thr in acetabular fracture

 38 yr old 2 yrs  post acetabular fracture and supracondylar fracture presented with pain and stiffness.  no free movements plan was to remove proximal femoral screws and any acetabular screws  interfering with the cup

 

 templating done by Dr. kattab who is my colleague

The two independent screws were intraarticular transfixing the  head  which had to osteotomised in situ. and a primary ceramic on ceramic hip was done. introp frozen section and cultures were taken/

1 . retained implants
2.infection
3.deformed acetabulum
 3.nonunion with dissociation or  resorption
4.cavitatory or segmental defects
5.HO
6.neurological deficit
7. Impaired musculature

if you asses the results one can find the following
 symptomatic acetabular loosening is higher
 uncemented  cups do better at medium term.
neurological defecits, HO are higher. Cavitatory defect can be filled with morcelised bone grafts and impacted or reverse reamed. Majority host bone contact should be at least 70 percent if possible specially in the wt bearing zone. Avoid large grafts as  they do not revascualrise completely and might fail in the medium term. In case of dissociation cage cup combo bypassing the defect would give reasonable 10 year results. Recently distraction of the dissociation stabilized by cup reinforced by cage and a cemented cup has been proposed and published by paprosky