Dynamic change of acetabular component position in total hip arthroplasty based on the spinopelvic classification: a prospective radiographic study
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Abstract Purpose Recent studies have proposed optimizing the position of the acetabular component based on spinal deformity and stiffness classification to avoid mechanical complication after total hip arthroplasty (THA). The aim of this study was to characterize the dynamic changes in cup alignment post-THA based on the spinopelvic classification and to evaluate the efficacy of cup placement of preventing dislocation. Methods This prospective study included a total of 169 consecutive patients awaiting THA who were classified into four groups based on spinal deformity (pelvic incidence minus lumbar lordosis) and spinal stiffness (change in sacral slope from the standing to seated positions). The cups were aligned based on the group with fluoroscopy. Additionally, postoperative radiographic inclination (RI), radiographic anteversion (RA) in standard anteroposterior radiograph, and lateral anteinclination (AI) in sitting and standing positions were measured. The cumulative incidence of dislocation was evaluated at a follow-up two years post-THA. Result RA was significantly greater in the group with normal spine alignment and stiff spine than in other groups ( P = 0.0006), and AI in the sitting position was lower than in other groups ( P = 0.012). Standing AI did not significantly differ between the groups. One posterior dislocation occurred during the study period (0.6%). Conclusion AI in the sitting position was lower in patients with normal spinal alignment and stiff spine despite larger RA in the standard anteroposterior radiographs. Consequently, with more anteversion in the normal spinal alignment and stiff spine group, spinopelvic parameters can help guide cup placement to prevent short-term dislocation post-THA.Keywords:
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New-generation threaded acetabulum components have been used in total hip arthroplasty (THA) with good outcomes. We have extensively used the EcoFit® SC cup (Implantcast, Buxtehude, Germany) in our practice. In this report, we present some major complications related to the use of this implant, as well as insights regarding the surgical technique to avoid such adverse effects. Furthermore, we attempt to describe certain contraindications for using threaded cups in THA, taking into account specific patient anatomy and intraoperative acetabulum preparation. We have observed acetabulum roof and posterior wall fractures, as well as incomplete placement of the component. Ensuring the meticulous preparation of the peripheral rim of the acetabulum is crucial to prevent incomplete placement since threaded components have a larger diameter than that of the reamers used to prepare the acetabulum. Additionally, when dealing with the acetabula where the posterior or anterior walls have thinned, it is advisable to refrain from using a threaded cup to avoid the risk of intraoperative fractures caused by the torque forces exerted during implant insertion.
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Objective To summarize the diagnostic experience of dislocation of hip joint complicated with acetabulum,inform early diagnosis of acetabulum fracture and early operational treatment for relevent patients.Methods The clinical data of 30 cases with dislocation of hip joint complicated with acetabulum fracture were analyzed.Results In the 26 cases of paitnets who were followed up,12 cases were excellent,10 cases were good,3 cases were fair and one case was poor and the effective rate was 84%.Conclusion Operational treatment and anatomical reduction must be performed early for all hip dislocation complieated with acetabulum fracture patients with fracture displacement over 3mm or free bone fragment in acetabulum joint.The femoral traction treatment after manual reduction can be used to acetabulum fracture patients without obvious displacement.
Acetabular fracture
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Background: Acetabulum is an approximately hemispherical cavity on the lateral aspect of the hip bone. Acetabulum is not always of the same shape, size, or depth. Any deviations of the parameters from normal range have strong correlation with the development of various kinds of pathologies. Aims and Objectives: Acetabulum is an approximately hemispherical cavity on the lateral aspect of the hip bone. Acetabulum is not always of the same shape, size or depth. Any deviations of the parameters from normal range have strong correlation with the development of various kinds of pathologies. Materials and Methods: This study was conducted in department of Anatomy, Yenepoya Medical College, Mangalore. Two hundred hip bones were included in the study. Various parameters of the acetabulum were measured. The morphometrical parameters measured were: (a) Transverse diameter of acetabulum, (b) acetabular height, (c) acetabular depth, (d) acetabular volume, (e) distance from pubic tubercle to anterior rim of acetabulum, (f) ratio between distance from pubic tubercle to anterior rim of acetabulum and acetabular height. Range, mean, standard deviation, and standard error of mean were determined for each parameter. P value was also calculated to compare the parameters side wise. Results: The independent T test was done and the P value was calculated for each parameter. Acetabular volume showed a significant difference between left- and right-sided bones. Most of the parameters showed highly significant difference between male and female hip bones in both right side and left side. Conclusion: As total and partial hip replacements are common surgeries performed these days, knowledge of the dimensions of acetabulum will assist prosthetists to construct suitable prosthesis for Indian population. It would be also useful in the fields of anatomy, osteology, and anthropology.
