Does Adding Femoral Lengthening at the Time of Rotation Hip Transposition After Periacetabular Tumor Resection Allow for Restoration of Limb Length and Function? Interim Results of a Modified Hip Transposition Procedure.

BACKGROUND: Reconstruction after pelvic tumor resection of the acetabulum is challenging. Previous methods of hip transposition after acetabular resection have the advantages of reducing wound complications and infections of the allograft or metal endoprosthesis but were associated with substantial limb length discrepancy. We therefore developed a modification of this procedure, rotation hip transposition after femur lengthening, to address limb length, and we wished to evaluate its effectiveness in terms of complications and functional outcomes. QUESTIONS/PURPOSES: In this study, we asked: (1) What were the Musculoskeletal Tumor Society scores after this reconstruction method was used? (2) What complications occurred after this reconstruction method was used? (3) What proportion of patients achieved solid arthrodesis (as opposed to pseudarthrosis) with the sacrum and solid union of the femur? (4) What were the results with respect to limb length after a minimum follow-up of 2 years? METHODS: From 2011 to 2017, 83 patients with an aggressive benign or primary malignant tumor involving the acetabulum were treated in our institution. Of those, 23% (19 of 83) were treated with rotation hip transposition after femur lengthening and were considered for this retrospective study; 15 were available at a minimum follow-up of 2 years (median [range], 49 months [24 to 97 months]), and four died of lung metastases before 2 years. No patients were lost to follow-up before 2 years. During the period in question, the general indications for this approach were primary nonmetastatic malignant bone tumor or a locally aggressive benign bone tumor that could not be treated adequately with curettage. There were seven men and 12 women with a median age of 43 years. Nine patients underwent Zones I + II resection, eight patients had Zones I + II + III resection, and two received Zones II + III resection. After tumor resection, rotation hip transposition after femur lengthening reconstruction was performed, which included two steps. The first step was to lengthen the femur with the insertion of an allograft. Two methods were used to achieve limb lengthening: a "Z" osteotomy and a transverse osteotomy. The second step was to take the hip transposition and rotate the femoral head posteriorly 10° to 20°. The median (range) operative time was 510 minutes (330 to 925 minutes). The median intraoperative blood loss was 4000 mL (1800 to 7000 mL). We performed a chart review on the 15 available patients for clinical and radiographic assessment of functional outcomes and complications. Arthrodesis and leg length discrepancy were evaluated radiographically. RESULTS: The median (range) Musculoskeletal Tumor Society score was 21 points (17 to 30). Eleven of 19 patients developed procedure-related complications, including six patients with allograft nonunion, two with deep infection, two with delayed skin healing, and one with a hematoma. Two patients had minor additional surgical interventions without the removal of any implants. Local recurrences developed in four patients, and all four died of disease. All seven patients treated with a Z osteotomy had bone union. Among the eight patients with transverse osteotomy, bone union did not occur in six patients. After hip transposition, stable iliofemoral arthrodesis was achieved in seven patients. Pseudarthrosis developed in the remaining eight patients. The median (range) lower limb length discrepancy at the last follow-up visit or death was 8 mm (1 to 42 mm). CONCLUSION: Although complex and challenging, rotation hip transposition after femur lengthening reconstruction with a Z osteotomy provides acceptable functional outcomes with complications that are within expectations for resection of pelvic tumors involving the acetabulum. Because of the magnitude and complexity of this technique, we believe it should be used primarily for patients with a favorable prognosis, both locally and systemically. This innovative procedure may be useful to other surgeons if larger numbers of patients and longer-term follow-up confirm our results. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Hip arthroscopy with initial access to the peripheral compartment provides significant improvement in FAI patients.

