Peri-acetabular external fixation for hip disease: an anatomical study.
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SUBMITTER: Brown S
PROVIDER: S-EPMC2322838 | biostudies-other | 2007 Dec
REPOSITORIES: biostudies-other
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Project description:OBJECTIVES:To quantify and compare peri-acetabular bone mineral density (BMD) between a monoblock acetabular component using a metal-on-metal (MoM) bearing and a modular titanium shell with a polyethylene (PE) insert. The secondary outcome was to measure patient-reported clinical function. METHODS:A total of 50 patients (25 per group) were randomised to MoM or metal-on-polyethlene (MoP). There were 27 women (11 MoM) and 23 men (14 MoM) with a mean age of 61.6 years (47.7 to 73.2). Measurements of peri-prosthetic acetabular and contralateral hip (covariate) BMD were performed at baseline and at one and two years' follow-up. The Western Ontario and McMaster Universities osteoarthritis index (WOMAC), University of California, Los Angeles (UCLA) activity score, Harris hip score, and RAND-36 were also completed at these intervals. RESULTS:At two years, only zone 1 showed a loss in BMD (-2.5%) in MoM group compared with a gain in the MoP group (+2.2%). Zone 2 showed loss in both groups (-2.2% for MoM; -3.9% for MoP) and zones 3 and 4 a gain in both groups (+0.1% for MoM; +3.3% for MoP). No other between-group differences were detected. When adjusting for BMD of the contralateral hip, no differences in BMD were observed. The only significant differences in functional scores at two years were higher UCLA activity (7.3 (sd 1.2) vs 6.1 (sd 1.5); p = 0.01) and RAND-36 physical function (82.1 (sd 13.0) vs 64.5 (sd 26.4); p = 0.02) for MoM bearings versus MoP. One revision was performed in the MoM group, for aseptic acetabular loosening at 11 months. CONCLUSIONS:When controlling for systemic BMD, there were no significant differences between MoM and MoP groups in peri-acetabular BMD. However, increasing reports of adverse tissue reactions with large head MoM THR have restricted the use of the monoblock acetabular component to resurfacing only.
| S-EPMC3743302 | biostudies-literature
Project description:Developmental dysplasia of the hip (DDH) is a known risk factor for articular tissue damage and secondary hip osteoarthritis. Acetabular labral tears are prevalent in hips with DDH and may result from excessive loading at the edge of the shallow acetabulum. Location-specific risks for labral tears may also depend on neuromuscular factors such as movement patterns and muscle-induced hip joint reaction forces (JRFs). To evaluate such mechanically-induced risks, we used subject-specific musculoskeletal models to compare acetabular edge loading (AEL) during gait between individuals with DDH (N = 15) and healthy controls (N = 15), and determined the associations between AEL and radiographic measures of DDH acetabular anatomy. The three-dimensional pelvis and femur anatomy of each DDH and control subject were reconstructed from magnetic resonance images and used to personalize hip joint center locations and muscle paths in each model. Model-estimated hip JRFs were projected onto the three-dimensional acetabular rim to predict instantaneous AEL forces and their accumulative impulses throughout a gait cycle. Compared to controls, subjects with DDH demonstrated significantly higher AEL in the antero-superior acetabulum during early stance (3.6 vs. 2.8 × BW, p ≤ 0.01), late stance (4.3 vs. 3.3 × BW, p ≤ 0.05), and throughout the gait cycle (1.8 vs. 1.4 × BW*s, p ≤ 0.02), despite having similar hip movement patterns. Elevated AEL primarily occurred in regions where the shallow acetabular edge was in close proximity to the hip JRF direction, and was strongly correlated with the radiographic severity of acetabular deformities. The results suggest AEL is highly dependent on movement and muscle-induced joint loading, and significantly elevated by the DDH acetabular deformities.
