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Physiologically Based Treatments
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
Valgus intertrochanteric osteotomy with tenotomy is also the best choice in protrusio acetabuli (Fig. 15). The resultant force R (or its counterforce R’) can be resolved into a longitudinal component L (or Z,’) and a transverse component Q (or L’) as long as both the force R and its counterforce R’ are resolved along the same directions. Force Q’ is the component that pushes the femoral head into the depth of the socket. In protrusio acetabuli, the goal of surgery is to (1) decrease the medial pressure in the depths of the acetabulum, thus decreasing the transverse component Q’ and (2) displace the line of action of force R laterally from the depths toward the roof of the socket. This is achieved through a valgus intertrochanteric osteotomy combined with tenotomy (4,16).
Digital templating in total hip arthroplasty
Published in K. Mohan Iyer, Hip Preservation Techniques, 2019
Any hip dysplasia, protrusio acetabuli, or overly lateralized acetabulum should be noted by looking at the acetabular offset and comparing it to the contralateral side. In protrusion acetabuli, i.e. where the femoral head projects medially from Kohler's line, it is often necessary to graft the medial wall and lateralize the cup, thereby restoring the acetabular rotational center. In dysplastic hips, lack of superolateral cover may require bone grafting or augmentation in order to avoid inadvertently overly medializing the cup to obtain coverage. It is also important to note any osteophytes or cysts that may require curettage or defects that may require augmentation. In some cases, such as with severe bone loss of ipsilateral dysplasia, it can be useful to template the contralateral hip.
Bones and joints
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Brian J Pollard, Gareth Kitchen
The long bones are slender, with long limbs. Arm span usually exceeds the patient’s total height. There is joint laxity and arachnodactyly with abnormal lengthening of the digits. The ‘thumb sign’ is positive when the nail of the thumb in a clenched fist extends beyond the ulnar border of the small finger. Another sign of arachnodactyly is the ‘wrist sign’, in which the patient encircles the wrist with their contralateral hand and the thumb overlaps the small finger. Protrusio acetabuli is another feature.
Femoroacetabular impingement: the past, current controversies and future perspectives
Published in The Physician and Sportsmedicine, 2018
Surgical treatment of FAI has been divided into open surgical dislocation, arthroscopy and arthroscopy-assisted surgery combined with mini-open techniques. Open approaches remain an effective tool for correction of intra- and extra-articular deformity. Almost the same functional outcome scores in patients undergoing open dislocation and those with arthroscopic treatment were reported; however, in health-related quality of life scores, the arthroscopy group tends to show greater improvements postoperatively [16]. It should also be kept in mind that the minimally invasive arthroscopic approach may not safely address conditions such as cam-type deformities with considerable posterolateral extension, deficient acetabular coverage, protrusio acetabuli, or coxa profunda [17]. The labrum plays an important role with regard to hip stability through the suction-seal effect, as well as protecting cartilage by distributing the mechanical load. Labrum repair was reported to be associated with significant improvement in the modified Harris Hip Score in comparison with labral debridement [18]. There have been several labral repair techniques described, but thus far no definitive evidence exists to support any particular method of repair, and no significant improvement in one technique over another has been reported using an objective outcome measure [19]. Labral reconstruction is also an option, especially in young patients whose labrum is deficient due to prior debridement or other reasons. However, there has been no strong comparative evidence except large case series and cohort studies addressing labral reconstruction thus far [20].