OBJECTIVE: To evaluate precise assessment methods for predicting the optimal acetabular cup size in total hip arthroplasty (THA). METHODS: A clinical data of 73 patients (80 hips) who underwent primary THA between December 2022 and July 2024 and met the inclusion criteria was analyzed. There were 39 males and 34 females with an average age of 66.3 years (range, 56-78 years). Among them, 66 cases were unilateral THA and 7 were bilateral THAs. There were 29 patients (34 hips) of osteoarthritis, 35 patients (35 hips) of femoral neck fractures, and 9 patients (11 hips) of osteonecrosis of the femoral head. Based on anteroposterior pelvic X-ray films, three methods were employed to predict acetabular cup size, including preoperative template planning, radiographic femoral head diameter (FHD) measurement, and intraoperative FHD measurement. The predicted acetabular cup sizes from these methods were compared with the actual implanted sizes. RESULTS: The predicted acetabular cup sizes using the preoperative template planning, radiographic FHD measurement, and intraoperative FHD measurement were (51.25±2.81), (49.72±3.11), and (49.90±2.74) mm, respectively, compared to the actual implanted cup size of (50.57±2.74) mm, with no significant difference ( P>0.05). Regarding agreement with the actual implanted cup size, the preoperative template planning achieved exact matches in 35 hips (43.75%), one-size deviation in 41 hips (51.25%), and two-size deviations in 4 hips (5%); the radiographic FHD measurement achieved exact matches in 12 hips (15%), one-size deviation in 57 hips (71.25%), and two-size deviations in 11 hips (13.75%); and the intraoperative FHD measurement achieved exact matches in 26 hips (32.5%), one-size deviation in 52 hips (65%), and two-size deviations in 2 hips (2.5%). There were significant differences in agreement distributions between the three methods and the actual implanted cup sizes ( H=18.579, P<0.001). CONCLUSION The intraoperative FHD measurement, as a simple, cost-effective, and accurate method, effectively guides acetabular cup selection, reduces the risk of prosthesis wear, enhances postoperative joint stability.
Humans ; Arthroplasty, Replacement, Hip/instrumentation* ; Male ; Female ; Middle Aged ; Acetabulum/diagnostic imaging* ; Aged ; Hip Prosthesis ; Prosthesis Design ; Femur Head/surgery* ; Osteoarthritis, Hip/surgery* ; Radiography ; Femoral Neck Fractures/surgery* ; Femur Head Necrosis/surgery*

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: 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 operative reduction techniques and clinical results of surgical treatment of type C1 (AO/ASIF) acetabular fracture by posteroproximal-posteroanterior sequential reduction and internal fixation.

METHODSFrom August 2004 to January 2012, 13 patients with type C1 (AO/ASIF) acetabular fracture were treated by posteroproximal-posteroanterior sequential reduction and internal fixation. Of them, 8 cases were male and 5 cases were female with an average age of 42 years years old (ranged, 18 to 64). Pelvis 3-dimentional CT reconstruction were used to confirmed the classification of fracture, and the operation were performed during from 5 to 20 days with an average of 9.5 days. Operation time, blood loss, complications and reduction were recorded and evaluated. The function of hip joint were accessed at the final follow-up.

RESULTSThe operation time ranged from 190 to 290 min with an average of 240 min. The mean blood loss was 1 800 ml (ranged, 1 300 to 3 000 ml). One case had superficial infection and healed after 3 weeks. According to Matta reduction criteria, 8 cases obtained anatomical reduction, 4 cases got satisfied results and 1 cases got unsatisfied results. Eleven cases were followed up with an average of (24.0 +/- 8.0) months, and 2 cases were lost to follow-up. According to revised Mede d'Aubingne and Postel evaluation system, 7 cases got excellent results, 2 good, 1 moderate and 1 poor.

CONCLUSIONPosteroproximal-posteroanterior sequential reduction and internal fixation for the treatment of type C1 (AO/ASIF) acetabular fracture can achieve satisfied surgical proces and operation quality.

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

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 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

BACKGROUND: The results after acetabular fracture are primarily related to the quality of the articular reduction. We evaluated the results of internal fixation of posterior wall fractures with using three-step reconstruction. METHODS: Thirty-three patients (mean age at the time of injury, 47.9 years; 28 males and 5 females) were followed for a minimum of 2 years after surgery. The three-step reconstruction included 1) preservation of soft tissues and reduction of the marginally impacted osteochondral (articular) fragments using screws, 2) filling the impacted cancellous void with a bone graft, and 3) reinforcement with buttress-plating. Clinical evaluation was done according to the criteria of D'aubigne and Postel, while the radiological criteria were those of Matta. The associated injuries and complications were evaluated. RESULTS: The clinical results were excellent in 15 (45.5%) patients and they were good in 5 (15.2%), (i.e., satisfactory in 60.7%), while the radiologic results were excellent in 10 (30.3%) and good in 14 (42.4%) (satisfactory in 72.7%). Heterotopic ossification was common, but this did not require excision, even without prophylactic treatment with indomethacin. Deep infection was the worst complication and this was accompanied by a poor outcome. CONCLUSIONS: This study confirms that three-step reconstruction facilitates accurate and firm reduction of displaced posterior wall fractures of the acetabulum. Therefore, we anticipate less long-term arthrosis in the patients treated this way.
Acetabulum/*injuries/radiography/*surgery ; Adult ; Aged ; Bone Plates ; Bone Screws ; Bone Transplantation ; Female ; Fracture Fixation, Intramedullary/*methods ; Fractures, Bone/radiography/*surgery ; Humans ; Male ; Middle Aged ; Ossification, Heterotopic ; Surgical Wound Infection ; Treatment Outcome ; Young Adult

OBJECTIVETo discuss the operative effects and evaluate how the waiting time before surgery influence the outcome of complex acetabular fractures.

METHODSFrom January 2006 to December 2008, 33 patients, 28 males and 5 females, with complex acetabular fractures were operated in our hospital. All of them were followed up for an average 24 months (ranged, 14 to 47 months). The average age was 42 years (ranged,27 to 57 years). According to the waiting time before surgery, all patients were divided into two groups, namely preoperative waiting time of more than 14 days group and preoperative waiting time of less than 14 days group. Postoperative reduction quality and long-term radiographic results were evaluated according to the Matta radiological systems. The modified Merle d' Aubigne-postel hip scoring system was used for evaluating the functional outcomes. The Mos SF-36 was used to evaluate the quality of life.

RESULTSAnatomical reduction in 28 cases, good in 4 cases, and poor in 1 case. According to the mean Merle d'Aubigne and Postel Score, 22 patients got excellent result, 4 good, 4 fair and 3 bad. Average score of the Mos SF-36 was (70.63 +/- 17.03). When time was measured as a categorical variable, an anatomical reduction and an excellent or good functional outcome were more likely if surgery was performed within 14 days. Postoperative complications: iatrogenic injuries of sciatic nerve in 2 cases, heterotopic ossification in 6 cases,traumatic osteoarthritis in 3 cases, and femoral head necrosis in 1 case.

CONCLUSIONGood image evaluation,correct approaches, appropriate time before surgery and approach, early functional rehabilitation are essential for better outcomes in the treatment of complex acetabular fractures, of which, time to surgery is a crucial and controllable prognostic factor.

Acetabulum ; injuries ; physiopathology ; surgery ; Adult ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; adverse effects ; methods ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Ossification, Heterotopic ; prevention & control ; Osteoarthritis ; prevention & control ; Postoperative Complications ; prevention & control ; Radiography ; Sciatic Nerve ; injuries ; Time Factors

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

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