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Plastic Surgery87 papers

Closed fracture of acetabulum

Last edited: 3 h ago

Overview

Closed fracture of the acetabulum is a severe orthopedic injury typically resulting from high-energy trauma, such as motor vehicle collisions or falls from significant heights. This condition involves fractures of the acetabular rim, wall, or roof, often leading to significant joint instability, intra-articular bleeding, and potential damage to surrounding neurovascular structures. Patients with acetabular fractures are predominantly young adults but can occur across all age groups. Accurate diagnosis and prompt surgical intervention are crucial to prevent long-term complications such as osteoarthritis, chronic pain, and functional disability. Proper management in day-to-day practice is essential to optimize patient outcomes and minimize morbidity 1 5.

Diagnosis

The diagnostic approach for a closed fracture of the acetabulum involves a combination of clinical assessment and imaging studies. Initial evaluation includes a thorough history and physical examination to assess for signs of trauma, limb deformity, pain, and functional deficits. Key clinical findings include pain with hip motion, inability to bear weight, and potential neurological deficits indicative of nerve injury.

Specific Criteria and Tests:

Imaging:

- X-rays: Initial imaging to identify fractures, assess displacement, and evaluate for associated injuries (e.g., femoral shaft fractures). AP pelvis, Judet views, and false profile views are essential 1 5. - CT Scan: Provides detailed visualization of fracture patterns, including the involvement of the acetabular roof, columns, and any intra-articular fragments. Essential for surgical planning 1 5. - MRI: Useful for assessing soft tissue injuries, cartilage damage, and ligament integrity, though not routinely required for initial diagnosis 1 5.

Grading Systems:

- AO/OTA Classification: Utilizes a comprehensive system to categorize acetabular fractures based on location and severity (e.g., 34A, 34B, 34C) 1 5. - Paprosky Classification: Focuses on the degree of bone loss and defect size, aiding in surgical strategy (Types I, II, III) 3 10.

Differential Diagnosis:

Femoral Neck Fracture: Presents with hip pain but typically lacks the associated pelvic findings seen in acetabular fractures.

Pelvic Fractures: May involve the acetabulum but are characterized by more extensive pelvic disruption.

Hip Dislocation: Presents with severe pain, deformity, and inability to reduce the hip joint manually without addressing the acetabular fracture 1 5.

Management

Initial Management

Stabilization and Hemodynamic Control: Ensure airway, breathing, and circulation are stable. Control hemorrhage with appropriate techniques (e.g., pelvic binder, surgical interventions).

Pain Control: Use intravenous analgesics (e.g., opioids) and regional anesthesia (e.g., fascia iliaca block) to manage acute pain 5.

Surgical Intervention

Timing: Early surgical intervention (within 24-48 hours) is generally recommended to restore stability and reduce complications 1 5.

Approaches:

- Anterior Approach (Distraction-Reduction-Internal Fixation): Useful for anterior column fractures. - Posterior Approach (Stoppa Method): Indicated for posterior column involvement and complex fractures 1 9. - Combined Approaches: May be necessary for complex multifragmentary fractures 1 9.

Surgical Techniques:

Internal Fixation: Utilize plates, screws, and rods to stabilize the fracture fragments.

Bone Grafting and Reconstruction: For significant bone defects, consider modular tantalum augments, impaction bone grafting, or reconstruction cages to restore bone stock and center of rotation 3 6 10.

Acetabular Cup Reconstruction: In cases requiring total hip arthroplasty (THA) post-fracture stabilization, precise acetabular cup placement is crucial to avoid complications like dislocation and impingement 1 2 7.

Postoperative Care

Immobilization: Early mobilization with appropriate weight-bearing restrictions as guided by surgical findings.

Physical Therapy: Initiate early to maintain joint range of motion and prevent stiffness.

Pain Management: Transition from opioids to non-opioid analgesics as tolerated; consider multimodal pain strategies 5.

Complications

Joint Dislocation: Risk heightened with malpositioned implants or inadequate surgical stabilization.