PURPOSE: This study was designed to evaluate the clinical and radiographic results of arthroscopic treatment of femoroacetabular impingement (FAI) using the technique of initial access to the peripheral compartment. It is based on a single surgeon large case series with a minimum of 2 years follow-up. METHODS: Prospective longitudinal study with consecutive patients. Inclusion criteria were the presence of FAI syndrome that had failed non-operative treatment and had a hip arthroscopy with initial access to the peripheral compartment. Exclusion criteria were previous hip surgery, patients younger than 16 or older than 60 years, Tönnis grade ≥ 2 osteoarthritis, hip dysplasia based on radiographic evidence of LCEA less than 25° and workers compensation cases. One hundred and sixty hips met the inclusion criteria, 84 were female and 70 were male patients (six bilateral cases), with a median age of 36 years (range 16-59). RESULTS: The median alpha angle correction was 22.6º (range 5.9-46.7) (p < 0.01) and the average LCEA correction when acetabuloplasty was undertaken was 6.5º (range - 1.4-20.8) (p < 0.01). The mean NAHS at baseline was 56.1 (range 16-96) and improved to 83.2 at the last follow up (range 44-100) for the patients that had no additional procedure (p < 0.01). The mean average improvement was 27.7º points (range - 16-73). No iatrogenic labral perforation and no full-thickness chondral damage were recorded during the arthroscopic procedures. CONCLUSIONS: Favourable outcomes are reported for the arthroscopic treatment of FAI with initial access to the peripheral compartment. The technique is protective against iatrogenic chondral and labral damage, more conservative to the joint capsule, but the mean traction time was relatively long when suture anchors were used. The results are comparable to the classic initial central compartment approach. LEVEL OF EVIDENCE: Level IV.

Correction of the acetabular index is more crucial than the type of acetabuloplasty in developmental dysplasia.

BACKGROUND: Acetabular remodeling may not be predictable after open reduction in developmental dysplasia of the hip (DDH) in older children. Several acetabuloplasties have been developed, and all are aimed at correcting the dysplastic acetabulum. The goal of this study is to evaluate if the type of pelvic acetabuloplasty and the corrected (postoperative) acetabular index (AI) affect early follow-up femoral head coverage. METHODS: A retrospective review of single-surgeon consecutive acetabuloplasties (Dega or Pemberton) from December 2012 to December 2015 was conducted. The inclusion criteria were a diagnosis of DDH, undergoing simultaneous primary open reduction, and follow-up of at least 18 months. Univariable analysis was based on the type of acetabuloplasty. The correlation between AI and final center edge angle (CEA) was tested. Multiple regression was performed. RESULTS: Of the total 58 hips in 39 patients included, 41 underwent Dega acetabuloplasty, and 17 had Pemberton acetabuloplasty. The median follow-up was 40.50 months (interquartile range 27.25-57). Pemberton acetabuloplasty produced a lower corrected AI, but the difference was not significant in follow-up measurements. Corrected AI was significantly correlated with final CEA (R = - 0.31, P = 0.018). In the multiple regression, only corrected AI was independently associated with final CEA (B = - 0.29, SE = 0.15, P = 0.06), whereas the type of acetabuloplasty, age, and preoperative severity of the dislocation were not. CONCLUSION: The correction obtained during acetabuloplasty affects early follow-up femoral head coverage. Ensuring proper sizing and placement of the grafted bone is probably more important than the type of acetabuloplasty chosen. LEVEL OF EVIDENCE: Level III.

The mid-long term results of reconstructional cage and morselized allografts combined application for the Paprosky type III acetabular bone defects in revision hip arthroplasty.

BACKGROUND: Severe acetabular bone defects is a complex problem in revision hip arthroplasty, cage is one of the reconstruction options. The purpose of this study is to report the mid-long term clinical and radiographic results of Paprosky type III acetabular bone defects revised with reconstructional cage and morselized allogeneic cancellous bone graft without impaction. METHODS: We retrospectively analyzed 28 patients who underwent revision hip arthroplasty with reconstructional cage and allogeneic cancellous bone graft between January 2007 and January 2016. There were 13 Paprosky type IIIA bone defect patients and 15 Paprosky type IIIB bone defect patients and 4 patients of the 15 were also with pelvic discontinuity. Clinical assessment included Harris Hip Score (HHS) and Short Form-12 (SF-12). Radiographic assessment included center of rotation, cage migration, and bone graft incorporation. RESULTS: All patients were followed up with a mean follow-up of 79.5 months (range 38-141), HHS improved from 31.4 (13-43) points preoperatively to 84.6 (55-94) points at last follow-up and SF-12 also improved significantly. There was 1 re-revision for the cage loosening and screw breakage at 61 months after surgery, and 2 patients had nonprogressive radiolucency in zone III and the junction of zone II and zone III at the bone implant interface. CONCLUSION: The reconstructional cage combining with morselized allografts without impaction achieves a good result with a high complete allograft incorporation rate in Paprosky type III acetabular bone defects.