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Background: Hip bone, also known as the innominate bone, because it is formed by three independent elements during the sub adult life and is directly involved with child birth. The lateral surface of hip bone has a deep cup shaped acetabulum, bounded by a ridge known as rim of acetabulum articulating with the femoral head. The features of acetabulum are characteristic used for sexual dimorphism and for the design of prostheses in Total Hip Arthroplasty. Materials and Methods: Two hundred un paired acetabular part of dry hip bones were collected for this study (50 right male,50 left male,50 right female and 50 left female) from Vinayaka Mission’s Kirupananda Variyar Medical College, Salem. This study is designed to measure Acetabulum transverse diameter, Acetabulum Superoinferior diameter, Total diameter of acetabulum and Depth of acetabulum. Statistical analysis has been done in acetabulum using SPSS 21.0 software and P values were derived by applying unpaired student T test. Results: In the present study, mean value of left sided Acetabulum transverse diameter, Acetabulum superoinferior diameter, Total diameter of acetabulum and Depth of acetabulum among male and female shows 5.24 & 4.9, 5.99 & 5.30, 5.24 & 4.78, 2.60 & 2.43 respectively and all the values are higher in males than females. The mean value of right sided Acetabulum transverse diameter, Acetabulum superoinferior diameter, Total diameter of acetabulum and Depth of acetabulum among male and female shows 5.20 & 4.71,5.26 & 4.89 ,5.2 & 4.72 ,2.67 & 2.35 respectively. All the right sided acetabular parameters are statistically significantly higher among the males as compared with females (P value <.0001), because of strong skeleton and muscle mass and these parameters have minimal role in formation of birth canal. Conclusion: The study of acetabulum may be helpful to the radiologists in diagnosing congenital hip dysplasia. For orthopaedic surgeons in planning before acetabular surgery and treatment of hip joint fractures and to understand the rarity of primary osteoarthritis. The relation between depth and diameter is of immense importance to the Orthopedicians and Radiologists. KEY WORDS: Total Hip Arthroplasty, Acetabulum.
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Acetabulum kalca ekleminin medial bolumunde yer alan hemisferik sekilli bir cukurdur.Acetabulum on kenari’nin morfolojisi total kalca artroplastisi icin onemlidir. Acetabulumcapinin ve derinliginin bilinmesi acetabulum kiriklarinin cerrahi tedavisi icin degerlidir.Amac:Bu calismanin amaci acetabulum cerrahisinde ve dogumsal acetabulum displazisitanisinda deger tasiyan acetabulum derinligini, capini, aralarindaki iliskiyi ve acetabulum onkenarinin morfolojisini tanimlamaktir.Gerec ve yontem: Bu calisma 154 kalca kemiginde yapildi. Iki morfometrik ve birmorfolojik parametre degerlendirildi. Corpus ischii’ye en yakin acetabulum kenari ve iliakkemik on kenarinin acetabulum kenarini kestigi nokta arasindaki uzaklik acetabulum capiolarak adlandirildi. Acetabulum’daki en derin nokta ile acetabulum kenarlarina teget gecenyatay plan arasindaki dikey uzaklik acetabulum derinligiolarak adlandirildi. Acetabulumon kenari morfolojik olarakdegerlendirildi ve dort farkli gruphalinde (kavisli, acili, duz ve irreguler) siniflandirildi.Bulgular: Acetabulum on kenari 154 kemigin 71’inde kavisli (%46,1), 36’sinda duz (%23,3), 26’sinda koseli (%16,8), 21’inde irreguler (%13,6) olarak bulundu. Morfometrikolcumler olan acetabulum derinligi ve capi ortalama 29,49 ± 4,2 mm ve 54,29 ± 3,8 mmolarak bulundu ve iki parametre arasindaki korelasyon Pearson