Screw-Hole Clusters in Acetabular Cups: A Morphological Study of Optimal Positioning of Screw-Holes

2017 ◽  
Vol 27 (4) ◽  
pp. 382-388 ◽  
Author(s):  
Xinghua Yin ◽  
Yixin Zhou ◽  
Qiheng Tang ◽  
Dejin Yang ◽  
Hao Tang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Distribution Pattern ◽  
Hip Arthroplasty ◽  
Morphological Study ◽  
Screw Fixation ◽  
Bone Stock ◽  
Separation Angle ◽  
Screw Hole ◽  
Osseous Structure ◽  
Neurovascular Structures

Background Rigid and safe transacetabular screw fixation in total hip arthroplasty (THA) is achieved by pursuing deeper bone stock and avoiding injuries to the neurovascular structures, but these efforts can be restricted by the distribution of screw-holes on cups by the manufacturer. We therefore tried to determine: (i) optimal screw-hole positions on cups to allow anatomical placement of screws; (ii) rationality of the basic 3-screw-hole cluster on commercial cups; and (iii) the optimum method for placing commercial cups in accordance with acetabular anatomy. Methods Periacetabular osseous structure of 64 hips and arterial structures of 50 hips were three-dimensionally reconstructed. Simulated transacetabular screw fixation during THA was performed in these hips with 3 different screw lengths (15, 25, and 35 mm) to define deeper and safer screw trajectories. Screw-hole locations of 7 commercially available cups were measured and matched with the periacetabular anatomy. Results When the cup was placed into the acetabulum at 45° of abduction and 20° of anteversion, the optimal locations of 2 screw-holes on the cups were at 30° and 64° of latitude, with a 35° separation angle. The inversetriangle distribution pattern was safer than the triangle pattern in basic 3-screw-hole-cluster cups. When placing the commercial cups, 5°-10° of anterior rotation can be added to allow better screw trajectories. Conclusions Our study determined optimal screw-hole positions and their distribution pattern on cups. We describe methods to place the commercial cups that are not designed according to acetabular anatomy.

scholarly journals Surgical anatomy of the pelvic vasculature, with particular reference to acetabular screw fixation in cementless total hip arthroplasty in Asian population

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668552 ◽  
Author(s):  
Hironori Ohashi ◽  
Shinichi Kikuchi ◽  
Shigeo Aota ◽  
Michiyuki Hakozaki ◽  
Shinichi Konno
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Vascular Injury ◽  
Hip Arthroplasty ◽  
Screw Fixation ◽  
Kirschner Wire ◽  
Safety Zone ◽  
Total Hip ◽  
Cementless Total Hip Arthroplasty ◽  
Posterior Area

Purpose: Pelvic vascular injury is a serious complication associated with acetabular component setting with screw fixation in cementless total hip arthroplasty (THA). In this study, we investigated the safety zone for acetabular component setting with screw fixation in cementless THA as a means to prevent pelvic vascular injury. Methods: Thirty left hip joints of Japanese cadavers (11 males and 19 females) were analyzed. We used a hemispherical measuring cup with 52 guide holes designed to allow vertical insertion of a Kirschner wire. After the measuring cup was placed on the acetabulum, the Kirschner wire was inserted from each guide hole to examine the anatomical relationship between the acetabulum and the pelvic vessels. We calculated the frequency of pelvic vessel punctures and measured the distance from the acetabular surface to the pelvic vessels at each guide hole. Results: Our findings revealed that pelvic vessels do not exist in certain parts of the posterior area of the acetabulum. Furthermore, in this area, intrapelvic vessels are either lacking or located at a distance ≥31 mm from the surface of the acetabulum. Conclusion: The posterior area of the acetabulum, excluding its central portion, appeared to be the safety zone for acetabular screw fixation in Japanese cadavers.

Evaluation of medial acetabular wall bone stock in patients with developmental dysplasia of the hip using a helical computed tomography multiplanar reconstruction technique

2009 ◽  
Vol 50 (7) ◽  
pp. 791-797 ◽  
Author(s):  
Rui Yu Liu ◽  
Kun Zheng Wang ◽  
Chun Sheng Wang ◽  
Xiao Qian Dang ◽  
Zhi Qin Tong
Keyword(s):  
Computed Tomography ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Helical Computed Tomography ◽  
Reconstruction Technique ◽  
Bone Stock ◽  
Total Hip ◽  
Dysplasia Of The Hip ◽  
Acetabular Wall