Combined open reduction and Dega transiliac osteotomy for developmental dysplasia of the hip in walking children.

The iliac osteotomy described by Dega in Poland, in 1969, is an acetabuloplasty that changes the acetabular configuration and its inclination. The aim of this work is to analyze a group of patients with DDH treated by combined open reduction and Dega transiliac osteotomy ,to evaluate the results and determine the advantages and disadvantages, as well as, assess the factors affecting the final outcome of such procedure. A prospective study was conducted during the period, from November 2010 to October 2014, on 39 hips, in 29 children, with neglected DDH after walking age, either diagnosed late or after failure to respond to previous non operative treatment. The mean age at the time of surgery was 27.6 months ranging from 18 to 48 months. All hips were followed up clinically and radiologically for a mean period of 33.6 months (range from 18 to 48 months). No patient was lost to follow up. At the end of follow up, satisfactory final clinical results were obtained in 34 hips (87.2%) and unsatisfactory in 5 (12.8%) according to McKay's criteria. Radiologically, satisfactory results were obtained in 32 hips (82.1%) and unsatisfactory in seven (17.9%), according to Severin's criteria. In conclusion, the results of our series show open reduction combined with Dega transiliac osteotomy to be a safe and efficient method for the surgical treatment of DDH in selected patients, and can easily and safely be combined with associated procedures for single stage correction of acetabular dysplasia.

Short-term follow-up of anterior and posterior both column fractures of acetabulum managed through both column plating.

OBJECTIVE: To evaluate the results of short-term follow-up of patients of both column acetabular fractures managed through anterior and posterior column plating. INTRODUCTION: Both column acetabular fractures are challenging articular injuries. Majority of them are treated operatively. The concept of "secondary congruence" was introduced by Letournel. Despite this, biomechanical data on secondary congruence indicate that nonoperative treatment leads to an increase in peak pressures in the supraacetabular region with the potential risk of developing posttraumatic degenerative osteoarthritis. Operative management is therefore justified. METHODOLOGY: A cohort of 10 patients having both column (anterior and posterior) acetabular fractures managed using bicolumnar plating between January 2016 and December 2017 were enrolled in the study and were analyzed during follow-up period. RESULTS: In total, 80% of the patients had excellent to good result. Average postoperative score was 85.7. Assessment was done using modified Harris Hip score.

Should Acetabular Retroversion Be Treated Arthroscopically? A Systematic Review of Open Versus Arthroscopic Techniques.

PURPOSE: To compare patient-reported outcomes, progression of radiographic arthritis, revision rates, and complications for hips with acetabular retroversion treated by open versus arthroscopic methods. METHODS: The PubMed and EMBASE databases were searched in August 2016 for literature on the open and arthroscopic techniques using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) method. All studies published in the English language that focused on the surgical treatment of femoroacetabular impingement caused by retroversion were included. All arthroscopic procedures, such as acetabuloplasty and labral repair, and open procedures, including anteverting periacetabular osteotomy and surgical dislocation with osteoplasty, were included. Articles that did not describe how retroversion was defined were excluded, as were studies with less than 6 months' follow-up and fewer than 5 patients. Two authors screened the results and selected articles for this review based on the inclusion and exclusion criteria. All results were scored using the Methodological Index for Non-randomized Studies (MINORS) criteria. RESULTS: There were 386 results returned and 15 articles that met the inclusion criteria of this study. Among the studies, 11 reviewed arthroscopic techniques and 4 reviewed open surgical procedures. Both techniques yield good results based on patient-reported outcomes with minimal progression of osteoarthritis and low complication rates. CONCLUSIONS: This review showed statistically and clinically significant improvements for the treatment of acetabular retroversion based on patient-reported outcomes, with low progression of radiographic arthritis, revision rates, and complications using both open and arthroscopic methods. LEVEL OF EVIDENCE: Level IV, systematic review of Level I to IV studies.

