Primary Total Hip Arthroplasty After Acetabular Fracture* by Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am Volume 82(9):1328-1328 September 1,

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Presentation transcript:

Primary Total Hip Arthroplasty After Acetabular Fracture* by Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am Volume 82(9): September 1, 2000 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 1-A, 1-B, and 1-C: The structural importance of acetabular defects is related to their size, location, and characterization as a cavitary or segmental lesion.Fig. 1-A: Oblique three- dimensional computed tomographic scan, made one year after a fracture... Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior radiograph of a hip, made two years after a transtectal transverse fracture that was treated nonoperatively, showing a central segmental defect of moderate size with a principal axis of more than ten millimeters but less than twenty-five mil... Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior radiograph of a pelvis, made two years after a transtectal T-type fracture that was treated nonoperatively, showing progression to a large central segmental defect with a principal axis of approximately fifty millimeters. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 2-A and 2-B: A forty-eight-year-old man sustained a T-type acetabular fracture, which was managed with limited internal fixation. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior radiograph made after the total hip arthroplasty, showing the large defect obliterated by a jumbo cup. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 3-A through 3-D: Illustrations showing the surgical approaches commonly used in total hip arthroplasty for late reconstruction of acetabula with various defects and accompanying deformities.Fig. 3-A: The modified Hardinge (anterolateral) incision is u... Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-B: The Kocher-Langenbeck incision is useful for fractures involving the posterior wall and column. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-C: The modified triradiate incision, with preservation of the greater trochanter, is an extensile approach that is useful for complete visualization of both the anterior and posterior columns and the hip joint. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-D: The limited extended iliofemoral incision is an extensile approach that is useful for visualization of the entire hemipelvis and allows for a corrective pelvic osteotomy. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 4-A, 4-B, and 4-C: A forty-one-year-old pilot sustained a displaced iliac-wing, or so-called crescent, fracture of the left hip and a T-type acetabular fracture of the right hip in a free fall in his helicopter from 200 feet (sixty-one meters). Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Postoperative anteroposterior radiograph showing a partial correction of the left pelvic deformity and a right cementless total hip replacement with immobilization of the acetabulum. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior radiograph of the right hip, made eleven years after the arthroplasty, showing a successful long-term result. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

A T-type fracture of the posterior wall that initially was managed nonoperatively progressed to a nonunion with deformity and degenerative change. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 6-A and 6-B: A twenty-eight-year-old man sustained a transverse fracture of the posterior wall of the left acetabulum. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior radiograph, made five years after the total hip arthroplasty, showing stable fixation of the ring along with a cemented polyethylene cup and a cementless stem. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 7-A, 7-B, and 7-C: Drawings showing multiple designs of cages with diverse extension plates that are available for use with a cemented cup.Fig. 7-A: M¸ller ring with a smaller posterosuperior flange. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Ganz ring with a superior flange and an inferior hook for anchorage in the obturator foramen. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Burch-Schneider cage with large superior and inferior flanges for anchoring screws. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 8-A, 8-B, and 8-C: A fifty-three-year-old man who had a fracture of the posterior wall was managed with an acute open reduction and internal fixation with use of a plate. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Transaxial computed tomographic scan, made four weeks after the injury, showing erosive damage to more than 30 percent of the femoral head. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Iliac oblique radiograph, made after the total hip arthroplasty, showing the structural autograft secured with two cancellous screws. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 9-A and 9-B: A thirty-five-year-old man sustained a fracture of the posterior wall and posterior column of the right acetabulum and was managed initially with limited internal fixation. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior radiograph of the right hip, made six years after the total hip arthroplasty, showing continued stable fixation of the cup in a superior position. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Photograph showing the modular bilobed cup (Mars; Biomet, Warsaw, Indiana), which allows application of a lobe of three different sizes to obliterate corresponding acetabular defects. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 11-A, 11-B, and 11-C: A fifty-six-year-old man who had failure of fixation of a transverse acetabular fracture of the right hip was managed with a total hip arthroplasty with use of central mesh, morselized bone graft, and lag screws.Fig. 11-A: Antero... Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Schematic drawings of the central mesh and morselized impacted bone chips. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Obturator oblique radiograph, made after the hybrid total hip arthroplasty, showing a central mesh and a metal-backed cup secured with three screws. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 12-A, 12-B, and 12-C: Cables can be used for reconstruction of the inner pelvic table in a so-called geriatric acetabular fracture pattern in which the quadrilateral plate is displaced medially. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Photograph of an intact anatomical pelvic model, showing the position of a cable on the outer pelvic table. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior radiograph made after total hip arthroplasty with two cables that buttress the crucial quadrilateral surface. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Increased radiodensity of the acetabular roof on the left side is a subtle but important finding of acetabular avascular necrosis. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 14-A, 14-B, and 14-C: A twenty-four-year-old woman sustained a fracture of both columns of the left acetabulum, which was initially treated with open reduction through a triradiate approach and dissection on the outer and inner pelvic tables. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior radiograph made soon after the total hip arthroplasty and six years after the initial injury. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Iliac oblique radiograph, made two years after the total hip arthroplasty, showing a completely loose cup and a transverse dissociation secondary to marked osteolysis of the anterior and posterior columns. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.

Three-dimensional computed tomographic scan of the hip of a seventy-three-year-old woman who had complete, traumatic loss of the posterior acetabular column. Dana C. Mears, and John H. Velyvis J Bone Joint Surg Am 2000;82:1328 ©2000 by The Journal of Bone and Joint Surgery, Inc.