ACETABULAR

FIXATION SURGERY

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ACETABULAR FIXATION SURGERY INDIA – TYPES OF SURGERY &
COST IN INDIA

Acetabular Fixation Options in Total Hip Replacements

Osteolysis and loosening, despite great changes in bearing materials,

continue to be a problem in total hip replacements (THR). Hybrid fixation, proposed
in 1989 to aid such problems, has not completely solved them.2 There are times
during surgery that an alternative to the routine, predetermined technique is needed.

Recent alterations in cementless femoral and/or cemented acetabular

fixation have produced promising clinical returns and have shown improvement in
dealing with linear wear and osteolysis.

3,4 Despite these results, cementless acetabular fixation has now

become the treatment of choice because of its ease of insertion and predictability.
There are times, however, when the bone presents a need for a different means of
fixation than that planned preoperatively.
Results :-

Of the 54 hips (n=54 patients) in the hybrid group, 8 patients died with
a well-functioning arthroplasty (range, 2.7-16.9 years) and none were lost to follow-
up. Five hybrid THRs (9.3%) were revised. Two (3.7%) underwent revision for a
loose acetabular component caused by pelvic osteolysis, 2 (3.7%) for a loose
femoral component, and 1 (1.9%) for a fractured femoral stem.

One hip (1.9%) had a partially loose acetabular cup but was not
revised. Of the 54 hips (n=54 patients) in the reverse hybrid group, 4 patients died
with a well-functioning arthroplasty (range, 2.3-14.6 years) and none were lost to
follow-up. One patient underwent a revision procedure due to a loose femoral stem.
No patients in the reverse hybrid group reported significant postoperative
complications, including residual polyethylene wear, osteolysis, or evidence of
acetabular aseptic loosening.
Conclusion :-

This study shows that the reverse hybrid THR, although unusual, is a
successful alternative to hybrid THR when a need arises and institutional resources
allow.

With the exclusion of varying patient demographics (gender, body

mass index, age, and primary diagnosis), the reverse hybrid series of 54 hips
accounted for excellent postoperative hip performance, mobility, and survivorship,
showing clinical outcomes better than the hybrid series following a minimum 2-year
follow-up retrospective review.

However, because of the overall difficulty in cementing the acetabular

cup, the ease and predictability of the cementless fixation, and now the options of
modular bearing surfaces, cementless fixation for the acetabular cup must be
considered the gold standard.
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