Outcomes of Hip Arthroscopy in a Military Population Are Similar to Those in the Civilian Population: Matched Paired Analysis at 2 Years.

PURPOSE: The purpose of this study was to compare the clinical outcomes, including the visual analog pain score, University of California Los Angeles activity, modified Harris hip score, and radiologic outcomes after hip arthroscopy in male patients whose symptoms developed during military services with those in a matched-pair control group of active young, nonmilitary patients at a minimum postoperative follow-up of 2 years. METHODS: From September 2009 to December 2014, 28 male patients with mechanical symptoms that developed during military service underwent hip arthroscopic surgery. The control group included 28 professional male athletes who were matched with gender, Tönnis grade 0 or 1, crossover percentage, and labral procedure. At the minimum 2-year follow-up, radiographic and clinical outcomes were assessed using serial radiography. Statistical analysis was performed to confirm the differences between the preoperative and postoperative outcome measures. RESULTS: Most common arthroscopic procedures in the study and control groups were femoroplasty (64.4% vs 53.6%) and labral repair (64.3% vs 53.6%). All improvements in both groups were statistically significant at the last postoperative follow-up (P < .001). In the study group, 89.3% of soldiers were able to return to their preoperative military branch. Although radiologic and clinical outcomes in both groups were not significantly different, hospitalization time in soldiers was significantly longer than that in the control group (79.4 ± 27.0 vs 4.0 ± 1.3 days, P < .001). Time of return to their preoperative military branch in the study group was similar to sports activity in the control group (5.9 ± 4.3 vs 6.3 ± 3.7 months, P = .258). CONCLUSIONS: Male patients with symptoms that developed during military services achieved similar levels of benefit from hip arthroscopy as those in the control group of active young patients. Although hospitalization time in the military population was significantly longer than that in the control group, time to return to activity was similar in both groups. LEVEL OF EVIDENCE: Level III, comparative trial.

Clinical outcomes following arthroscopic treatment of femoro-acetabular impingement using a minimal traction approach and an initial capsulotomy. Minimum two year follow-up.

PURPOSE: Although the arthroscopic management of femoroacetabular impingement (FAI) is increasing, severe complications have been reported due to traction. We developed an arthroscopic technique based on an initial capsulotomy and a minimal traction approach. The main purpose of this study was to analyze the clinical outcomes of FAI treatment using this technique after at least two years of follow-up. METHODS: Forty-seven consecutive patients underwent surgery for FAI. There were two initial portals: a proximal anterolateral portal and a distal anterior instrumental portal. An anterior working space was created and a T-shaped incision was made in the anterior capsule to relieve joint distraction. Short traction (less than 20 mn) made it possible to approach the central compartment. Acetabuloplasty was performed in the presence of pincer impingement. Traction was then released. A head-neck femoral osteochondroplasty was performed in case of bump impingement. All patients underwent a mean 3.3 ± one years of follow-up based on two self-administered questionnaires: the Harris hip score and the QOL Oxford score. None of the patients were lost to follow-up. RESULTS: There were three complications: two ossifications and one case of injury to the femoral cutaneous nerve with good clinical outcomes at the final follow-up. Five patients (10%) underwent surgical revision after a mean 1.4 years of follow-up: three total hip arthroplasties, one peri-acetabular osteotomy, and one repeat arthroscopic hip debridement. The Harris score increased significantly from 60 ± 10 to 86 ± 15 (p < 0.0001) and the Oxford score improved from 34 ± 15 to 50 ± 11. Only 25% of patients had a "forgotten hip" at the final follow-up. CONCLUSION: Our clinical results were comparable to previously reported outcomes with other surgical techniques for the management of FAI. However, it should also be noted that despite these good clinical outcomes, the percentage of patients with a "forgotten hip" is low, and patients should be informed of this.

