Tönnis triple pelvic osteotomy is an accepted technique to correct acetabular dysplasia and degenerative labral pathology. A series of 409 consecutive patients who underwent a triple pelvic osteotomy between 1987 and 1999 were followed for a mean of 7.1 years (2 to 15). Five patients (1.2%), all women, developed a double nonunion and required revision, which involved excision of the pseudarthrosis, autologous bone grafting and osteosynthesis with screws or
Femoral impaction bone grafting was first developed in 1987 using
morselised cancellous bone graft impacted into the femoral canal
in combination with a cemented, tapered, polished stem. We describe
the evolution of this technique and instrumentation since that time. Between 1987 and 2005, 705 revision total hip arthroplasties
(56 bilateral) were performed with femoral impaction grafting using
a cemented femoral stem. All surviving patients were prospectively
followed for a mean of 14.7 years (9.8 to 28.3) with no loss to
follow-up. By the time of the final review, 404 patients had died.Aims
Patients and Methods
Total hip replacement (THR) after acetabular
fracture presents unique challenges to the orthopaedic surgeon.
The majority of patients can be treated with a standard THR, resulting
in a very reasonable outcome. Technical challenges however include
infection, residual pelvic deformity, acetabular bone loss with
ununited fractures, osteonecrosis of bone fragments, retained metalwork,
heterotopic ossification, dealing with the sciatic nerve, and the
difficulties of obtaining long-term acetabular component fixation.
Indications for an acute THR include young patients with both femoral
head and acetabular involvement with severe comminution that cannot
be reconstructed, and the elderly, with severe bony comminution.
The outcomes of THR for established post-traumatic arthritis include
excellent pain relief and functional improvements. The use of modern
implants and alternative bearing surfaces should improve outcomes
further. Cite this article:
Bleeding is a major complication of revision total hip replacement. We report a case where the inflated balloon of a urinary catheter was used to temporarily control intrapelvic bleeding from the superior gluteal artery, while definitive measures for endovascular embolisation were made.