testi ile sinandi. Acetabulumderinligi ve capi arasinda pozitif ve anlamli korelasyon saptandi (r = 0,498, p < 0,001).Sonuc: Acetabulum derinligi, acetabulum capi ile iliskilidir. En fazla gorulen acetabulumkenari sekli kavisli’dir (%46,1). Bu bilgi kalca artroplastisi sirasinda, kalca eklemi kiriklarinintedavisinde ve konjenital kalca eklemi displazisi tanisinda yararli olabilir. Key words: Acetabulum, morfometri, morfoloji, acetabulum on kenariAcetabulum is a hemispherical cavity on the medialpart of the hip joint (1). Anterior acetabular ridgemorphology is important in total hip arthroplasty. It isvaluable to know the diameter (AD1) and depth (AD2) ofthe acetabulum for surgical treatment of acetabularfractures. Previous studies evaluated the anterioracetabular ridge’s morphology regarding whether there isproportion between the diameter and thickness of theacetabulum (2,3). Murphy studied on prehistorical NewZealand Polynesian hip bones and evaluated theusefulness of acetabulum diameter in determining thegender (4). Patriquin et al. studied correlations betweenAD2 and os coxae measures to determine the gender (5).Han et. al tried to determine the utility of severalacetabular parameters in acetabular dysplasia diagnosis(6). Aktas et al. described the acetabular dysplasiafrequency and normal hip joint morphometry in adultTurks (7). Govsa et al. described the anterior acetabularridge’s shape morphologically (8). Basaloglu et al.measured the vertical and transvers diameters ofacetabulum in both sexes comparatively (9). In this studywe aimed to determine the relationship betweenacetabular depth and diameter. Additionally to describethe anterior acetabular ridge’s morphology that can beuseful for diagnosing congenital acetabular dysplasiadiagnosis and during acetabular surgery.MATERIAL AND METHODSThis study was held on 154 os coxae. Twomorphometrical and one morphological parameters wereevaluated. 0.1 mm. sensitive compass was used formorphometric measurements. Correlation betweenparameters were analysed using Pearson’s correlationtest. p < 0.05 was the significant level. The distanceFigure 1. The distance between the acetabular ridge nearest tocorpus ischii and anterior iliac margin intersecting the acetabularridge (acetabular diameter) (AD1)
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Objective To introduce the method and effect of the treatment of acetabulum dysplasia by rotation acetabulum osteotomy.Methods 18 hips with acetabulum dysplasia were treated by rotation acetabulum osteotomy with measurement of JOA scoring preoperatively and postoperatively,CE angle and Sharp angle.Osteotomy were performed archedly 2.0 cm from acetabulum brim,the acetabulum was rotated anteriorly,laterally and inferiorly,the allograft bone and osteolet were inserted into the gap,and fixed by absorbable screws.Results The average follow-up time were 4~42 months.X-ray showed the relationship and shape of acetabulum and femoral head were restored to normal.Bone graft healed up within 2 months.The function of 17 hips were restored normal within 6 months.The JOA,CE and Sharp angles were restored from 75.2±3.1,15.8°±1.3° and 47.3°±2.5° preoperatively to 93.5±3.5,33.4°±1.7° and 29.8°±2.1° postoperatively.The JOA scores increased 18.3,CE angle increased 17.6°,and the Sharp angle decreased 17.5°.The difference was significant(P0.05).Conclusions Rotation acetabulum osteotomy can correct the abnormal relation between femoral head and acetabulum,relieve the pain and effectively arrest the progression of osteoarthritis.It is an ideal method to treat the acetabulum dysplasia combined with osteoarthritis in early and medium stage.