Acetabular reconstruction with the Kerboull-type plate at mid-term follow-up: survivorship analysis and prognostic factors for loosening.

INTRODUCTION: Successful reconstruction during total hip arthroplasty for acetabular bone defects remains challenging. The purpose of our study was to evaluate clinical and radiographic results and performed a survivorship analysis for patients with acetabular bone loss undergoing total hip arthroplasty (THA) or revision THA using Kerboull-type acetabular reinforcement device(KT plate). Additionally, some independent prognostic factors for radiographic failure were identified. METHODS: A retrospective cohort study was conducted. Thirty patients (36 hips) were available for follow-up examination between 1997 and 2012, with a mean follow-up period of 10 years. We evaluated clinical and radiographic results. The mean patient age at the time of the operation was 66 years. RESULTS: Failure occurred in 6 cases, and further revisions were required for 2 hips. With failure for any reason as an endpoint, the cumulative survival at 10 years was 85%. Survival analysis at 10 years with failure as the endpoint revealed that the inclination angle of the KT plate ≤ 45° group showed higher survivorship than the inclination angle > 45° group (95.8 vs. 63.6%, P = 0.0047). CONCLUSIONS: With a mean follow-up of 10 years, the clinical and radiographic outcomes were satisfactory. While this study group was small, the results suggest that prosthesis longevity may be improved by setting the inclination angle of this reinforcement device at ≤ 45°.

Arthroscopic Reconstruction of Segmental Defects of the Hip Labrum: Results in 22 Patients With Mean 2-Year Follow-Up.

PURPOSE: To report mean 2-year patient-reported outcomes (PROs) and the incidence of revision hip arthroscopy or conversion to total hip arthroplasty (THA) in patients who had undergone arthroscopic reconstruction of the hip labrum for segmental defects. METHODS: Data were prospectively collected and retrospectively reviewed on all patients who had undergone hip arthroscopy from April 2008 to April 2013. All patients who underwent arthroscopic labral reconstruction with either a semitendinosus allograft or a gracilis autograft with mean 2-year follow-up were part of the inclusion criteria. The following outcomes were recorded: modified Harris hip score, nonarthritic athletic hip score, hip outcome score-sports-specific subscale, hip outcome score-activities of daily living subscale, visual analog scale, for pain, patient satisfaction, revision hip arthroscopies, and conversion to THA. A 2-tailed Student's t-test was used to assess for statistically significant differences between the mean of preoperative and postoperative PROs. P values less than .05 were considered statistically significant. RESULTS: A total of 22 patients (14 females, 8 males) met the inclusion criteria. There was 100% follow-up. The mean age of the study population was 32.2 years. Twelve patients had reconstruction as part of a revision procedure and 10 patients had a reconstruction at the time of primary arthroscopy. Concomitant arthroscopic procedures included acetabuloplasty and femoroplasty. There was statistically significant improvement in all PROs (P = .013 to < .001). The mean changes for the modified Harris hip score, nonarthritic athletic hip score, hip outcome score-sports-specific subscale, and hip outcome score-activities of daily living subscale were 11.0 ± 19.5, 22.2 ± 15.0, 23.1 ± 30.9, and 19.1 ± 17.5 points, respectively. The mean improvement in the visual analog scale was 3.33 ± 2.92 points (P < .001), and the mean patient satisfaction was 6.73 out of 10 points. One patient required conversion to THA for presumed progression of osteoarthritis and 2 patients required a revision procedure for adhesions. CONCLUSIONS: This arthroscopic technique for labral reconstruction was associated with a significant improvement in PROs and function. Conversion to THA with the procedure was 4.5%. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Isolated Acetabuloplasty and Labral Repair for Combined-Type Femoroacetabular Impingement: Are We Doing Too Much?

