PubMed · 7231950
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A M Sokolovskiĭ. 1981. [Acetabular transposition methods].. https://pubmed.ncbi.nlm.nih.gov/7231950/
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The aim of our study was to describe the technique of percutaneous injection of acrylic surgical cement into acetabulum malignancies [percutaneous acetabuloplasty (PCA)] and determine its efficiency in relieving pain. Eighteen patients (8 men, 10 women; aged 40-81 years) with painful acetabular malignancies (18 lesions; 17 metastases, 1 multifocal bone sarcoma) were treated with PCA. Procedures were done using lateral approach with fluoroscopic guidance. The 18 procedures were evaluated and resulted in 4 (22 %) total improvement, 7 (39 %) clear improvement, 4 (22 %) moderate improvement, 1 (6 %) no improvement, and 2 (11 %) worsening in keeping with a cement leak in contact with the sciatic nerve and a leak towards the joint. Follow-up ranged from 2 to 48 months (average 9.4 months). We observed 2 cases of recurrence of pain at 6 and 39 months, both in keeping with local tumoral progression. PCA of malignancies is a minimally invasive and low-cost procedure that provides immediate and long-term pain relief.
A retrospective clinical and radiographic analysis was performed in 27 hips (23 patients), in which a threaded, porous-coated acetabular component with cylindrical liner was implanted (Sintered T-Tab-ST cup, Biomet, Warsaw, IN). Sixteen hips had cemented stems; 11 had cementless, circumferentially porous-coated stems. The mean clinical and radiographic follow-up period was 68 months. The mean patient age was 49 years; the mean patient weight was 68 kg. The mean rates of linear and volumetric wear were 0.25 mm/y and 149 mm3/y, respectively. Osteolysis occurred in 51.8% (14 hips). Wear rate and young age correlated with osteolysis (P = .0002 and P = .01, respectively). There were no cases of distal femoral osteolysis.
Controversy exists over whether to remove a well-fixed femoral component at the time of revision of a failed acetabular component, and it has been suggested that the femoral component be removed and recemented. The hypothesis presented in this article is that only the acetabular component should be revised in these situations. Thirty-eight isolated, uncemented acetabular revisions were performed by 1 surgeon and prospectively followed for a mean of 4 years (range, 2-10 years). The femoral component was well fixed at the time of revision and left in situ. There were 30 cemented and 8 uncemented femoral components, which had been in place for a mean of 10.7 years. The hips were evaluated clinically using the Harris hip score rating system. Radiographic evaluation of both components was performed using well-established criteria. Morselized cancellous allograft was used to fill acetabular defects in 30 hips, and a bulk allograft was used in 1 hip. There was a good or excellent clinical result in 32 hips (84%). Two cemented femoral components required revision for aseptic loosening at 2.5 and 4 years. No acetabular component migrated or was revised, and no revisions of either component are pending. Thirty-six (95%) of the unrevised femoral components remain well fixed at the most recent follow-up examination. Compared with a similar population of hips in which both the acetabular and femoral components were revised, the mean blood loss for these revisions was 52% less and the mean surgical time was 35% shorter. Revision of only the acetabular component is recommended for isolated acetabular aseptic loosening. Because the femoral component is not removed, surgical time and blood loss are decreased and serious potential complications related to removing a well-fixed femoral component can be avoided.