The Hip: Preservation, Replacement and Revision

THR: Acetabular Component


 - See: Total Hip Replacement Menu / acetabular component revision:

- Surgical Technique:
    - preoperative planning:
           - acetabular biomechanics:
           - operative considerations for hip dyplasia
           - protrusio
           - types of components:
                  - press fit components:
                  - cemented acetabular component
                  - acetabular component revision 
           - clinical exam:
                  - note the amount of standing lordosis and the amount of hip abduction;
                  - adduction contracture may cause pelvis to tilt downward which might over-estimate hip abduction;
    - acetabular exposure:
           - if exposure is not optimal, then consider trochanteric osteotomy;
    - re-establish anatomy of the acetabular floor:
    - reaming technique:
    - component insertion: (press fit components)
    - component position: (anteversion and inclination)
    - screw placement:
    - poly insertion
    - bone grafting for acetabular defects: 
    - complications:
           - acetabular fracture:
                  - acetabuli should not be underreamed by more than 1 mm, especially in osteoporotic bone;
                  - underreaming of the acetabulum by two milimeters may result in frx in 20-25% of cases;
                  - when intra-operative frx is recognized intra-op, then augment component with as many acetabular screws as possible; 
                  - references:
                         - Periprosthetic fracture of the acetabulum during and following total hip arthroplasty.   
                         - Fracture of the acetabulum during insertion of an oversized hemispherical component
                         - Intraoperative Fractures of the Acetabulum During Primary Total Hip Arthroplasty 
           - acetabular component loosening
           - screw insertion injuries;
           - osteolysis
           - protrusio
           - dislocation 
                  - references: 
                          - The elevated-rim acetabular liner in total hip arthroplasty: relationship to postoperative dislocation
                          - The use of a lipped acetabular liner decreases the rate of revision for instability after total hip replacement: a study using data from the New Zealand Joint Registry.


- Radiographic Evaluation:
    - preop acetabular x-ray evaluation:
           - protrusio vs DDH
                  - reference:
                         - Radiographic measurements in protrusio acetabuli.
           - bone grafting for acetabular defects:
           - references:
                  - The acetabular teardrop and its relevance to acetabular migration.
                  - Bone grafting in total hip replacement for acetabular protrusion.
    - postop radiographic evaluation:
           - acetabular component loosening:
           - component position;
           - polyethylene wear:
           - osteolysis:
                  - references:
                         - Severe Osteolysis of the Pelvis in Association with Acetabular Replacement without Cement.
                         - The relationship between the design, position, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis
                         - Are cementless acetabular components the cause of excess wear and osteolysis in total hip arthroplasty?


   - acetabular component revision



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, February 26, 2016 11:22 am