PURPOSE: To evaluate patient outcomes after isolated arthroscopic volumetric acetabular osteoplasty and labral repair for the treatment of patients with combined femoroacetabular impingement (FAI) lesions. METHODS: A review of a prospectively collected registry identified 86 patients (106 hips) with an average age of 38.1 years (range, 17-59 years) with combined-type FAI that underwent isolated acetabular osteoplasty and labral repair. Preoperative α-angle, degree of radiographic degenerative changes, and presence of a crossover sign were recorded. Clinical outcomes were assessed with the modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), and patient satisfaction score (out of 10) at a minimum 2-year follow-up. RESULTS: Clinical follow-up was obtained at a mean follow-up of 37.2 months (range, 27.9-79.2 months). Patients with Tönnis grade 0 and I findings had significantly higher mHHS (83.5 vs 71.5, P = .01), HOS-SSS (81.3 vs 59.9, P = .02), and iHOT-12 scores (71.1 vs 58.8, P = .04) compared to patients with Tonnis grade II changes. However, patient satisfaction scores (8.0 vs 7.2, P = .45) were no different. No significant difference was noted between unilateral and bilateral hip patient outcome scores. Patient age and preoperative α-angles did not correlate with any outcome scores (all R2 <0.05). There were no cases of revision surgery or progression to arthroplasty. CONCLUSIONS: Isolated acetabular decompression may adequately address the underlying impingement in combined-type FAI while avoiding the risks associated with femoral-sided decompression. Good to excellent patient-reported outcomes and satisfaction scores were noted with significantly higher scores in patients with minimal arthritic change. Patient age and preoperative α-angle had less effect on postoperative outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

[Revision arthroplasty of the hip : Direct anterior approach]. / Revisionsendoprothetik des Hüftgelenks : Der anteriore Zugang.

The direct anterior approach to the hip allows good exposure of acetabulum and periacetabular bones. For simple acetabular revisions it can be chosen to be small (minimally invasive); in the case of extensive periacetabular bone loss exposure of the entire ilium cranial of the acetabulum may be achieved, and the pubic bone as well as inner-pelvic structures adjacent to the acetabulum can be exposed. The internerval plane of the approach between muscles innervated by the femoral nerve and the gluteal nerves allows exposure of the ilium without endangering the nerve supply of gluteal muscles.

Acetabular defect classification in times of 3D imaging and patient-specific treatment protocols.

Parallel to the rising number of revision hip procedures, an increasing number of complex periprosthetic osseous defects can be expected. Stable long-term fixation of the revision implant remains the ultimate goal of the surgical protocol. Within this context, an elaborate preoperative planning process including anticipation of the periacetabular defect form and size and analysis of the remaining supporting osseous elements are essential. However, detection and evaluation of periacetabular bone defects using an unsystematic analysis of plain anteroposterior radiographs of the pelvis is in many cases difficult. Therefore, periacetabular bone defect classification schemes such as the Paprosky system have been introduced that use standardized radiographic criteria to better anticipate the intraoperative reality. Recent studies were able to demonstrate that larger defects are often underestimated when using the Paprosky classification and that the intra- and interobserver reliability of the system is low. This makes it hard to compare results in terms of defects being studied. Novel software tools that are based on the analysis of CT data may provide an opportunity to overcome the limitations of native radiographic defect analysis. In the following article we discuss potential benefits of these novel instruments against the background of the obvious limitations of the currently used native radiographic defect analysis.

[Biological downsizing : Acetabular defect reconstruction in revision total hip arthroplasty]. / Biologisches Downsizing : Azetabuläre Knochendefekte in der Hüftrevisionsendoprothetik.

