Total hip arthroplasty for acetabular fractures: "Early Application".

BACKGROUND: The aim of this study was to evaluate the functional and clinical results of early total hip arthroplasty performed to treat acetabulum fracture. METHODS: Evaluation of 17 patients who were diagnosed with acetabulum fracture and treated with early total hip arthroplasty between January 2008 and October 2013 was performed. In all, 14 patients were male, and 3 were female, with mean age of 52 years (range: 29-80 years). Time elapsed between trauma and operation was mean of 13 days (range: 2-21 days). Observation period was average of 48.2 months (range: 24-70 months). Mean Harris Hip Score was 89.6 (range: 70-100). RESULTS: In 13 patients, score was good or excellent. Total of 7 of 10 patients had returned to their pre-trauma jobs. Mean length of time for return to work was determined to be 7.2 months (range: 1.5-24 months). Of the total, 9 (52.9%) patients were diagnosed with heterotopic ossification according to Brooker Classification. CONCLUSION: After acetabulum fracture, early total hip arthroplasty with the correct indications and appropriate patient can result in functional, pain-free hip joint with the advantages of early mobilization, early return to work, and decrease in reoperation risk. Heterotopic ossification prophylaxis should be considered in the presence of 1 or more risk factors, such as a head injury, high-energy trauma, or associated musculoskeletal injuries.

The Effect of Dislocation Type (Crowe Types I-IV) on Pelvic Development in Developmental Dysplasia of the Hip: A Radiologic Study of Anatomy.

Classification of hip pathology in developmental dysplasia of the hip (DDH) helps in appropriate placement of implants during total hip arthroplasty. We examined preoperative unilateral and bilateral pelvic radiographs of 57 patients (114 hips) undergoing total hip arthroplasty because of DDH. Both sides of the pelvis were visually separated into 3 areas for comparison. When area ratios of hips with Crowe types II, III, and IV DDH were compared with ratios for healthy hips, values in hips with DDH were significantly low for the iliac wings, significantly high for the acetabular regions, and significantly low for the ischial area. Using a line crossing the healthy hip's teardrop and parallel to a line joining the distal sacroiliac joints is useful for calculating limb-length discrepancy.

The extensor hallucis longus tendon as the distal reference point in total knee arthroplasty and tibial alignment.

OBJECTIVE: The aim of this study was to compare the effects on tibial alignment of the use of the extensor hallucis longus (EHL) tendon with the use of the 2nd metatarsal as a reference in total knee arthroplasty (TKA) using the extramedullary technique. METHODS: The study evaluated 100 postoperative radiographs of 79 patients who underwent primary TKA between 2004 and 2008. Patients were grouped according to the distal anatomical landmark used during surgery. There were 36 patients (mean age: 68.3 years, range: 56 to 82 years) in the EHL-referenced (ERT) group and 43 patients (mean age: 70.2 years, range: 54 to 78 years) in the 2nd metatarsal-referenced (MRT) group. There were 47 components in the ERT group and 53 in the MRT group. Frontal alignments of the tibial components were measured. Angles of 90±2° were accepted as the normal boundaries while those above that value were labeled as 'varus' and those below as 'valgus'. RESULTS: Average frontal alignment was 88.57° in the MRT group and 89.17° in the ERT group. The number of tibial components in the normal range was significantly higher (p=0.017) and the number of varus-oriented components significantly lower (p=0.024) in the ERT group. There were no significant differences in valgus-oriented outliers between groups (p=1.000). CONCLUSION: The use of the EHL tendon as a reference improves coronal tibial alignment. The EHL is a reliable anatomical landmark to use with extramedullary guide systems.