Abstract
The use of rim mesh to augment acetabular defects at the time of revision hip surgery is a valuable technique. Where acetabular containment is compromised by segmental rim defects, it can be achieved by using a flexible wire mesh fixed to the wall of the ilium by multiple screws. Morsilised bone graft is then impacted onto the acetabular bed and wire mesh thus creating a new hemi-spherical acetabular bed for cementation of a new socket.
Standard AP and lateral radiographs are acceptable methods for assessing conventional socket revisions. However if a rim mesh has been used the mesh itself will obscure the socket and both columns of the acetabulum making interpretation difficult. We have modified the Judet views classically used in acetabular fracture surgery to allow better imaging of the socket. The views taken are dependant upon rim mesh position at surgery. Technique: Positioning for posterior acetabular rim mesh
From the supine position the patient is rotated 45° so that the side under examination is raised. Radiolucent pads are used to support the pelvis and leg. The hips and knees should not be flexed.
Positioning for anterior acetabular rim mesh
From the supine position the patient is rotated 45° so the non affected side is raised. Using radiolucent pads the pelvis is supported. The femur should not be flexed and externally rotated as they would be for an oblique hip
The film is centred approximately 2cm below the ASIS of the hip being examined.
These views of the hip allow complete imaging of the socket and the reconstructive construct. Radiographic evaluation of the bone graft and bone cement-graft interface can be reliably made.
We would recommend these views for the radiographic follow up of socket revisions involving the rim mesh technique.
Theses abstracts were prepared by Mr Peter Kay. Correspondence should be address to him at The Hip Centre, Wrightington Hospital, Appley Bridge, Wigan, Lancashire WN6 9EP.
