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When placing acetabular screws to supplement cementless acetabular fixation in total hip arthroplasty, placing screws in which zone poses the highest risk to damaging the external iliac vasculature?
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A 64-year-old male undergoes acetabular revision of his failed total hip arthroplasty using a large uncemented component. Post-operatively he is noted to have a foot drop and radicular pain in the operative extremity. A CT scan of the hip is obtained and reveals screw penetration into the sciatic notch. Where was this screw most likely inserted in the acetabulum?
Anterior superior quadrant
Through the medial wall
Anterior inferior quadrant
Posterior superior quadrant
Through the femoral nerve
In order to determine the boundaries of the posterior-superior safe zone for acetabular screw placement during THA, a line is initially drawn through which of the following two anatomic landmarks, represented by dots on the illustration?
A and C
B and C
D and C
C and E
A and E
HPI - Active male.
Sustained fracture neck femur right hip in Nov 2014 for which optd at another center with Uncemented Bipolar HRA utilizing posterior approach.
Post op had persistent and increasing pain and stiffness right hip and painful weight bearing..
Jan 2015 - Evaluated for the above ...Healed surgical wound .. local temp increased painful movement .... Radiographs s/o progressive heterotopic ossification around hip ... Bone scan +ve for infected prosthesis, ESR and CRP positive. TLC WNL. Alkaline phosphatase - 100.
Underwent Hip aspiration under fluoroscopic guidance .. No pus/ fluid aspirated.
Feb 2015 - Underwent Removal of prosthesis and Debridement with excision of heterotopic mass which was obstructing implant removal. Intra op no pus or any abnormal fluid. Intra op cultures negative
Post op skeletal Traction applied.. indl was totally non compliant with skeletal traction .. surgical wound healed .. Post op given Tab ofloxacin and rifampicin for 06 weeks
Which approach to hip has the maximum risk for heterotopic ossification
HPI - 34 y o male 20 years post both distal femur fracture operated many times. Now, complain of inability to sit on floor or use Indian toilet. he is not in pain.
what type of procedure will you do for him
HPI - patient had a MVA 10 years ago.the set up he was did not have a proper teriary hospital and he was treated conservatively. for over 3 years he had draining sinuses from his femur lower third.
patient has limitations but going about his life with limitations.patient wants to know whether intervention will improve his quality of life or he continue as he is