In this study, the author presents the case of one patient who had a Harris-Galante total hip replacement for pigmented villonodular synovitis of the left hip joint, the locking system failed and separation of the polyethylene liner from the acetabular metal shell occurred while the closed reduction of the posterior dislocation of the femoral prosthesis was performed. This study indicates that the design of the acetabular assembly should be modified. The gap between the rims of metal shell and polyethylene liner should be reduced or eliminated.
Acetabulum*/radiography ; Hip Prosthesis* ; Human ; Male ; Middle Age ; Postoperative Complications/radiography* ; Prosthesis Failure ; Synovitis/surgery* ; Synovitis, Pigmented Villonodular/surgery*

Anatomic structure of acetabular fractures are complex and operative exposure and fixation are extremely difficult. For those obviously displaced acetabular fractures, close reduction is doomed to cause deformed healing. Open reduction with internal fixation (ORIF) not only results in anatomic reduction, but also brings complications. No matter which method will be adopted, traumatic arthritis or avascular necrosis of femoral head might occur. In order to treat acetabular fractures more effectively, orthopedic surgeons should be required to fully master the acetabular anatomy, biomechanics, classification and the necessary knowledge for complication prevention.
Acetabulum ; diagnostic imaging ; injuries ; surgery ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; classification ; diagnostic imaging ; surgery ; Humans ; Orthopedic Procedures ; Radiography

BACKGROUND: Cotyloplasty is a technique that involves making a perforation of the medial wall of a shallow acetabulum and then inserting an acetabular cup with the medial aspect of its dome beyond the Kohler line. The purpose of this study was to evaluate the results of cementless total hip arthroplasty (THA) using cotyloplasty with focusing on the amount of medial cup protrusion. METHODS: Sixteen hips with insufficient acetabulum in sixteen patients were treated by cementless THA using cotyloplasty. The average patient age was 47 years. The diagnoses included dysplastic hip (12) and infection sequelae (4). All the patients were followed up for at least 2 years. Clinically, the Harris hip scores were assessed and radiologically, the amount of cup protrusion, the hip center movement and cup fixation were evaluated. RESULTS: The average Harris hip score improved from 57 to 94 postoperatively. The average proportion of cup surface beyond the Kohler line was 44.1% and the hip centers were medialized by an average of 23 mm. Stable fixation of the acetabular cup was achieved in all the cases except one. In this one case, migration of the cup was detected 2 weeks postoperatively and a reoperation was performed. CONCLUSIONS: Using cotyloplasty, good coverage of the acetabular cup was obtained without a block bone graft, and the hip joint centers were medialized. However, the safety margin for the amount of protrusion should be established.
Acetabulum/*pathology/radiography/*surgery ; Adult ; Arthritis, Infectious/complications/pathology ; *Arthroplasty, Replacement, Hip ; Female ; Hip Dislocation, Congenital/pathology/surgery ; Hip Joint/radiography ; *Hip Prosthesis ; Humans ; Male ; Middle Aged

OBJECTIVETo explore the operative indications and operative methods of primary total hip arthroplasty for acetabular fracture and to observe the clinical curative effect.

METHODSWe retrospectively summarized and analyzed the traumatic conditions, fracture types, complications, operative time, operative techniques, and short term curative effect of 11 patients (10 males and 1 female, with a mean age of 42.4 years) with acetabular fracture who underwent primary total hip arthroplasty.

RESULTSThe patients were followed up for 6-45 months (mean=28 months). Their average Harris score of postoperative hip joint was 78.

CONCLUSIONUnder strict mastery of indications, patients with acetabular fracture may undergo primary total hip arthroplasty, but stable acetabular components should be made.

