Uncemented hemispherical acetabular components, impacted into an acetabulum that has been under-reamed by 1 to 2mm, can be used in virtually all primary and revision hips. Although the component may be stable with a press fit alone, if screws are necessary, it is important to avoid the anterior superior “quadrant of death” because of potential danger to the iliac vein and artery (Wasielewski et al. 1990, Keating et al. 1990). Cement is never necessary even with massive bone grafts unless contact with living bone is less than 10%.
KeywordsAcetabular Component Bone Implant Acetabular Defect Cavity Defect Structural Graft
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References and Further Reading
- Hodge WA, Carlson KL et al. (1989) Contact pressures from an instrumented hip endoprosthesis. J Bone Joint Surg (Am) 71:1378–1386Google Scholar
- Jasty M, Harris WH (1988) Results of total hip surgery with structural femoral head allografting for major acetabular defects. Orthop Trans 12:716Google Scholar
- Keating EM, Ritter MA, Faris PM (1990) Structures at risk from medially placed acetabular screws. J Bone Joint Surg (Am) 72:509–511Google Scholar
- Mulroy RD, Harris WH (1990) Failure of acetabular autogenous grafts in total hip arthroplasty. J Bone Joint Surg (Am) 72:1536–1540Google Scholar
- Russotti GM, Harris W (1988) High placement of the acetabular cup: A long-term follow-up study. Orthop Trans 12:90–91Google Scholar
- Wasielewski RC, Cooperstein LA, Kruger MP, Rubash HE (1990) Acetabular anatomy and the transacetabular fixation of screws in total hip arthroplasty. J Bone Joint Surg (Am) 72:501–508Google Scholar
- White RE, Cook J (1989) Resorption of large intra-pelvic bone grafts for medial acetabular defects in cementless revision total hip replacement. AAOS 56th Annual Meeting, p.46Google Scholar