components with screws, respectively. The Harris hip scoring system was used for functional assessments. Radiologic assessments were based on the DeLee and Charnley criteria for the acetabular component, and on the Gruen zones and the Engh criteria for the femoral component. The mean follow-up period was 44 months (range 22 to 79 months).Results: Union was achieved in all cases in a mean of 14 weeks (range 11 to 15 weeks). The mean leg length discrepancy decreased from 4 cm to 1.5 cm postoperatively. A positive Trendelenburg sign was found in 13 patients and four patients before and after surgery, respectively. The mean Harris hip score improved from 37 to 83 postoperatively. None of the patients developed deep infection, dislocation, sciatic nerve palsy, or nonunion at the osteotomy site. No clinical and radiologic signs of loosening were observed and no revisions were required.Conclusion: Femoral shortening with subtrochanteric segmental resection in THR is a safe technique in patients with high total dislocation of the hip, leading to satisfactory functional results., Amaç: Yüksek total kalça çıkığı nedeniyle çimentosuz total kalça artroplastisi uygulanan olgularda subtrokanterik segmental rezeksiyon ile femoral kısaltma sonuçları değerlendirildi.Çalışma planı: Yüksek total çıkığı ve gelişimsel kalça displazisi olan 16 hastanın (15 kadın, 1 erkek; ort. yaş 41; dağılım 22-55) 19 kalçasına şiddetli ağrı nedeniyle total kalça artroplastisi uygulandı. Tüm hastalarda subtrokanterik segmental rezeksiyon ile femoral kısaltma uygulandı ve asetabulum anatomik olarak restore edildi. Tüm hastalarda çimentosuz, vidalı asetabuler komponentler ve çimentosuz femoral komponentler kullanıldı. Fonksiyonel değerlendirme Harris kalça skoru ile yapıldı. Radyolojik değerlendirmede asetabuler komponent için De Lee ve Charnley ölçütleri, femoral komponent ise Gruen zonları ve Engh ölçütleri kullanıldı. Ortalama izlem süresi 44 ay (dağılım 22-79 ay) idi.Bulgular: Tüm hastalarda ortalama 14 haftada (dağılım 11-15 hafta) rezeksiyon hattında kaynama elde edildi. Ameliyat öncesinde ortalama 4 cm olan ekstremite eşitsizliği ameliyat sonrasında 1.5 cm bulundu. Ameliyat öncesinde 13 hastada görülen Trendelenburg bulgusu ameliyat sonrasında dört hastada gözlendi. Ameliyat öncesinde 37 puan olan Harris kalça skoru ortalaması, ameliyat sonrasında 83 puana yükseldi. Hiçbir hastada derin enfeksiyon, dislokasyon, siyatik sinir palsisi ve rezeksiyon hattında kaynamama durumu görülmedi; klinik ve radyolojik gevşeme saptanmadı ve revizyon uygulanmadı.Çıkarımlar: Yüksek total dislokasyonlu gelişimsel kalça displazisi olan hastalarda, total kalça artroplastisinde subtrokanterik segmental rezeksiyonla yapılan femoral kısaltma, güvenli ve fonksiyonel olarak tatminkar sonuçlar sağlayıcı bir yöntemdir.

Objectives: The purpose of this study was to review the epidemiological aspects of displacement fractures of the acetabulum that had been treated surgically at the National Institute of Traumatology and Orthopedics (INTO). Methods: We retrospectively analyzed 126 acetabulum fractures that had been treated surgically at INTO between March 2006 and November 2008. The following factors were taken into account: age, sex, trauma mechanism, injury classification, time elapsed between trauma and surgery, affected side and associated bone injuries. Results: 76.8% were male; the mean age was 39.6 years. The trauma mechanism was traffic accidents in 59%; the time that elapsed between injury and surgery was on average 16.4 days; 55% of the cases were on the right side; 30% of the patients presented associated fractures. Conclusion: Most of the patients were male, in an economically active age group, and were victims of traffic accidents. Edge and/or posterior column fractures were the most frequent types. Associated injuries were common and most of the fractures operated in our service came to us late.