Acetabulum ; diagnostic imaging ; injuries ; Arthroplasty, Replacement, Hip ; methods ; Female ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Radiography

To explore the effect of application of soft tissue loosening and acetabular reconstruction in hip replacement for patients with severe femoral head necrosis on joint function.
 Methods: From June 2012 to August 2016, 68 patients with severe femoral head necrosis (Ficat III, IV) underwent total hip replacement with soft tissue release and acetabular reconstruction at the Second Xiangya Hospital of Central South University. Total hip replacement is performed by the posterolateral approach. The acetabulum was rebuilt and the length of the affected limb was prolonged after clearing the scar tissue, proliferating the epiphysis, releasing the abductor muscle group and the adductor muscle group, dissecting the soft tissue around the acetabulum. One year after surgery, Harris score, X-ray positive lateral radiograph for the affected side and full-length X-ray examination for both lower extremities were performed to evaluate the curative effect.
 Results: The postoperative follow-up time ranged from 1.0 to 5.5 years. All patients' femoral heads returned to normal anatomical position and the affected limb length was restored to 1.5-3.5 cm; all patients did not damage the sciatic nerve. The Harris scores for 68 patients increased from 38.6±7.5 to 78.2±5.7 (P=0.029) in the first year after surgery.
 Conclusion: During hip replacement surgery for severe femoral head necrosis, soft tissue dissection and acetabular reconstruction can be used to ensure anatomical reconstruction for the acetabular fossa and to improve abductor function.
Acetabulum ; Arthroplasty, Replacement, Hip ; Femur Head ; Femur Head Necrosis ; surgery ; Follow-Up Studies ; Humans ; Radiography ; Treatment Outcome

BACKGROUND: The authors report the results of femoroacetabular impingement (FAI) treated with a surgical dislocation. METHODS: From April 2005 to May 2007, 15 FAI hips were treated with a surgical dislocation. The male/female ratio, mean age and mean symptom duration was 12/2, 35.8 years and 2.3 years, respectively. Radiographs and MR arthrograms were taken. The clinical evaluation involved changes in the pre- and postoperative Harris hip score (HHS). RESULTS: There were 12 hips (80%) with at least one structural abnormality in the radiographs, with 11 (79%) labral tears and 8 (73%) abnormally high angles in the MR arthrograms. We performed 15 osteochondroplasties, 12 labral repairs, 12 acetabuloplasty, and 3 debridements. The mean HHS improved from 76 to 93 points. Three non-unions of the trochanteric osteotomy sites were encountered as complications. CONCLUSIONS: Radiographs and MR arthrograms are important for making a proper diagnosis of FAI and planning treatment. A surgical dislocation can be used to treat FAI but further technical improvements will be needed for fixation of the greater trochanteric osteotomy sites.
Acetabulum/surgery ; Adult ; Female ; Femoracetabular Impingement/radiography/*surgery ; Femur Head/surgery ; Humans ; Ligaments, Articular/surgery ; Male ; Middle Aged ; Orthopedic Procedures/methods ; Osteotomy ; Treatment Outcome ; Young Adult

BACKGROUND: We analyzed the extent of the comminution in the acetabular weight-bearing area, the clinical and radiographic results, and the complications after a minimum 2-year follow-up of the modified Stoppa approach for the treatment of acetabular fractures, and we attempted to evaluate the efficacy of the operative technique. METHODS: All of the 22 patients, who needed the anterior approach for the treatment of acetabular fractures at our hospital from November 2007 to November 2010, were subjected to surgery via the modified Stoppa approach. Fracture pattern, operative time, blood loss during the operation, quality of reduction, number of bony fragments in the acetabular weight-bearing area, and postoperative complications were assessed by retrospectively analyzing the medical records and the radiographic examinations. The results after the operation were analyzed based on the criteria of Matta. RESULTS: The clinical results were excellent in 3 cases, good in 13 cases, and poor in 4 cases, while the radiographic results were excellent in 5 cases, good in 13 cases, and poor in 2 cases. Although the quality of reduction and the clinical results according to the extent of comminution were statistically significant (p = 0.03 and p = 0.04, respectively), the radiographic results were not statistically significant (p = 0.74). CONCLUSIONS: It can be concluded that the modified Stoppa approach could be used as an alternative to the classic ilioinguinal approach. In addition, comminution of the acetabular fracture was an important factor causing non-anatomic reduction and finally unsatisfactory clinical results.
Acetabulum/injuries/radiography/*surgery ; Adult ; Aged ; Female ; Fracture Fixation, Internal/*methods ; Fractures, Bone/radiography/*surgery ; Fractures, Comminuted/radiography/surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Weight-Bearing ; Young Adult

OBJECTIVETo investigate the clinical usage of percutanious retrograde acetabular anterior horn screw fixation.