| S-EPMC8281296 | biostudies-literature
Project description:BackgroundTotal hip arthroplasty (THA) is the treatment of choice for posttraumatic arthritis with failed internal fixation for hip fractures. However, the postoperative prognosis is not clear.Questions/purposesThe primary aim of the study is to report the postoperative outcome, prognosis, and complication rates of total hip arthroplasty in posttraumatic hip arthritis after failed internal fixation of fractures around the hip. The secondary aim of the study is to report results among different fracture types around the hip.Patients and methodsWe enrolled salvage THA patients after failed internal fixation of fractures around the hip and matched control patients undergoing primary THA for hip osteoarthritis. Subgroup analysis was performed to compare the postoperative outcomes, prognosis, and complication rates of salvage THA in posttraumatic hip arthritis after failed internal fixation of different fracture types around the hip.ResultsA total of 315 THAs (105 salvage THAs and 210 primary THAs) were analyzed. Patients with salvage THA had a longer operative time, lower postoperative hemoglobin (Hb) level, more Hb drop (2.2 ± 1.4 vs. 1.7 ± 1.2 gm/dl, p = 0.002), and delayed ambulation. The salvage THA group also had a higher dislocation rate within 2 months after salvage THA (9.5% vs. 1.9%, p = 0.002), reoperation rate (10.5% vs. 3.8%, p = 0.019, including debridement, open and closed reduction under sedation, revision surgery, surgical fixation for periprosthetic fractures), and revision rate (5.7% vs. 0.5%, p = 0.003) than patients undergoing primary THA. Patients who had failed fixation for acetabular fractures were younger and tended to recover well. Patients with previous intertrochanteric fracture had the longest operative time, more hip pain (83.8%, p = 0.022) and more complications.ConclusionSalvage THA in posttraumatic hip arthritis after failed internal fixation required a longer operative time and led to more blood loss and postoperative complications. The dislocation, reoperation, and revision rates after salvage THA were higher than those after primary THA. Patients with salvage THA after failed internal fixation for intertrochanteric fractures were the most susceptible to more complications compared to those with femoral neck fracture or acetabular fracture. Level of Evidence level III.
| S-EPMC9843827 | biostudies-literature
Project description:BackgroundThe surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the anatomical plates.MethodsA consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with a limited approach and the anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted.ResultsAll of the patients were operated using the limited pararectus approach and the anatomical plates successfully. The mean operative time and blood loss were 90.9 min and 334.1 ml, respectively. The average postoperative residual gap and step displacement on CT were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively.ConclusionsThe limited pararectus approach with the advantages of less trauma, direct exposure to the anterior column and quadrilateral plate. The anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction. The combination approach can be a good choice for limited surgery of displaced anterior acetabular fractures especially involving the quadrilateral plate.
| S-EPMC7891165 | biostudies-literature
Project description:IntroductionCustom acetabular components have become an established method of treating massive acetabular bone defects in hip arthroplasty. Complication rates, however, remain high and migration of the cup is still reported. Ischial screw fixation (IF) has been demonstrated to improve mechanical stability for non-custom, revision arthroplasty cup fixation. We hypothesize that ischial fixation through the flange of a custom acetabular component aids in anti-rotational stability and prevention of cup migration.MethodsElectronic patient records were used to identify a consecutive series of 49 custom implants in 46 patients from 2016 to 2022 in a unit specializing in complex joint reconstruction. IF was defined as a minimum of one screw inserted into the ischium passing through a hole in a flange on the custom cup. The mean follow-up time was 30 months. IF was used in 36 cups. There was no IF in 13 cups. No difference was found between groups in age (68.9 vs. 66.3, P = 0.48), BMI (32.3 vs. 28.2, P = 0.11) or number of consecutively implanted cups (3.2 vs. 3.6, P = 0.43). Aseptic loosening with massive bone loss was the primary indication for revision. There existed no difference in Paprosky grade between the groups (P = 0.1). 14.2% of hips underwent revision and 22.4% had at least one dislocation event.ResultsNo ischial fixation was associated with a higher risk of cup migration (6/13 vs. 2/36, X2 = 11.5, P = 0.0007). Cup migration was associated with an increased risk for all cause revision (4/8 vs. 3/38, X2 = 9.96, P = 0.0016, but not with dislocation (3/8 vs. 8/41, X2 = 1.2, P = 0.26).ConclusionThe results suggest that failure to achieve adequate ischial fixation, with screws passing through the flange of the custom component into the ischium, increases the risk of cup migration, which, in turn, is a risk factor for revision.