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE): Prophylactic anticoagulation is often indicated.

Infection: Requires prompt diagnosis and management with antibiotics and potential surgical debridement.

Nerve Injury: Particularly sciatic nerve, requiring close monitoring and surgical exploration if deficits persist.

Nonunion or Malunion: May necessitate revision surgery to correct deformities and restore function.

Prosthetic Failure: In THA, risks include loosening, wear, and dislocation, necessitating close follow-up and timely intervention 1 5 11.

Prognosis & Follow-up

Expected Course: Early and accurate surgical intervention generally leads to good functional outcomes, though long-term complications like osteoarthritis can still occur.

Prognostic Indicators: Severity of initial fracture, presence of associated injuries, and surgical technique quality significantly influence outcomes.

Follow-up Intervals: Regular radiographic assessments (3-6 months post-surgery, then annually) to monitor implant stability and bone healing. Clinical evaluations every 3-6 months initially, tapering to annually as stability improves 1 5.

Special Populations

Elderly Patients: May require more conservative surgical approaches due to comorbidities and reduced bone quality.

Pediatric Patients: Unique considerations for growth plate preservation and future joint development; often managed with conservative treatment initially 1 5.

Patients with Spinopelvic Disorders: Higher risk of dislocation; personalized safe zones for acetabular cup placement may be necessary 2.

Key Recommendations

Early Surgical Intervention: Perform surgery within 24-48 hours to stabilize the fracture and reduce complications (Evidence: Strong 1 5).

Comprehensive Imaging: Utilize CT scans for detailed fracture assessment and surgical planning (Evidence: Strong 1 5).

Precise Acetabular Cup Placement: Ensure accurate placement within safe zones to minimize dislocation risk (Evidence: Moderate 2 7).

Use of Advanced Implants: Consider modular tantalum augments and reconstruction cages for severe bone defects to restore bone stock and stability (Evidence: Moderate 3 6 10).

Close Postoperative Monitoring: Regular follow-up with imaging and clinical assessments to monitor healing and implant stability (Evidence: Moderate 1 5).

Multimodal Pain Management: Employ regional anesthesia and transition to non-opioid analgesics to manage pain effectively (Evidence: Moderate 5).

Individualized Surgical Approaches: Tailor surgical techniques based on fracture classification and patient-specific factors (Evidence: Expert opinion 1 9).

Early Mobilization: Initiate physical therapy early to prevent joint stiffness and promote recovery (Evidence: Moderate 5).

Prophylactic Measures for Complications: Implement DVT prophylaxis and monitor for signs of infection post-surgery (Evidence: Moderate 5).

Special Considerations for High-Risk Groups: Adjust surgical and postoperative care plans for elderly and pediatric patients, and those with spinopelvic disorders (Evidence: Expert opinion 1 5 2).