METHODSFrom June 2006 to November 2011,27 patients with anterior horn accetabular fractures were treated with percutaneous retrograde screw. There were 20 males and 7 females with an average age of 35 years (ranged,20 to 61). According to Tile classification,type A was in 5 cases,type B was in 18 cases and type C was in 4 cases. The intra-operative blood loss volume, fractured reduction and screw location were observed.

RESULTSPostoperative X-ray and CT scan showed good reduction. According to the standard of Matta, 10 cases got excellent results, 15 good and 2 poor. All fractures healed and no complications such as neurovascular injuries and femoral head necrosis were found.

CONCLUSIONPercutanious retrograde acetabular anterior horn screw technique have advantages of little trauma, less blood loss volume, reliable fixation, which can be effectively used in clinic.

Acetabulum ; diagnostic imaging ; injuries ; surgery ; Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Radiography

OBJECTIVETo discuss clinical effects of complex acetabular fracture.

METHODSFrom January 2005 to December 2010, totally 31 patients with complex acetabular fracture received surgery. There were 21 males and 10 females with an average age of 38.6 years old (ranged, 31 to 57). X-ray, CT, operation scheme and clinical efficiacy were retrospectively analyzed. American Academy of Orthopaedic Surgery standard was used to evaluate hip joint function.

RESULTSAll patients were followed up from 12 to 36 months with an average of 17.6 months. No complications and neurovascular injury occurred. One case received total hip replacement arthroplasty. There were 17 cases obtained anatomical reduction, 12 cases got satisfied reduction and 2 cases not satisfied. According to American Academy of Orthopaedic Surgery standard, 18 cases got excellent result, good in 9 cases, fair in 3 cases and poor in 1 case.

CONCLUSIONComplex acetabular fracture combine with lots of complications and easily had occurre postoperative complications. It can improve curative effect by accurate reduction and reliable fixation and maximize restoring function of hip joint.

Acetabulum ; diagnostic imaging ; injuries ; surgery ; Adult ; Female ; Fracture Fixation, Internal ; Hip Fractures ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo explore the treatment methods and outcome of posterior wall fractures of the acetabulum.

METHODSThe data of 31 patients (25 males and 6 females, aged 19-59 years, mean: 40.5 years) with posterior wall fractures of the acetabulum hospitalized in our department from 2002 to 2006 were analyzed retrospectively in this study. The types of fractures, number of fragments, combined dislocations, and sciatic nerve function were documented before admission. All the fractures were treated with open reduction and internal fixation. Based on the fracture type and site, either screws alone or reconstructive plates were used. The patients were immobilized for an average of 12 weeks before partial weight bearing was permitted. After follow-up for 12-70 months (43.6 months on average), modified Merle d'Aubigne score was adopted to evaluate the outcomes of the operations.

RESULTSThe percentages of the excellent, good, fair and poor results were 48.4%, 41.9%, 6.5%, and 3.3%, respectively, with a good to excellent rate of 90.2%. Idiopathic sciatic nerve injury occurred in only one case.

CONCLUSIONSThe sciatic nerve should be routinely exposed and protected during the surgery. The type of fixation should be based on the fracture type and site. Prolonged immobilization may be helpful in improving the final outcomes.

Acetabulum ; diagnostic imaging ; injuries ; Adult ; Bone Plates ; Bone Screws ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Immobilization ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Young Adult