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ACETABULAR FIXATION SURGERY IN INDIA

 

Acetabular Fixation Options in Total Hip Replacement Surgery in india

Osteolysis and loosening, despite great changes in bearing materials, continue to be a problem in total hip replacements (THR). Hybrid fixation, proposed in 1989 to aid such problems, has not completely solved them.2 There are times during surgery that an alternative to the routine, predetermined technique is needed. Recent alterations in cementless femoral and/or cemented acetabular fixation have produced promising clinical returns and have shown improvement in dealing with linear wear and osteolysis

we prospectively evaluated clinical and radiographic outcomes in patients with displaced combined transverse-posterior wall acetabular fractures managed at our Institution over a period of seven years by posterolateral single approach, direct posterior wall and posterior column reduction and plating, and indirect reduction of anterior column controlled by fluoroscopic images with or without lag-screw fixation. The aim was to identify if the obtained immediate postoperative Matta radiographic roof-arc angles after fracture reduction and fixation alters in the postoperative period when comparing posterior plating alone versus posterior plate and anterior column lag-screw fixation

Hip impingement syndrome, also known as femoro-acetabular impingement (FAI) syndrome, is a recently accepted pathological condition that primarily affects young and middle-aged adults. It is characterized by hip pain felt mainly in the groin, and can result in chronic pain and decreased range of motion in flexion and internal rotation. Femoro-acetabular impingement syndrome has been reported to be associated with progressive osteoarthritis of the hip. History, physical examination, as well as supportive radiographical findings including evidence of articular cartilage damage, acetabular labral tearing, and early-onset degenerative changes can aid in diagnosing this condition. Several pathological changes of the femur and acetabulum are known to predispose individuals to develop FAI syndrome.

Fractures of the acetabulum occur primarily in young adults as a result of high-velocity trauma. These fractures are often associated with other life-threatening injuries.

Displacement of the fracture fragments leads to articular incongruity of the hip joint that results in abnormal pressure distribution on the articular cartilage surface. This can lead to rapid breakdown of the cartilage surface, resulting in disabling arthritis of the hip joint. Anatomic reduction and stable fixation of the fracture, such that the femoral head is concentrically reduced under an adequate portion of the weightbearing dome of the acetabulum, is the treatment goal in these difficult fractures. See examples of fractures below.

The posterior Kocher-Langenbeck approach is probably the best-known and the easiest incision for the management of acetabular fractures. However, the reduction of acetabular fractures through this approach is not altogether straightforward, since the exposure provided is limited, and the proximity of vital structures makes some of the manipulations involved in the reduction dangerous . This article recalls some of the basic principles of the management of acetabular fractures through the Kocher-Langenbeck approach.

For acetabular surgery, certain special instruments are required, which greatly facilitate the reduction of the fracture fragments.

The joint is deep, and the fragments are, therefore, difficult to mobilize. The ball-spike instrument named “picador” by Emile Letournel is a modified bone awl that allows fragments to be pushed or held in place. A small (Lambotte) bone hook makes it possible to pull on and to mobilize fragments (e.g. a posterior column at the sciatic notch).[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_message style=”square” message_box_color=”mulled_wine”]

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