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Importance of preoperative imaging in acetabular revision surgery - a case report.

Schmitz H, Egidy C, Al-Khateeb H, Cárdenas G, Gehrke T, Kendoff D - Open Orthop J (2012)

Bottom Line: Potential complications include injury of nerves, blood vessels and other intrapelvic structures.In our case, a major bony defect of the acetabulum was a result of the protrusion of an implanted reinforcement ring.A preoperative, contrast-enhanced CT scan showed that the urethra was in close proximity to the hook of the reinforcement ring.The preoperative imaging aided in identifying and understanding the potential complications that could occur intraoperatively.Additionally, it delineated the intact anatomic structures prior to surgery, which could have medico-legal implications.The importance of preoperative imaging and the existing literature is discussed within this case description.

View Article: PubMed Central - PubMed

Affiliation: ENDO-Klinik Hamburg, Helios Group, Holstenstraße 9, 22767 Hamburg, Germany.

ABSTRACT
Acetabular defects, particularly as a result of protrusion of acetabular components into the hemipelvis, may cause serious complications during revision procedures as a result of iatrogenic injury to surrounding anatomical structures. In these challenging cases, we advocate the utilisation of preoperative three dimensional imaging. MRI and CT- imaging offer superior understanding of the three-dimensional quality of bony defects and the relationship of implants to important anatomical structures. Appropriate preoperative planning may also prevent major complications during the removal of the pre-existing hardware, prior to re-implantation of implants. Potential complications include injury of nerves, blood vessels and other intrapelvic structures.In our case, a major bony defect of the acetabulum was a result of the protrusion of an implanted reinforcement ring. A preoperative, contrast-enhanced CT scan showed that the urethra was in close proximity to the hook of the reinforcement ring.The preoperative imaging aided in identifying and understanding the potential complications that could occur intraoperatively. Additionally, it delineated the intact anatomic structures prior to surgery, which could have medico-legal implications.The importance of preoperative imaging and the existing literature is discussed within this case description.

No MeSH data available.


Related in: MedlinePlus

Pelvis AP final result with a complete reinforcement ringand combined allograft impaction grafting to stabilise the all-polyethylenecup.
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Figure 6: Pelvis AP final result with a complete reinforcement ringand combined allograft impaction grafting to stabilise the all-polyethylenecup.

Mentions: Through a posterior approach, the complete reinforcement ring was safely retrieved, with particular attention paid to identifying the hook and careful dissection of the surrounding soft tissues performed. Intra-operative findings confirmed that the reinforcement ring had protruded into the pelvis. A large osseous defect was noted in the acetabulum which required further fixation and stabilisation utilising a larger complete reinforcement ring and additional five screws into the ileum were placed. The osseous defect was addressed with a combination of structural allograft and impaction bone grafting. Finally, an all-polyethylene acetabular cup was cemented into place. Leg lengths and soft tissue tensioning was restored using an additional long neck and off set variation (Fig. 6).


Importance of preoperative imaging in acetabular revision surgery - a case report.

Schmitz H, Egidy C, Al-Khateeb H, Cárdenas G, Gehrke T, Kendoff D - Open Orthop J (2012)

Pelvis AP final result with a complete reinforcement ringand combined allograft impaction grafting to stabilise the all-polyethylenecup.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3367474&req=5

Figure 6: Pelvis AP final result with a complete reinforcement ringand combined allograft impaction grafting to stabilise the all-polyethylenecup.
Mentions: Through a posterior approach, the complete reinforcement ring was safely retrieved, with particular attention paid to identifying the hook and careful dissection of the surrounding soft tissues performed. Intra-operative findings confirmed that the reinforcement ring had protruded into the pelvis. A large osseous defect was noted in the acetabulum which required further fixation and stabilisation utilising a larger complete reinforcement ring and additional five screws into the ileum were placed. The osseous defect was addressed with a combination of structural allograft and impaction bone grafting. Finally, an all-polyethylene acetabular cup was cemented into place. Leg lengths and soft tissue tensioning was restored using an additional long neck and off set variation (Fig. 6).

Bottom Line: Potential complications include injury of nerves, blood vessels and other intrapelvic structures.In our case, a major bony defect of the acetabulum was a result of the protrusion of an implanted reinforcement ring.A preoperative, contrast-enhanced CT scan showed that the urethra was in close proximity to the hook of the reinforcement ring.The preoperative imaging aided in identifying and understanding the potential complications that could occur intraoperatively.Additionally, it delineated the intact anatomic structures prior to surgery, which could have medico-legal implications.The importance of preoperative imaging and the existing literature is discussed within this case description.

View Article: PubMed Central - PubMed

Affiliation: ENDO-Klinik Hamburg, Helios Group, Holstenstraße 9, 22767 Hamburg, Germany.

ABSTRACT
Acetabular defects, particularly as a result of protrusion of acetabular components into the hemipelvis, may cause serious complications during revision procedures as a result of iatrogenic injury to surrounding anatomical structures. In these challenging cases, we advocate the utilisation of preoperative three dimensional imaging. MRI and CT- imaging offer superior understanding of the three-dimensional quality of bony defects and the relationship of implants to important anatomical structures. Appropriate preoperative planning may also prevent major complications during the removal of the pre-existing hardware, prior to re-implantation of implants. Potential complications include injury of nerves, blood vessels and other intrapelvic structures.In our case, a major bony defect of the acetabulum was a result of the protrusion of an implanted reinforcement ring. A preoperative, contrast-enhanced CT scan showed that the urethra was in close proximity to the hook of the reinforcement ring.The preoperative imaging aided in identifying and understanding the potential complications that could occur intraoperatively. Additionally, it delineated the intact anatomic structures prior to surgery, which could have medico-legal implications.The importance of preoperative imaging and the existing literature is discussed within this case description.

No MeSH data available.


Related in: MedlinePlus