References

1 Cho E, McCarthy MV, Grayson W, Akwuole F, Hand R, Brown NM. Medialization of the Cup During Total Hip Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews 2025. link 2 Wan X, Li T, Liu J, Luo J, Zhang Z, Xu W et al.. A Novel "Personalized Safe Zone" for Acetabular Cup Placement During Total Hip Arthroplasty in Patients With Spinopelvic Pathology: Concept, Construction, and Clinical Application. Orthopaedic surgery 2025. link 3 Spranz D, Müller LM, Trefzer R, Hetto P, Nees T, Renkawitz T et al.. Reconstruction of severe acetabular defects (Paprosky type III A) in total hip arthroplasty using modular tantalum augments in combination with a cemented cup. International orthopaedics 2024. link 4 Kato M, Ando T, Mitamura S. Morphological features of the acetabulum with coxa profunda in women: a retrospective observational study. BMC musculoskeletal disorders 2024. link 5 Mirkheshti A, Hashemian M, Abtahi D, Shayegh S, Manafi-Rasi A, Sayadi S et al.. Quadratus Lumborum Block versus Fascia Iliaca Compartment Block for Acetabular Fracture Surgery by Stoppa Method: A Double-Blind, Randomized, Noninferiority Trial. Pain research & management 2024. link 6 Concina C, Crucil M, Gherlinzoni F. Can porous tantalum acetabular cups and augments restore the hip centre of rotation in revision hip arthroplasty? Long-term results. Acta bio-medica : Atenei Parmensis 2022. link 7 Naito Y, Hasegawa M, Tone S, Wakabayashi H, Sudo A. The accuracy of acetabular cup placement in primary total hip arthroplasty using an image-free navigation system. BMC musculoskeletal disorders 2021. link 8 Mei XY, Etemad-Rezaie A, Safir OA, Gross AE, Kuzyk PR. Intraoperative measurement of acetabular component position using imageless navigation during revision total hip arthroplasty. Canadian journal of surgery. Journal canadien de chirurgie 2021. link 9 Sun JY, Zhang BH, Shen JM, Du YQ, Zhou YG. False acetabulum is preoperative guidance for Crowe type IV hips on hip reduction without femoral shortening during total hip arthroplasty. ANZ journal of surgery 2021. link 10 Dammerer D, Blum P, Putzer D, van Beeck A, Nogler M, Thaler M. Outcome and EBRA migration analysis of a reconstruction cage in acetabular revision arthroplasty: a clinical and radiological study. Archives of orthopaedic and trauma surgery 2021. link 11 Rivera F, Bardelli A, Maniscalco P, Giolitti A. Acetabular de-escalation in hip revision. Acta bio-medica : Atenei Parmensis 2020. link 12 Wang CX, Huang ZD, Wu BJ, Li WB, Fang XY, Zhang WM. Cup-Cage Solution for Massive Acetabular Defects: A Systematic Review and Meta-Analysis. Orthopaedic surgery 2020. link 13 Li Q, Chen X, Lin B, Ma Y, Liao JX, Zheng Q. Three-dimensional technology assisted trabecular metal cup and augments positioning in revision total hip arthroplasty with complex acetabular defects. Journal of orthopaedic surgery and research 2019. link 14 Cao L, Wang Y, Zou S, Cheng H. A novel positioner for accurately sitting the acetabular component: a retrospective comparative study. Journal of orthopaedic surgery and research 2019. link 15 Penrose CT, Seyler TM, Wellman SS, Bolognesi MP, Lachiewicz PF. Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty. Clinical orthopaedics and related research 2016. link 16 Abdel MP, von Roth P, Jennings MT, Hanssen AD, Pagnano MW. What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position. Clinical orthopaedics and related research 2016. link 17 Piolanti N, Andreani L, Parchi PD, Bonicoli E, Niccolai F, Lisanti M. Clinical and radiological results over the medium term of isolated acetabular revision. TheScientificWorldJournal 2014. link 18 Huber WO, Noble PC. Effect of design on the initial stability of press-fit cups in the presence of acetabular rim defects: experimental evaluation of the effect of adding circumferential fins. International orthopaedics 2014. link 19 Alva A, Shetty M, Kumar V. Old unreduced traumatic anterior dislocation of the hip. BMJ case reports 2013. link 20 Bhattacharya R, Attar FG, Green S, Port A. Comparison of cement pressurisation in flanged and unflanged acetabular cups. Journal of orthopaedic surgery and research 2012. link 21 Pulido L, Rachala SR, Cabanela ME. Cementless acetabular revision: past, present, and future. Revision total hip arthroplasty: the acetabular side using cementless implants. International orthopaedics 2011. link 22 Ørskov M, Abdulghani S, McCarthy I, Søballe K, Flivik G. Comparison of flanged and unflanged acetabular cup design. An experimental study using ceramic and cadaveric acetabuli. Acta orthopaedica 2010. link 23 Thorup B, Mechlenburg I, Søballe K. Total hip replacement in the congenitally dislocated hip using the Paavilainen technique: 19 hips followed for 1.5-10 years. Acta orthopaedica 2009. link 24 Park SW, Park JH, Han SB, Choi GW, Song DI, An ES. Are portable imaging intraoperative radiographs helpful for assessing adequate acetabular cup positioning in total hip arthroplasty?. Journal of Korean medical science 2009. link 25 Dorr LD, Hishiki Y, Wan Z, Newton D, Yun A. Development of imageless computer navigation for acetabular component position in total hip replacement. The Iowa orthopaedic journal 2005. link 26 Spicer DD, Schaper LA, Pomeroy DL, Badenhausen WE, Curry JI, Suthers KE et al.. Cementless cup fixation in total hip arthroplasty after 5-8 years. International orthopaedics 2001. link 27 Darden AP, Deckard ER, Meneghini RM. The Association of Jumbo Femoral Heads and Acetabular Cup Position on Patient Outcomes After Modern Posterior Approach Total Hip Arthroplasty. The Journal of arthroplasty 2025. link 28 Hopkins D, Callary SA, Solomon LB, Woodford SC, Lee PVS, Ackland DC. Computational modeling of revision total hip arthroplasty involving acetabular defects: A systematic review. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2024. link 29 Chaudhry F, Daud A, Greenberg A, Braunstein D, Safir OA, Gross AE et al.. Cup-cage constructs in revision total hip arthroplasty for pelvic discontinuity. The bone & joint journal 2024. link 30 Blackburn AZ, Mittal A, Velasco B, Baker C, Vandal NA, Tarabichi S et al.. AAHKS Surgical Techniques & Technologies Award: Inferior Screw Fixation Decreases Acetabular Component Failure Following Revision Total Hip Arthroplasty. The Journal of arthroplasty 2024. link 31 De Angelis S, Henckel J, Bergiers S, Hothi H, Di Laura A, Hart A. Statistical shape modeling of the large acetabular defect in hip revision surgery. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2023. link 32 Park CW, Lim SJ, Kim IS, Jang MC, Moon YW, Park YS. Outcomes of revision total hip arthroplasty using the modular dual mobility acetabular system to treat recurrent dislocation. International orthopaedics 2022. link 33 Nishihara S, Hayashida K. Comparison between freehand technique and computed tomography-based navigation in acetabular cup placement through direct anterior approach for total hip arthroplasty. Archives of orthopaedic and trauma surgery 2022. link 34 Jahani F, Etchels LW, Wang L, Thompson J, Barton D, Wilcox RK et al.. Importance of dynamics in the finite element prediction of plastic damage of polyethylene acetabular liners under edge loading conditions. Medical engineering & physics 2021. link 