To assess if Osteoset (CaSO4) improves graft incorporation after shelf procedure and whether spica immobilisation is necessary 49 patients with acetabular dysplasia treated by shelf procedure were reviewed retrospectively. Group 1 (19 children) and group 2 (12 adults) had shelf acetabuloplasty using autogenous bone graft and CaSO4. Group 3 (18 children) underwent shelf acetabuloplasty using autogenous bone graft alone. Group 2 was assessed separately to avoid age bias. Within group 3 we compared 10 patients managed in plaster for six weeks with 8 mobilized on crutches post operatively. Total shelf and graft area, total shelf length, extra-osseous shelf length and speed of graft incorporation were measured radiologically. There was no difference in shelf indices between patients treated in plaster and those mobilized on crutches. Use of CaSO4 significantly enlarged shelf volume by 3 months post-operative with less resorption, which was maintained throughout follow-up. In contrast the non-CaSO4 group showed a steady decrease in shelf volume. The extra-osseous shelf length was initially similar in groups 1 & 3. By 6 weeks the group 1 extra-osseous shelf was significantly greater than for group 3 and was maintained throughout follow-up. Graft incorporation was faster in group 1. Shelf area and extra-osseous shelf length improved significantly in group 2. However total shelf length decreased slightly by 6 months.Aim
Methods/results
The purpose of our study was to estimate the influence of previous fractures and operative procedures around the hip, the follow-up period from the arthroplasty, and effect of the age of patients at the time of surgery on the results of total hip replacement in patients with a history of fracture of the hip. Forty-six patients were analysed after a mean follow-up of 6 years after arthroplasty. There were 34 females and 12 males. Mean age at the time of operation was 65 years (range 32 to 82). The reasons for arthroplasty were displaced subcapital femoral neck fracture in 23 patients (50%), failure of internal fixation for femoral neck fracture in nine patients (20%), and posttraumatic osteoarthritis of the hip in 14 patients (30%) that included six patients with a history of fracture of the acetabulum. Results were assessed with the Merle d’Aubigne Postel scale (evaluation of gait, range of motion, pain). Radiographic findings were classified according to the Moreland Grouen scale. Quality of life after arthroplasty and subjective assessment of patients was recorded. Results were: 33 (71%) satisfactory, 14 (30%) excellent, and 19 (41%) good. Thirteen (29%) were classified as unsatisfactory: 9 (20%) fair and 4 (9%) poor. Patients with acute fracture or non-union of the femoral neck showed the best results: 11 excellent and 8 good. The poorest results were in the group of patients with osteoarthritis following acetabular fracture treated by total hip replacement: 3 were classified as fair and 3 as poor. Twelve cases of internal fixation of the femoral neck before arthroplasty had no influence on the final outcome. Although none of the patients returned to their previous occupation, subjective assessment showed 27 (59%) and 14 (30%) with excellent and good results, respectively. There was no significant relationship between age of patient and the final outcome of total hip arthroplasty. Total hip arthroplasty following hip injury provided satisfactory long-term results. Previous history of internal fixation had no influence on final outcome. The poorest results were achieved in patients with a history of acetabular fracture. Patients’ subjective assessment was satisfactory in most cases despite radiological evidence of loosening of the prosthesis in a statistically insignificant number of patients.
