Clinical Orthopaedics and Related Research®

, Volume 470, Issue 12, pp 3537–3541 | Cite as

Cross-sectional Anatomy of the Ilium: Implications for Acetabular Component Placement in Total Hip Arthroplasty

Clinical Research

Abstract

Background

High hip center reconstructions, used in revision and complex primary THAs, rely on pelvic bone stock at least 35 mm above the anatomic teardrop. However, the technique does not restore normal hip biomechanics and controversy exists regarding acetabular implant survival. Previous reports document a wide range of implant positioning above the teardrop. There is no anatomic guidance in the literature regarding the amount of bone stock available for initial implant stability in this area of the ilium.

Questions/purposes

We therefore determined the thickness of the human ilium and related it to acetabulum cup coverage in high hip center reconstructions.

Methods

We sectioned 16 cadaveric hips from the anterior superior iliac spine to the anatomic teardrop in 5-mm increments, then measured the thickness of the ilium for each cross section.

Results

The maximum thickness of 42 ± 9 mm occurred at the dome of the acetabulum 35 ± 3 mm above the teardrop. At a distance of 1 cm above the dome, the ilium was reduced by 24%, to 32 ± 6 mm. At 2 cm above the dome, the ilium thickness was 22 ± 4 mm, a 48% reduction from its maximum.

Conclusion

There are substantial anatomic limitations to high hip reconstructions 2 cm above the acetabular dome.

References

  1. 1.
    Christodoulou NA, Dialetis KP, Christodoulou AN. High hip center technique using a biconical threaded Zweymuller cup in osteoarthritis secondary to congenital hip disease. Clin Orthop Relat Res. 2010;468:1912–1919.PubMedCrossRefGoogle Scholar
  2. 2.
    Dearborn J, Harris W. High placement of an acetabular component inserted without cement in a revision total hip arthroplasty: results after a mean of ten years. J Bone Joint Surg Am. 1999;81:469–480.PubMedGoogle Scholar
  3. 3.
    Doehring TC, Rubash HE, Dore DE. Micomotion measurements with hip center and modular neck length alterations. Clin Orthop Relat Res. 1999;362:230–239.PubMedCrossRefGoogle Scholar
  4. 4.
    Doehring, TC, Rubash HE, Shelly FJ, Schwendeman LJ, Donaldson TK, Navalgund YA. Effect of superior and superolateral relocations of the hip center on hip joint forces: an experimental and analytical analysis. J Arthroplasty. 1996;11:693–703.PubMedCrossRefGoogle Scholar
  5. 5.
    Hauser DL, Fox JC, Sukin D, Mudge B, Coutts RD. Anatomic variation of structural properties of periacetabular bone as a function of age: a quantitative computed tomographs study. J Arthroplasty. 1997;12:804–811.PubMedCrossRefGoogle Scholar
  6. 6.
    Hendricks KJ, Harris WH. High placement of noncemented acetabular components in revision total hip arthroplasty a concise follow-up, at a minimum of fifteen years, of a previous report. J Bone Joint Surg Am. 2006;88:2231–2236.PubMedCrossRefGoogle Scholar
  7. 7.
    Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am. 1964;46:1615–1646.PubMedGoogle Scholar
  8. 8.
    Pagnano W, Hanssen AD, Lewallen DG, Shaughnessy WJ. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Joint Surg Am. 1996;78:1004–1014.PubMedGoogle Scholar
  9. 9.
    Rubenstein J, Kellam J, McGonigal D. Cross-sectional anatomy of the adult bony acetabulum. J Can Assoc Radiol. 1982;33:137–138.PubMedGoogle Scholar
  10. 10.
    Russotti GM, Harris WH. Proximal placement of the acetabular component in total hip arthroplasty. J Bone Joint Surg Am. 1991;73:587–592.PubMedGoogle Scholar
  11. 11.
    Yoder SAA, Brand RA, Pederson DR, Gorman TW. Total hip acetabular component position affects component loosening rates. Clin Orthop Relat Res. 1988;228:79–87.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  1. 1.Department of OrthopaedicsUniversity of Maryland School of MedicineBaltimoreUSA

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