| S-EPMC9724270 | biostudies-literature
Project description:Background and Objectives: Adequate initial fixation of the uncemented acetabular component in total hip arthroplasty is necessary to achieve long-term survival. Although screw fixation contributes to improved cup stability, there is currently no consensus on the use of this method. This study aimed to assess the existing randomized controlled trials (RCTs) on the efficacy and safety of cup fixation in total hip arthroplasty without screws. Materials and Methods: We searched the EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases to identify RCTs published before February 2022. Primary outcomes were reoperation, cup migration, and Harris Hip Score. Secondary outcomes were the presence of a radiolucent line in the acetabular region, translation and rotation movement, and polyethylene wear. We conducted meta-analyses using the random-effects models. The revised Cochrane risk-of-bias tool was used to assess the risk of bias for outcomes of interest; the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to summarize the body of evidence. Results: We included six reports from four studies. Total hip arthroplasty without screw fixation to the acetabular cup had little to no effect on reoperation (pooled relative risk, 0.98; 95% confidence interval, 0.14-6.68; I2 = 0%), cup migration (pooled relative risk, 1.72; 95% confidence interval, 0.29-10.33; I2 = 1%), Harris Hip Score (mean difference, 1.19; 95% confidence interval, -1.31-3.70; I2 = 0%), radiolucent line (pooled relative risk, 5.91; 95% confidence interval, 0.32-109.35), translation and rotation of all axes, and polyethylene wear (mean difference, 0.01; 95% confidence interval, -0.01-0.04; I2 = 0%), with very low certainty of evidence on all measures. Conclusions: The efficacy of acetabular cups without screw fixation in total hip arthroplasty remains uncertain, suggesting the need for prudent clinical application. Further large-scale, well-designed studies with low risk of bias are required.
| S-EPMC9413682 | biostudies-literature
Project description:Closed reduction and percutaneous internal fixation (CRPIF) for acetabular fractures was introduced as a less invasive alternative to open reduction and internal fixation (ORIF) for moderately displaced fractures. Currently, comparisons of ORIF and CRPIF outcomes are rare. Twenty-three patients treated with CRPIF were matched with patients treated with ORIF based on sex, age, and fracture classification. Surgery-dependent and -independent factors of the in-hospital stay, the conversion rate to total hip arthroplasty (THA), and quality of life were assessed. The ORIF group had a higher preoperative fracture step (p = 0.04) and gull wing sign (p = 0.003) compared with the CRPIF group. Postoperatively, the gap and step size were not significantly different between the groups (p > 0.05). CRPIF required less time (p < 0.0001) and transfusions (p = 0.009) and showed fewer complications (p = 0.0287). Four patients were converted to THA (CRPIF, n = 1; ORIF, n = 3; p = 0.155) because of posttraumatic osteoarthritis. Functional outcomes and pain were similar in both groups (p > 0.05). The present study revealed less blood loss and a lesser extent of reduction in patients treated with CRPIF than in those treated with ORIF. The rates of conversion to THA and functional outcomes did not differ between CRPIF and ORIF. CRPIF appeared to be a valuable treatment option for selected patients.