Hip Dysplasia
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Background: Anatomy of the hip must be taken into account to study the anatomy of various surgical approaches. Reconstruction of the acetabulum in patients with significant acetabular bone deficiency remains a major challenge in revision total hip arthroplasty. Appropriate anatomic concepts for surgery to treat femoroacetabular impingement require a precise appreciation of the native acetabular anatomy. Since the acetabulum is not always of same shape, width or depth, joint congruences are frequent with minor anatomical variations in the shape of the acetabulum. Hence the present study was undertaken as controversies still exist on the importance of these variations and to prevent problems following surgical procedures such as acetabular reconstruction and femoroacetabular impingement.Methods: Material of the study consisted of 110 human hip bones (60 males and 50 females). Depth of Acetabulum (DA) was measured on these hip bones on both the sides. Statistical analysis was done using SPSS (Statistical Package for the Social Sciences) version 11 and Microsoft Excel 2007.Results: The mean depth of acetabulum in male was 26.89 mm and female was 25.31 mm. The mean depth of acetabulum on right side was 26.24 mm and left side was 26.11 mm. Depth of the acetabulum was greater in males as compared to females and the differences were statistically significant. Depth was greater on the right side as compared to the left side but the difference was statistically non-significant.Conclusions: Depth of the acetabulum was greater in males as compared to females.
Femoroacetabular Impingement
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In a previous study of 177 hips treated in infancy for congenital dislocation and followed for 10 to 27 years, all were found to have well-developed acetabula. Nevertheless, there were two cases with minimal arthrotic changes. In this paper, a further study of 107 of these hips, with a follow-up of 15 to 30 years, indicates that the number of hips with arthrotic changes has increased. Attention was given to the fate of the acetabulum in relation to its depth or shallowness as measured by the CE angle. It is concluded that a hip with a slightly shallow acetabulum (CE angle, approximately 20 degrees) is less susceptible to wear or deterioration than a hip with a deeper acetabulum (CE angle, greater than 25 degrees).
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Objective: To study and discuss the install methods of hip prosthesis while perform a total hip arthroplasy for hypoplastic acetabulum. Methods: For 15 patients amount to 22 joints of osteoarthrasis due to hypoplasia of acetabulum, the authors adopted 3 methods to perform the total hip arthroplasty according to the developmental degree of acetabulum, which were implant bone on external upper lip of acetabulum, deepen acetabulum and slightly inward depening acetabulum. Took a X-ray photo for both joints with the same radiological condition in order to learn the installing angel of acetabulum and the coalescence of acetabulum with its bone bed after 3,6,9,12 months and every half a year of the operation.The average follow-up term were 24 months. Results:By follow-up, it was found that the acetabulum contacted well with its bed, the angle and the recovery of joint function was satisfied among the cases given the operation methods of deepen acetabulum and slightly inward deepened acetabulum. In the case of implanted bone on external upper lip of acetabulum, there was a zona pellucida between the implanted bone and the artificial acetabulum after 2 years of the operation. Conclusion: While performing total hip arthroplasty, various methods should be adopted according to the condition of the bed of acetabulum for the joints of osteoarthrasis due to hypoplasia of acetabulum. For the case of acetabulum shallowed and too much bone at the bottom of acetabulum bed, the surgeons should install the acetabulum by wear the acetabulum inward and deepen it. Be ware of not wearing the acetabulum too deeply to affecting the stability of the inner wall of acetabulum.
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Thirty-four patients were studied through the whole of the Perthes’ disease in Alder Hey Children’s Hospital, Liverpool. The acetabular changes included osteopaenia of the roof, irregularity of its contour, and decrease in the depth. These changes were proportional to the femoral head involvement. The purpose of the study was to know the effect of the morphological changes of the femoral head on the acetabulum and its outcome. Radioisotope scans of the hip were examined in fourteen children with unilateral Perthes’ disease and comparison was made with the contralateral hip. These scans showed increased uptake on the lateral part of the acetabulum and no uptake over the avascular part of the femoral head. Average follow-up was ten years and on an average children were followed up from six years to fifteen years of age. Six readings of the measurements of various dimensions of the acetabulum and the femoral head were done. CT scan also showed irregularity in the acetabulum. Statistical tests lead to the conclusion that the decrease in the depth of the acetabulum was secondary to the femoral head involvement and the extent of its dimensional changes affected the final congruity between the femoral head and the acetabulum. Also the remodelling potential of acetabulum decreases as the child grows older. Therefore containment procedures could be done by femoral osteotomy in younger children and acetabular osteotomy may benefit older children.
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