BACKGROUND: Periacetabular bony defects remain a great challenge in revision total hip arthroplasty. After assessment and classification of the defect and selection of a suitable implant the primary stable fixation and sufficient biological reconstitution of a sustainable bone stock are essential for long term success in acetabular revision surgery. Biological defect reconstruction aims for the down-sizing of periacetabular defects for later revision surgeries. TECHNIQUE: In the field of biological augmentation several methods are currently available. Autologous transplants feature a profound osseointegrative capacity. However, limitations such as volume restrictions and secondary complications at the donor site have to be considered. Structural allografts show little weight bearing potential in the long term and high failure rates. In clinical practice, the usage of spongious chips implanted via impaction bone grafting technique in combination with antiprotrusio cages for the management of contained defects have shown promising long time results. Nevertheless, when dealing with craniolateral acetabular and dorsal column defects, the additional implantation of macroporous metal implants or augments should be considered since biological augmentation has shown little clinical success in these particular cases. PROSPECT: This article provides an overview of the current clinically available biological augmentation methods of peri-acetabular defects. Due to the limitations of autologous and allogeneic bone transplants in terms of size and availability, the emerging field of innovative implantable tissue engineering constructs gains interest and will also be discussed in this article.

[Partial exchange in total hip arthroplasty : What can we combine?] / Gelenkteilwechsel in der Hüftarthroplastik : Was dürfen wir kombinieren?

BACKGROUND: In case of hip revision arthroplasty, one component (cup/stem) is often well fixed and does not need to be exchanged. The newly implanted component needs to be compatible with the well-fixed implant. The combination of implants from different companies leads to "mix and match" or even mismatch between the implants. OBJECTIVES AND METHODS: The objective of this work was to describe possible combinations including their specifications that need to be considered in partial exchange of hip prostheses. For this purpose the literature, surgical techniques of companies and judgements concerning this topic were analysed and our own results and experiences were included. RESULTS AND CONCLUSIONS: Partial revision arthroplasty can be challenging and needs to be planned in detail. In case of isolated cup or inlay revision with exchange of a modular head the cone of the stem needs to be identified. A ceramic head may be used in revision with a titanium sleeve even from a different company as long as they are compatible. Patients however need to give their informed consent for this mix and match procedure. This procedure is done frequently and good study results support this, however from a juristic point of view a definite recommendation cannot be given. If the inlay of a cup is replaced, the original inlay should be used. If this is not available anymore, it can be manufactured as a special product in many cases. If this is also not possible, an inlay can also be cemented into a well-fixed cup. Biomechanical and clinical studies support this off-label technique. In case of an isolated exchange of the stem with a ceramic inlay that is retained in a well-fixed cup, the revision stem and ceramic head need to be from the same company as the cup. In case of ceramic fracture, a ceramic head with a titanium sleeve should be combined with a PE or ceramic inlay, a metal head or inlay should never be used.

[The acetabulum nonunion: reconstruction and reosteosynthesis : A long-term outcome]. / Die Acetabulumpseudarthrose: Rekonstruktion und Reosteosynthese : Ein Langzeitergebnis.

Acetabular nonunions are rare, especially after operative treatment of an acetabular fracture. There are only single reports of the reconstruction and therapy of acetabular nonunion. Furthermore, there are fewer reports for treatment of acetabular nonunion with a long follow-up. We report a successful revision of an acetabular nonunion after transversal fracture and previous operative intervention, as well as the long-term follow-up after revision surgery.

Combination acetabular radiofrequency ablation and cementoplasty using a navigational radiofrequency ablation device and ultrahigh viscosity cement: technical note.