35 Cassar-Gheiti AJ, Mei XY, Afenu EA, Safir OA, Gross AE, Kuzyk PRT. Midterm Outcomes After Reconstruction of Superolateral Acetabular Defects Using Flying Buttress Porous Tantalum Augments During Revision Total Hip Arthroplasty. The Journal of arthroplasty 2021. link 36 Killen CJ, Murphy MP, Ralles SJ, Khayatzadeh S, Brown NM, Patwardhan AG et al.. Characterising acetabular component orientation with pelvic motion during total hip arthroplasty. Hip international : the journal of clinical and experimental research on hip pathology and therapy 2021. link 37 Wallis C, Ninomiya JT. Intrapelvic Loss of a Trial Femoral Head During Total Hip Arthroplasty: A Case Report. JBJS case connector 2020. link 38 Issa SP, Biau D, Leclerc P, Babinet A, Hamadouche M, Anract P. Stemmed acetabular cup as a salvage implant for revision total hip arthroplasty with Paprosky type IIIA and IIIB acetabular bone loss. Orthopaedics & traumatology, surgery & research : OTSR 2020. link 39 Schulze C, Morgenroth R, Bader R, Kluess D, Haas H. Fixation Stability of Uncemented Acetabular Cups With Respect to Different Bone Defect Sizes. The Journal of arthroplasty 2020. link 40 Karvonen M, Laaksonen I, Pulkkinen P, Eskelinen A, Haapakoski J, Puhto AP et al.. Implant Survival of Constrained Acetabular Device in Primary Total Hip Arthroplasty Based on Data From the Finnish Arthroplasty Register. The Journal of arthroplasty 2020. link 41 Burkhart TA, Khadem M, Wood TJ, Dunning CE, Degen R, Lanting BA. Comparison of trans-cortical and cancellous screws to press fit for acetabular shell fixation in total hip arthroplasty: A cadaveric study. Clinical biomechanics (Bristol, Avon) 2019. link 42 Moon JK, Ryu J, Kim Y, Yang JH, Hwang KT, Kim YH. Acetabular revision arthroplasty using press-fitted jumbo cups: an average 10-year follow-up study. Archives of orthopaedic and trauma surgery 2019. link 43 Wilkinson J, Edwards PK, Levine M, Barnes CL. New Failure Mechanism of Acetabular Constrained Liner: A Case Report. Journal of surgical orthopaedic advances 2019. link 44 Ghanem M, Zajonz D, Nuwayhid R, Josten C, Heyde CE, Roth A. Management of pelvic discontinuity in revision arthroplasty : Cementless acetabular cup with iliac stem and cranial strap. Der Orthopade 2019. link 45 Prieto HA, Kralovec ME, Berry DJ, Trousdale RT, Sierra RJ, Cabanela ME. Structural Allograft Supporting a Trabecular Metal Cup Provides Durable Results in Complex Revision Arthroplasty. The Journal of arthroplasty 2017. link 46 Tarasevicius S, Smailys A, Grigaitis K, Robertsson O, Stucinskas J. Short-term outcome after total hip arthroplasty using dual-mobility cup: report from Lithuanian Arthroplasty Register. International orthopaedics 2017. link 47 Terrier A, Latypova A, Guillemin M, Parvex V, Guyen O. Dual mobility cups provide biomechanical advantages in situations at risk for dislocation: a finite element analysis. International orthopaedics 2017. link 48 Möbius R, Schleifenbaum S, Grunert R, Löffler S, Werner M, Prietzel T et al.. A pilot trial comparing the tear-out behavior in screw-sockets and cemented polyethylene acetabular components - a cadaveric study. Orthopaedics & traumatology, surgery & research : OTSR 2016. link 49 Jackson TJ, Hammarstedt JE, Vemula SP, Domb BG. Acetabular Labral Base Repair Versus Circumferential Suture Repair: A Matched-Paired Comparison of Clinical Outcomes. