Hip socket fractures are common injuries in the young active population. They result from four/ two wheeler accidents. The timely treatment is fracture fixation. Often this treatment fails when a hip replacement becomes necessary. This presentation outlines the role for an alternative to hip replacement for this condition

1. Abstract number 226 E Poster –AP03 Dr. A.K.Venkatachalam
Dr.A.K.Venkatachala
m
MS Orth, DNB Orth, FRCS, M.Ch Orth
Consultant Orthopedic
surgeon
Associate professor
Chennai

2. • Acetabular fractures occur in young patients
• THR requires acetabular reconstruction, bone grafting
and reconstruction
• Limb length discrepancy needs to be addressed-due to
proximal femoral migration, protrusio, proximal femoral
bone loss
• Possible to correct LLD on acetabular side with protrusio
alone by auto graft, allograft, synthetic bone substitutes,
metal
• Hence opportunity to preserve bone on femoral side
• Hence role for short stem femoral prostheses instead of
THR.
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam

3. • Case1-25 year male, longstanding mal-united acetabular fracture
with protrusio grade 3. Femoral side normal.
• Acetabular reconstruction with peripheral cup capture, bone grafting
with morsellized femoral head autograft. Cup lateralized to
anatomical center
• Short stem femoral prosthesis with ceramic on metal bearings
• Residual LLD- 1.5cm.
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam

4. • Case 2- 42 year old male, transverse fracture
acetabulum with ORIF.
• Acetabular reconstruction w/o bone grafting, short stem
femoral and uncemented cup. Ceramic on metal
bearings.
• No post op LLD.
• LLD
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam

5. • Case 3-47 year old female, transverse fracture acetabulum with
absorption of femoral head, proximal & central migration with
protrusio acetabuli
• THR –Acetabular reconstruction with peripheral cup placement, bone
grafting.
• Femoral reconstruction with THR as head was partially resorbed.
Metal on poly bearings
• No LLD post op
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam

6. • Case 4- 30 year old male, posterior wall & roof fracture, proximal
femoral head migration. Pre op LLD of three inches
• THR with posterior wall & roof acetabular reconstruction with femoral
head cortico-cancellous slice, Recon plate on acetabular side,
conventional uncemented femur. Ceramic on ceramic bearings.
• No post op LLD.
• Post op sciatic N. palsy
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam

7. • Myositis ossificans post op.
• Sciatic nerve palsy. Keep knee flexed during surgery.
• Limb length discrepancy.
• ? Retention / removal of previous metal ware.
• Hindrance during acetabular preparation from previous metal
ware. May need screw cutting rather than removal.
• Bone graft required- femoral autograft, cryo allograft,
• Synthetic bone substitutes- Hydroxy apatite, Calcium sulphate
• Metal restrictors- trabecular metal, Augments, cages. Cement
not preferred as most patients are young.
• Acetabular reconstruction with Jumbo cups, cages, augments,
restrictors, recon plate, bone graft.
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam

8. • THR has been standard procedure. Uncemented THR
preferred as most patients are young.
• When gross LLD is present, due to combination of
acetabular and femoral fractures, total hip replacement is
procedure of choice
• If LLD is mainly due to acetabular protrusio and femoral
anatomy is preserved, possible to do a short stem hip
replacement.
• Hard on hard bearings preferred as most patients are
young.
• Hard on cross linked poly in middle aged.
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam

9. • Previous metal work- can be left alone if Myositis present,
Other wise can be removed
• Pre op swabs for possible wound infection from previous metal
ware
• Acetabular defects analysed by Paproski classification.
Peripheral cup placement in protrusio. Cup should be
lateralized. Jumbo cup used. Central bone grafting
• Peripheral bone grafting in posterior wall and roof fractures.
Roof and wall reinforcement with metal & bone prior to hip
replacement.
• Possible to use TM augments, but since most patients are
young, bone graft preferred.
• Cup requires screw fixation rather than Mono block cups.
Standard or multi hole shells depending on bone loss.Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam

10. • LLD may be present from long standing proximal and
central migration of proximal femur
• Proximal femoral bone loss from AVN, Femoral head &
neck bone deficiency due to fracture.
• Neck anatomy may be altered precluding short stem
prostheses.
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam

11. • Short stem prosthesis are possible when proximal
femoral anatomy is preserved, minimal LLD( <2”)
• Advantage is femoral bone preservation in carefully
selected cases.
• Limb length < 1inch can be addressed with variable neck
lengths in non modular and modular femoral prosthesis.
• Versatility of bearing combinations like ceramics, metal,
poly.
• Femoral side conversion to primary THR in future
eliminating or reducing need for a revision femoral
implant.
• Increased cost of short stem prosthesis is a factor.
Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam