Alexandre Nehme

Modular porous metal augments for treatment of severe acetabular bone loss during revision hip arthroplasty.

Modular acetabular augments were implanted in 16 patients (16 hips) for support of an uncemented hemispheric acetabular component during revision acetabular reconstruction. Based on the classification of Paprosky, acetabular bone defects were classified as 2A in one hip, 2B in three hips, 2C in one hip, 3A in five hips, and 3B in six hips. Preoperatively, the prosthetic femoral head centers were located at a mean horizontal distance of 18.6 mm (range, −3-46 mm), and a mean vertical distance of 27.6 mm (range, −16-52 mm) from the approximate femoral head center. Postoperatively, the prosthetic femoral head centers were located at a mean horizontal distance of 10.4 mm (range, 1-25 mm), and a mean vertical distance of 7.4 mm (range, −15-25 mm). At final followup, no implant had evidence of migration or loosening. At early clinical followup, this modular acetabular augment system seems helpful in acetabular reconstructions that cannot be treated with an uncemented hemispheric cup that would have required other forms of treatment such as structural allografts, acetabular cages, bilobed acetabular components, or custom acetabular components. Longer term followup is required to determine whether there are untoward effects of using a modular acetabular reconstructive system.

Arthroscopic Excision of Intra-Articular Hip Osteoid Osteoma: A Report of 2 Cases

Intra-articular osteoid osteoma is uncommon accounting for approximately 12% of all osteoid osteomas. It presents diagnostic and therapeutic challenges since several traumatic or degenerative pathologies of the joint can be simulated with delay in the diagnosis. We report the clinical, radiographic, and histopathological findings in 2 cases of intra-articular osteoid osteoma of the femoral neck and of the acetabulum. Technical aspects of arthroscopic excision and results of surgery are discussed. Arthroscopy allowed complete excision of the osteoid osteomas, with a short postoperative rehabilitation and excellent functional results.

Acetabular morphology in bladder exstrophy complex

Little information is available concerning the acetabular morphology in adults with a history of bladder exstrophy. We documented the pelvic anatomy in adult patients with bladder exstrophy who never had prior surgery. We retrospectively reviewed 31 patients (62 hips) seen from 1976 to 2003 for urologic problems related to bladder exstrophy without adjunctive pelvic osteotomy. There were 18 males and 13 females with an average age of 30 years at last fol-lowup. Radiographs at final followup were analyzed for lateral center-edge angle, acetabular index, head extrusion, hip center of rotation, acetabular version, retroversion index, sacral width, and interteardrop distance. Most hips (60 hips) had no arthritis. The average lateral center-edge angle, ace-tabular index, and head extrusion index were 32°, 5.7°, and 0.266%, respectively. Fifty-eight percent of hips had a ret-roverted acetabulum and 42% were neutral or anteverted. The interteardrop distance averaged 154 mm. Most patients will not have early arthritis develop, and the majority of patients (58%) have retroverted orientation of the acetabulum.

Persistent bladder entrapment following acetabular fracture with subsequent vesical injury during total hip arthroplasty. A case report.

M ost urological injuries encountered by orthopaedic surgeons are associated with pelvic trauma. Acute injuries to the bladder, prostate, and urethra may occur in association with 13.5% to 46.6% of pelvic fractures1-3. Bladder ruptures account for the majority of these injuries4 and typically occur in association with high-energy trauma, such as motor-vehicle accidents, falls, industrial accidents, or abdominal blows5,6. While bladder rupture is much more common, three cases of acute bladder entrapment after pelvic fracture have been reported in the English-language literature4,7,8. Urological injuries following primary total hip arthroplasty are also infrequent. In patients with cemented acetabular components, acute injuries to the bladder can occur as the result of medial wall perforation or cement extrusion9,10 or in association with cement and component extraction during revision surgery11. In patients with uncemented acetabular components, acute urologic or gastrointestinal injuries can occur as a result of errant drill-bit or screw placement12. Late presentation of urologic complications has been reported as a consequence of medial migration of an acetabular component12,13. In the present report, we describe the case of a patient who had had a previous acetabular fracture that had healed with an unrecognized bladder entrapment and who sustained a penetrating bladder injury during primary total hip replacement. To our knowledge, injury of an entrapped bladder during hip arthroplasty has not been previously reported. The patient was informed that data concerning this case would be submitted for publication. A forty-three-year-old man was admitted to our institution for a right total hip arthroplasty. He had severe progressive mechanical pain in the right hip and a limited walking distance. Twenty years earlier, he had been involved in a motor-vehicle accident …

BILATERAL ASEPTIC NECROSIS OF THE OUTER END OF THE CLAVICLE

We describe a 46-year-old woman who presented at intervals of seven years with osteonecrosis of the outer end of both clavicles. The clinical, radiological features and the appearances of the bone scans are described. Although the condition may be confused with osteolysis there is a dear histological distinction between the two conditions. If the symptoms fail to respond to conservative treatment, excision of the outer end of the clavicle is recommended.

Locked Central Fracture Dislocation of the Hip in a Child after Low-Energy Trauma

We present the case of a 13-year-old boy who sustained a locked central fracture dislocation of the right acetabulum following a bicycle fall. Immediate external reduction maneuvers under general anesthesia were unsuccessful due to intrapelvic entrapment of the femoral head. Open reduction internal fixation was achieved 48 hours later. After an initial satisfactory postoperative course, the patient ended up developing severe hip osteoarthritis 16 months after the procedure. The rarity of this injury in children is discussed, with its possible implications on joint congruity and potential growth injury.

Surgical Hip Dislocation for Management of Acetabular Osteochondroma in an Adult

The purpose of this study is to report a rare case of acetabular osteochondroma with a unique clinical presentation occurring in an adult with normally developed hips. The distinctive size and location of the lesion required an open approach with surgical dislocation of the hip for complete resection.