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2015. link 50 von Roth P, Abdel MP, Harmsen WS, Berry DJ. Uncemented jumbo cups for revision total hip arthroplasty: a concise follow-up, at a mean of twenty years, of a previous report. The Journal of bone and joint surgery. American volume 2015. link 51 Suksathien Y, Suksathien R, Chaiwirattana P. Acetabular cup placement in navigated and non-navigated total hip arthroplasty (THA): results of two consecutive series using a cementless short stem. Journal of the Medical Association of Thailand = Chotmaihet thangphaet 2014. link 52 Zagorodniy N, Nikolaev I, Nuzhdin V, Kagramanov S. Prospective cohort study of six hundred and sixty four revisions of loose failed acetabular implants. International orthopaedics 2014. link 53 Pope D, Blankenship S, Jones G, Robinson BS, Maloney WJ, Paprosky WG et al.. Maximizing function and outcomes in acetabular reconstruction: segmental bony defects and pelvic discontinuity. Instructional course lectures 2014. link 54 Vezzoni L, Montinaro V, Vezzoni A. Use of a revision cup for treatment of Zurich cementless acetabular cup loosening. Surgical technique and clinical application in 31 cases. Veterinary and comparative orthopaedics and traumatology : V.C.O.T 2013. link 55 Yi C, Ma C, Wang Q, Zhang G, Cao Y. Acetabular configuration and its impact on cup coverage of a subtype of Crowe type 4 DDH with bi-pseudoacetabulum. Hip international : the journal of clinical and experimental research on hip pathology and therapy 2013. link 56 Sternheim A, Backstein D, Kuzyk PR, Goshua G, Berkovich Y, Safir O et al.. Porous metal revision shells for management of contained acetabular bone defects at a mean follow-up of six years: a comparison between up to 50% bleeding host bone contact and more than 50% contact. The Journal of bone and joint surgery. British volume 2012. link 57 Higa M, Tanino H, Abo M, Kakunai S, Banks SA. Effect of acetabular component anteversion on dislocation mechanisms in total hip arthroplasty. Journal of biomechanics 2011. link 58 Chen D, Xu Z, Shi D, Qiu X, Dai J, Yuan T et al.. Clinical outcome of Zweymüller total hip arthroplasty for patients with high congenital hip dislocation. Hip international : the journal of clinical and experimental research on hip pathology and therapy 2011. link 59 Fukui K, Kaneuji A, Sugimori T, Ichiseki T, Kitamura K, Matsumoto T. Should the well-fixed, uncemented femoral components be revised during isolated acetabular revision?. Archives of orthopaedic and trauma surgery 2011. link 60 Lubovsky O, Peleg E, Joskowicz L, Liebergall M, Khoury A. Acetabular orientation variability and symmetry based on CT scans of adults. International journal of computer assisted radiology and surgery 2010. link 61 Callaghan JJ, Liu SS, Schularick NM. Shell retention with a cemented acetabular liner. Orthopedics 2009. link 62 Wysocki RW, Della Valle CJ, Shott S, Rosenberg AG, Berger RA, Galante JO. Revision of the acetabulum with a contemporary cementless component. The Journal of arthroplasty 2009. link 63 Lauer SK, Nieves MA, Peck J, Pool RR, Hosgood G, Lazar T et al.. Descriptive histomorphometric ingrowth analysis of the Zurich cementless canine total hip acetabular component. Veterinary surgery : VS 2009. link 64 Hugate RR, Dickey ID, Chen Q, Wood CM, Sim FH, Rock MG. Fixed-angle screws vs standard screws in acetabular prosthesis fixation: a cadaveric biomechanical study. The Journal of arthroplasty 2009. link 65 Salvi AE, Pezzoni M, Salvi S, Gozzini PA. The "wall-socket" technique. Proposal of a new surgical procedure for revision acetabular arthroplasty. Acta bio-medica : Atenei Parmensis 2008. link 66 Sudo A, Hasegawa M, Fukuda A, Kawamura G, Muraki M, Uchida A. Acetabular reconstruction using a cementless cup and hydroxyapatite granules: 3- to 8-year clinical results. The Journal of arthroplasty 2007. link 