Primary Total Hip Arthroplasty After Acetabular Fracture* by Dana C. Mears, and John H. Velyvis J...

Primary Total Hip Arthroplasty After Acetabular Fracture*

by Dana C. Mears, and John H. Velyvis

J Bone Joint Surg AmVolume 82(9):1328-1328

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


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...



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.



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.



Anteroposterior radiograph made after the total hip arthroplasty, showing the large defect obliterated by a jumbo cup.



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...



Fig. 3-B: The Kocher-Langenbeck incision is useful for fractures involving the posterior wall and column.



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.



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.



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).



Postoperative anteroposterior radiograph showing a partial correction of the left pelvic deformity and a right cementless total hip replacement with immobilization of the acetabulum.



Anteroposterior radiograph of the right hip, made eleven years after the arthroplasty, showing a successful long-term result.



A T-type fracture of the posterior wall that initially was managed nonoperatively progressed to a nonunion with deformity and degenerative change.



Figs. 6-A and 6-B: A twenty-eight-year-old man sustained a transverse fracture of the posterior wall of the left acetabulum.



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.



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.



Ganz ring with a superior flange and an inferior hook for anchorage in the obturator foramen.



Burch-Schneider cage with large superior and inferior flanges for anchoring screws.



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.



Transaxial computed tomographic scan, made four weeks after the injury, showing erosive damage to more than 30 percent of the femoral head.



Iliac oblique radiograph, made after the total hip arthroplasty, showing the structural autograft secured with two cancellous screws.



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.



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.



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.



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...



Schematic drawings of the central mesh and morselized impacted bone chips.



Obturator oblique radiograph, made after the hybrid total hip arthroplasty, showing a central mesh and a metal-backed cup secured with three screws.



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.



Photograph of an intact anatomical pelvic model, showing the position of a cable on the outer pelvic table.



Anteroposterior radiograph made after total hip arthroplasty with two cables that buttress the crucial quadrilateral surface.



Increased radiodensity of the acetabular roof on the left side is a subtle but important finding of acetabular avascular necrosis.



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.



Anteroposterior radiograph made soon after the total hip arthroplasty and six years after the initial injury.



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.



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.



Primary Total Hip Arthroplasty After Acetabular Fracture* by Dana C. Mears, and John H. Velyvis J...

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