| S-EPMC9917484 | biostudies-literature
Project description:Using a validated finite element (FE) protocol, we quantified cartilage and labrum mechanics, congruency, and femoral coverage in five male patients before and after they were treated for acetabular retroversion with peri-acetabular osteotomy (PAO). Three-dimensional models of bone, cartilage, and labrum were generated from computed tomography (CT) arthrography images, acquired before and after PAO. Walking, stair-ascent, stair-descent, and rising from a chair were simulated. Cartilage and labrum contact stress, contact area, and femoral coverage were calculated overall and regionally. Mean congruency (average of local congruency values for FE nodes in contact) and peak congruency (most incongruent node in contact) were calculated overall and regionally. Load supported by the labrum was represented as a raw change in the ratio of the applied force transferred through the labrum and percent change following surgery (calculated overall only). Considering all activities, following PAO, mean acetabular cartilage contact stress increased medially, superiorly, and posteriorly; peak stress increased medially and posteriorly. Peak labrum stresses decreased overall and superiorly. Acetabular contact area decreased overall and laterally, and increased medially. Labral contact area decreased overall, but not regionally. Load to the labrum decreased. Femoral head coverage increased overall, anterolaterally, and posterolaterally, but decreased anteromedially. Mean congruency indicated the hip became less congruent overall, anteriorly, and posteriorly; peak congruency indicated a less congruent joint posteriorly. CLINICAL RELEVANCE:Medialization of contact and reductions in labral loading following PAO may prevent osteoarthritis, but this procedure increases cartilage stresses, decreases contact area, and makes the hip less congruent, which may overload cartilage. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2567-2576, 2017.
| S-EPMC5623608 | biostudies-literature
Project description:BackgroundThe initial stability of press-fit acetabular components is partially determined by the reaming technique. Nonhemispherical (NHS) acetabular shells, which have a larger radius at the rim than the dome, often require larger reaming preparations than the same-sized hemispherical (HS) shells. Furthermore, deeper central reaming may provide a more stable press fit. Using a reproducible, in vitro protocol, we compared initial shell stability under different reaming techniques with HS and NHS acetabular components.MethodsCavities for 54-mm NHS and 56-mm HS acetabular components were premachined in 20-pcf Sawbones blocks. Acetabular cavities included diameters of 54, 55, "54+," and "55+". "+" indicates a cavity with a 2-mm smaller diameter that is 2-mm deeper. A 4750N statically applied force seated shells to a height that was comparable with shell height after an orthopaedic surgeon's manual impaction. Force required to dislodge shells was assessed via a straight torque-out with a linear load.ResultsIncreased preparation depth (+) was associated with deeper shell seating in all groups. Deeper central reaming increased required lever-out force for all groups. Overall, HS and NHS implants prepared with 55 + preparation had the highest lever-out forces, although this was not significantly higher than those with 54+.ConclusionsIn 20-pcf Sawbones, representing dense bone, overreaming depth by 1-mm improved initial seating measurements. In both HS and NHS acetabular shells, seating depth and required lever-out force were higher in the "+" category. It is unclear, however, whether a decreased diameter ream increased seating stability (55+ vs 54+). Clinically, this deeper central reaming technique may help initial acetabular stability.
| S-EPMC7286971 | biostudies-literature
Project description:Hip preservation surgical techniques have steadily increased in the recent past. Therefore, precise knowledge of the vascular system of the hip and pelvis is critical for avoidance of possibly devastating complications during surgery. A colored latex injection in the common iliac artery of cadavers allows for a complete staining of the hip and pelvis vascular system. This technique creates more resilient vessels, whereas coloration with dye causes the vessels to be highly visible in comparison with the surrounding tissue. The proposed colored latex-dye solution injection allows for complete identification of the circulatory system of the lower extremity with specific focus on the hip and pelvis. This technique is simple, reproducible, and easily usable by orthopaedic surgeons in the laboratory to better understand the vascularization of the lower limb. The purpose of this technical note is to describe our technique for the injection of latex-dye solution in the common iliac artery, followed by dissection to key vascular structures of the hip and pelvis.
| S-EPMC5368340 | biostudies-literature