Background: The technique of medialization has been used to reconstruct acetabula at the level of true acetabula in total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). Appreciation of the bone stock in the medial acetabular wall is significant for making an optimal acetabular reconstruction plan and avoiding complications. Purpose: To evaluate the bone stock of the medial acetabular wall and its relation to the degree of subluxation in patients with DDH using computed tomography (CT). Material and Methods: Helical CT scans of 27 hips were obtained from 21 patients with osteoarthritis secondary to DDH who were scheduled for total hip arthroplasty. Eleven hips belonged to Crowe class I, while 16 hips belonged to Crowe class II/III. The raw CT data were reprocessed in various planes by scrolling multiplanar reformation (MPR). Acetabular opening, depth, and medial bone stock, as indicated by the minimum thickness of the medial acetabular wall, were measured in the transverse reformed MPR plane. Results: The minimum thicknesses of the medial acetabular wall in Crowe-I and Crowe-II/III hips were 3.8±2.1 mm and 7.1±3.1 mm, respectively, with statistically significant differences between the groups ( P<0.05). Furthermore, the bone stock in the medial acetabular wall correlated with the degree of subluxation ( R=0.69) and the acetabular depth ( R= ;− ;0.71). Conclusion: There was significantly more bone stock in the medial acetabular wall in patients with higher-degree subluxation than there was in the less-severe class. This difference should be taken into consideration when reconstructing acetabula in THA in patients with DDH using the technique of medialization.

Restoration of Femoral Bone Stock in Revision Total Hip Arthroplasty

1993 ◽  
Vol 24 (4) ◽  
pp. 697-703 ◽  
Author(s):  
William C. Head ◽  
Russell A. Wagner ◽  
Roger H. Emerson ◽  
Theodore I. Malinin
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Bone Stock ◽  
Revision Total Hip Arthroplasty ◽  
Femoral Bone ◽  
Total Hip

Reconstruction of acetabular defects with porous tantalum shells and augments in revision total hip arthroplasty at ten-year follow-up

2019 ◽  
Vol 101-B (3) ◽  
pp. 311-316 ◽  
Author(s):  
J. Löchel ◽  
V. Janz ◽  
C. Hipfl ◽  
C. Perka ◽  
G. I. Wassilew
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Screw Fixation ◽  
Acetabular Revision ◽  
Revision Total Hip Arthroplasty ◽  
Pelvic Discontinuity ◽  
Acetabular Defects

Aims The use of trabecular metal (TM) shells supported by augments has provided good mid-term results after revision total hip arthroplasty (THA) in patients with a bony defect of the acetabulum. The aim of this study was to assess the long-term implant survivorship and radiological and clinical outcomes after acetabular revision using this technique. Patients and Methods Between 2006 and 2010, 60 patients (62 hips) underwent acetabular revision using a combination of a TM shell and augment. A total of 51 patients (53 hips) had complete follow-up at a minimum of seven years and were included in the study. Of these patients, 15 were men (29.4%) and 36 were women (70.6%). Their mean age at the time of revision THA was 64.6 years (28 to 85). Three patients (5.2%) had a Paprosky IIA defect, 13 (24.5%) had a type IIB defect, six (11.3%) had a type IIC defect, 22 (41.5%) had a type IIIA defect, and nine (17%) had a type IIIB defect. Five patients (9.4%) also had pelvic discontinuity. Results The overall survival of the acetabular component at a mean of ten years postoperatively was 92.5%. Three hips (5.6%) required further revision due to aseptic loosening, and one (1.9%) required revision for infection. Three hips with aseptic loosening failed, due to insufficient screw fixation of the shell in two and pelvic discontinuity in one. The mean Harris Hip Score improved significantly from 55 (35 to 68) preoperatively to 81 points (68 to 99) at the latest follow-up (p < 0.001). Conclusion The reconstruction of acetabular defects with TM shells and augments showed excellent long-term results. Supplementary screw fixation of the shell should be performed in every patient. Alternative techniques should be considered to address pelvic disconinuity. Cite this article: Bone Joint J 2019;101-B:311–316.

scholarly journals Effect of screw fixation on acetabular component alignment change in total hip arthroplasty

2014 ◽  
Vol 38 (6) ◽  
pp. 1155-1158 ◽  
Author(s):  
Takaaki Fujishiro ◽  
Shinya Hayashi ◽  
Noriyuki Kanzaki ◽  
Shingo Hashimoto ◽  
Nao Shibanuma ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Screw Fixation ◽  
Component Alignment ◽  
Total Hip

scholarly journals Cup alignment change after screw fixation in total hip arthroplasty

2019 ◽  
Vol 53 (5) ◽  
pp. 618 ◽  
Author(s):  
Yingyong Suksathien ◽  
Urawit Piyapromdee ◽  
Thanut Tippimanchai
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Screw Fixation ◽  
Total Hip
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