الفهرس 
Anatomy of the AcetabulumOnly 14 pages are availabe for public view
 |  | from | 262 |  |  |
| | | from | 262 | | |
Abstract
Increasing number of total hip arthroplasty surgeries inevitably has led to increased number of revision total hip surgeries.
The acetabular bone defects are usually present due to the production of wear particles into the surrounding tissue, which may cause tissue reactions and further osteolysis of the periprosthetic bone, aseptic loosening of the com¬ponent and, if not treated within the optimal time, may ultimately lead to major bone defects. High-energy periacetabular fractures, the treatment of bone tumours and periprosthetic infections may also lead to major pelvic bone deficiency.
The most common used classifications for acetabular defects are the AAOS and Paprosky classification.
The acetabular reconstruction must allow appropriate component orientation to minimize the risk of dislocation, reestablish the anatomic hip center to improve the overall joint kinematics and initial component stability to promote osteointegration.
Surgical options include extra-large hemispheric cups, high hip center placement, impaction grafting, structural grafts, bilobed oblong cups, and reconstruction cages.
Reconstruction of acetabular defect using bone graft is one of the most successful methods for acetabular reconstruction .reconstruction can be done either by structural graft fixed by screws or by morsalized graft with or without use of cages.
A new porous biomaterial made of tantlum has recently been developed for potential application in reconstructive orthopaedics and other surgical disciplines. The material has an unusually high and interconnecting porosity with a very regular pore shape and size. It can be made into complex shapes and used either as a bulk implant or as a surface coating.
Trabecular metal augments were found to be an attractive alternative for complex acetabular reconstructions with successful results.
In this work, In the period between July 2015 to july 2018, a prospective study was conducted involving 30 patients (30 hips) who underwent total hip arthroplasty or revision total hip arthroplasty, divided into 2 equal groups have been treated by trabecular metal augments or bone graft in acetabular reconstruction on random basis and in alternate turns. All cases were operated upon in Ain Shams University Hospitals. The follow up of the cases ranged from 6 months to 25 months with a mean of 14 months. Finally we have 2 equal groups, group
(1) treated with bone graft and group (2) treated my trabecular metal augment.
Harris hip score was used for clinical evaluation of patients, pre and postoperatively and last follow up for all patients.
A. group (1) acetabular reconstruction with bone graft (15 cases)
In our study, the presented data show that acetabular bony defects due to different etiologies can be successfully reconstructed biologically. The use of autologous femoral head and neck grafts with total hip arthroplasty (either bulk graft fixed by screws or morsalized with or without cage) can achieve promising short to midterm results in this group of patients, with 80 % of cases show excellent outcome and 20 % of cases show good outcome according to Harris hip score HHS (Mean HHS 93.67 %) in the last follow up and good bone incorporaton of the graft with host bone with radiological follow up in all cases.
B. group (2) acetabular reconstruction with trabecular augments (15 cases)
In our study, The presented data show that acetabular bony defects due to different etiologies can be successfully reconstructed by using trabecular metal TM augments with different shapes. the use of TM augments (either wedge, buttress or resrictor) can achieve promising short to midterm results in this group of patients, with 80 % of cases (12 cases) show excellent outcome, 13.3 % of cases (2 cases) show good outcome and 6.7%of cases (1 case) show poor outcome according to HHS (Mean HHS 87.87%) in the last follow up and good osteointegration of the augment with host bone with radiological follow up in 14 cases (93.3%of cases).
The results show that there is statistically non- significant difference between both groups regarding the HHS postoperative
In this study, 4 cases had complications, 1 case in group (1) (transient sciatic nerve palsy) and 3 cases in group (2) (high hip center, serosanguineous discharge underwent debridment then died 2 weeks postoperatively and hip dislocation which is reduced with good final outcome). These complications were postoperative complications.
In conclusion, it appears that using either bone graft or TM augments in reconstruction of acetabular defect (either cavitary or segmental) is one of the most successful techniques for acetabular reconstruction and for restoring hip center.
However, the following points should br considered,
• Running the same study on larger number of patients
• Longer follow up