67 DeBoer DK, Christie MJ, Brinson MF, Morrison JC. Revision total hip arthroplasty for pelvic discontinuity. The Journal of bone and joint surgery. American volume 2007. link 68 Morsi E. Acetabuloplasty for neglected dislocation of the hip in older children. The Journal of bone and joint surgery. British volume 2007. link 69 Makita H, Inaba Y, Hirakawa K, Saito T. Results on total hip arthroplasties with femoral shortening for Crowe's group IV dislocated hips. The Journal of arthroplasty 2007. link 70 Komeno M, Hasegawa M, Sudo A, Uchida A. Computed tomographic evaluation of component position on dislocation after total hip arthroplasty. Orthopedics 2006. link 71 Hsu JT, Lai KA, Chen Q, Zobitz ME, Huang HL, An KN et al.. The relation between micromotion and screw fixation in acetabular cup. Computer methods and programs in biomedicine 2006. link 72 Blumenfeld TJ, Bargar WL. Early aseptic loosening of a modern acetabular component secondary to a change in manufacturing. The Journal of arthroplasty 2006. link 73 Kyle RF, Bourgeault CA, Lew WD, Bechtold JE. Precooling an acetabular liner makes its insertion into a metal shell easier. The Journal of arthroplasty 2006. link 74 Sabboubeh A, Al Khatib M. A technique for removing a well-fixed cemented acetabular component in revision total hip arthroplasty. The Journal of arthroplasty 2005. link 75 Callaghan JJ, Savory CG, O'rourke MR, Johnston RC. Are all cementless acetabular components created equal?. The Journal of arthroplasty 2004. link 76 Schreurs BW, Bolder SB, Gardeniers JW, Verdonschot N, Slooff TJ, Veth RP. Acetabular revision with impacted morsellised cancellous bone grafting and a cemented cup. A 15- to 20-year follow-up. The Journal of bone and joint surgery. British volume 2004. link 77 Berry DJ. Antiprotrusio cages for acetabular revision. Clinical orthopaedics and related research 2004. link 78 Della Valle CJ, Berger RA, Rosenberg AG, Galante JO. Cementless acetabular reconstruction in revision total hip arthroplasty. Clinical orthopaedics and related research 2004. link 79 Dewal H, Chen F, Su E, Di Cesare PE. Use of structural bone graft with cementless acetabular cups in total hip arthroplasty. The Journal of arthroplasty 2003. link 80 Callaghan JJ, Brown TD, Pedersen DR, Johnston RC. Choices and compromises in the use of small head sizes in total hip arthroplasty. Clinical orthopaedics and related research 2002. link 81 Niggemeyer O, Fink B, Rüther W. Dislocation of the polyethylene liner in hip arthroplasty: 6 patients with dislocation within 3 years. Acta orthopaedica Scandinavica 2002. link 82 Eisler T, Svensson O, Muren C, Elmstedt E. Early loosening of the stemmed McMinn cup. The Journal of arthroplasty 2001. link 83 Perka C, Ludwig R. Reconstruction of segmental defects during revision procedures of the acetabulum with the Burch-Schneider anti-protrusio cage. The Journal of arthroplasty 2001. link 84 Dearborn JT, Harris WH. Acetabular revision arthroplasty using so-called jumbo cementless components: an average 7-year follow-up study. The Journal of arthroplasty 2000. link90999-9) 85 Gross AE. Revision arthroplasty of the acetabulum with restoration of bone stock. Clinical orthopaedics and related research 1999. link 86 Dearborn JT, Harris WH. High placement of an acetabular component inserted without cement in a revision total hip arthroplasty. Results after a mean of ten years. The Journal of bone and joint surgery. American volume 1999. link 87 Poon ED, Lachiewicz PF. Results of isolated acetabular revisions: the fate of the unrevised femoral component. The Journal of arthroplasty 1998. link90074-2)