BACKGROUND: Percutaneous radiofrequency ablation and cementoplasty is an alternative palliative therapy for painful metastases involving axial load-bearing bones. This technical report describes the use of a navigational radiofrequency probe to ablate acetabular metastases from an anterior approach followed by instillation of ultrahigh viscosity cement under CT-fluoroscopic guidance. MATERIALS AND METHODS: The tumor ablation databases of two institutions were retrospectively reviewed to identify patients who underwent combination acetabular radiofrequency ablation and cementoplasty using the STAR Tumor Ablation and StabiliT Vertebral Augmentation Systems (DFINE; San Jose, CA). Pre-procedure acetabular tumor volume was measured on cross-sectional imaging. Pre- and post-procedure pain scores were measured using the Numeric Rating Scale (10-point scale) and compared. Partial pain improvement was categorically defined as ≥ 2-point pain score reduction. Patients were evaluated for evidence of immediate complications. Electronic medical records were reviewed for evidence of delayed complications. RESULTS: During the study period, 12 patients with acetabular metastases were treated. The median tumor volume was 54.3 mL (range, 28.3-109.8 mL). Pre- and post-procedure pain scores were obtained from 92% (11/12) of the cohort. The median pre-procedure pain score was 8 (range, 3-10). Post-procedure pain scores were obtained 7 days (82%; 9/11), 11 days (9.1%; 1/11) or 21 days (9.1%; 1/11) after treatment. The median post-treatment pain score was 3 (range, 1-8), a statistically significant difference compared with pre-treatment (P = 0.002). Categorically, 73% (8/11) of patients reported partial pain relief after treatment. No immediate symptomatic complications occurred. Three patients (25%; 3/12) were discharged to hospice within 1 week of treatment. No delayed complications occurred in the remaining 75% (9/12) of patients during median clinical follow-up of 62 days (range, 14-178 days). CONCLUSIONS: Palliative percutaneous acetabular radiofrequency ablation and cementoplasty can be feasibly performed from an anterior approach using a navigational ablation probe and ultrahigh viscosity cement instilled under CT-fluoroscopic guidance.

[Bernese periacetabular osteotomy. : Indications, technique and results 30 years after the first description]. / Periazetabuläre Osteotomie nach Ganz : Indikationen, Technik und Ergebnisse 30 Jahre nach Erstbeschreibung.

The Bernese periacetabular osteotomy (PAO) is a surgical technique for the treatment of (1) hip dysplasia and (2) femoroacetabular impingement due to acetabular retroversion. The aim of the surgery is to prevent secondary osteoarthritis by improvement of the hip biomechanics. In contrast to other pelvic osteotomies, the posterior column remains intact with this technique. This improves the inherent stability of the acetabular fragment and thereby facilitates postoperative rehabilitation. The birth canal remains unchanged. Through a shortened ilioinguinal incision, four osteotomies and one controlled fracture around the acetabulum are performed. The direction of acetabular reorientation differs for both indications while the sequence of the osteotomies remains the same. This surgical approach allows for a concomitant osteochondroplasty in the case of an aspherical femoral head-neck junction. The complication rate is relatively low despite the complexity of the procedure. The key point for a successful long term outcome is an optimal reorientation of the acetabulum for both indications. With an optimal reorientation and a spherical femoral head, the cumulative survivorship of the hip after 10 years is 80-90 %. For the very first 75 patients, the cumulative 20-year survivorship was 60 %. The preliminary evaluation of the same series at a 30-year follow-up still showed a survivorship of approximately 30 %. The PAO has become the standard procedure for the surgical therapy of hip dysplasia in adolescents and adults.

[Acetabuloplasty - The Dega and Pemberton technique]. / Beckenosteotomie nach Dega und Pemberton.

BACKGROUND: Hip dysplasia is the most common congenital deformity requiring surgical correction osteotomy in order to prevent early onset of secondary hip arthrosis. The shape of the acetabulum can be modified by Dega or Pemberton osteotomy and is indicated for hip dysplasia and luxation with irregularities of the socket for children aged between 2 and 12 when the y­physis is still open. METHOD: We will describe indication, contra-indication, preoperative planning as well as details of the Pemberton technique. In addition, we will provide practical advice based on our long-standing experience. RESULTS: We present long-term results from the literature and also from our department. In addition, we will explain and critically discuss our own experiences and the risks and complications of surgical techniques. Good long-term results are reported for acetabuloplasties and Salter osteotomy which are preferred for surgical treatment of hip dysplasia in early life. Advantages and disadvantages of both surgical techniques will be compared in the discussion section. CONCLUSION: Dega and Pemberton acetabuloplasty shows good long-term results regarding prevention of a secondary coxarthrosis. However, correct indication is crucial since this surgical technique is more difficult compared to Salter osteotomy but is also associated with a higher correction potential and a lower complication rate.