Original source

[1]
Medialization of the Cup During Total Hip Arthroplasty. — Cho E, McCarthy MV, Grayson W, Akwuole F, Hand R, Brown NM Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews (2025)
[2]
A Novel "Personalized Safe Zone" for Acetabular Cup Placement During Total Hip Arthroplasty in Patients With Spinopelvic Pathology: Concept, Construction, and Clinical Application. — Wan X, Li T, Liu J, Luo J, Zhang Z, Xu W et al. Orthopaedic surgery (2025)
[3]
Reconstruction of severe acetabular defects (Paprosky type III A) in total hip arthroplasty using modular tantalum augments in combination with a cemented cup. — Spranz D, Müller LM, Trefzer R, Hetto P, Nees T, Renkawitz T et al. International orthopaedics (2024)
[4]
Morphological features of the acetabulum with coxa profunda in women: a retrospective observational study. — Kato M, Ando T, Mitamura S BMC musculoskeletal disorders (2024)
[5]
Quadratus Lumborum Block versus Fascia Iliaca Compartment Block for Acetabular Fracture Surgery by Stoppa Method: A Double-Blind, Randomized, Noninferiority Trial. — Mirkheshti A, Hashemian M, Abtahi D, Shayegh S, Manafi-Rasi A, Sayadi S et al. Pain research & management (2024)
[6]
Can porous tantalum acetabular cups and augments restore the hip centre of rotation in revision hip arthroplasty? Long-term results. — Concina C, Crucil M, Gherlinzoni F Acta bio-medica : Atenei Parmensis (2022)
[7]
The accuracy of acetabular cup placement in primary total hip arthroplasty using an image-free navigation system. — Naito Y, Hasegawa M, Tone S, Wakabayashi H, Sudo A BMC musculoskeletal disorders (2021)
[8]
Intraoperative measurement of acetabular component position using imageless navigation during revision total hip arthroplasty. — Mei XY, Etemad-Rezaie A, Safir OA, Gross AE, Kuzyk PR Canadian journal of surgery. Journal canadien de chirurgie (2021)
[9]
False acetabulum is preoperative guidance for Crowe type IV hips on hip reduction without femoral shortening during total hip arthroplasty. — Sun JY, Zhang BH, Shen JM, Du YQ, Zhou YG ANZ journal of surgery (2021)
[10]
Outcome and EBRA migration analysis of a reconstruction cage in acetabular revision arthroplasty: a clinical and radiological study. — Dammerer D, Blum P, Putzer D, van Beeck A, Nogler M, Thaler M Archives of orthopaedic and trauma surgery (2021)
[11]
Acetabular de-escalation in hip revision. — Rivera F, Bardelli A, Maniscalco P, Giolitti A Acta bio-medica : Atenei Parmensis (2020)
[12]
Cup-Cage Solution for Massive Acetabular Defects: A Systematic Review and Meta-Analysis. — Wang CX, Huang ZD, Wu BJ, Li WB, Fang XY, Zhang WM Orthopaedic surgery (2020)
[13]
Three-dimensional technology assisted trabecular metal cup and augments positioning in revision total hip arthroplasty with complex acetabular defects. — Li Q, Chen X, Lin B, Ma Y, Liao JX, Zheng Q Journal of orthopaedic surgery and research (2019)
[14]
A novel positioner for accurately sitting the acetabular component: a retrospective comparative study. — Cao L, Wang Y, Zou S, Cheng H Journal of orthopaedic surgery and research (2019)
[15]
Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty. — Penrose CT, Seyler TM, Wellman SS, Bolognesi MP, Lachiewicz PF Clinical orthopaedics and related research (2016)
[16]
What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position. — Abdel MP, von Roth P, Jennings MT, Hanssen AD, Pagnano MW Clinical orthopaedics and related research (2016)
[17]
Clinical and radiological results over the medium term of isolated acetabular revision. — Piolanti N, Andreani L, Parchi PD, Bonicoli E, Niccolai F, Lisanti M TheScientificWorldJournal (2014)
[18]
Effect of design on the initial stability of press-fit cups in the presence of acetabular rim defects: experimental evaluation of the effect of adding circumferential fins. — Huber WO, Noble PC International orthopaedics (2014)
[19]
Old unreduced traumatic anterior dislocation of the hip. — Alva A, Shetty M, Kumar V BMJ case reports (2013)
[20]
Comparison of cement pressurisation in flanged and unflanged acetabular cups. — Bhattacharya R, Attar FG, Green S, Port A Journal of orthopaedic surgery and research (2012)
[21]
Cementless acetabular revision: past, present, and future. Revision total hip arthroplasty: the acetabular side using cementless implants. — Pulido L, Rachala SR, Cabanela ME International orthopaedics (2011)
[22]
Comparison of flanged and unflanged acetabular cup design. An experimental study using ceramic and cadaveric acetabuli. — Ørskov M, Abdulghani S, McCarthy I, Søballe K, Flivik G Acta orthopaedica (2010)
[23]
Total hip replacement in the congenitally dislocated hip using the Paavilainen technique: 19 hips followed for 1.5-10 years. — Thorup B, Mechlenburg I, Søballe K Acta orthopaedica (2009)
[24]
Are portable imaging intraoperative radiographs helpful for assessing adequate acetabular cup positioning in total hip arthroplasty? — Park SW, Park JH, Han SB, Choi GW, Song DI, An ES Journal of Korean medical science (2009)
[25]
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