The morphometric study demonstrates if a K-wire is placed 20 mm into the bone and remains lateral to the medial pedicle wall and the tip just engages the vertebral body, the screw trajectory is safe particularly in the lower thoracic and upper lumbar spine. A smaller distance may be utilized in the upper thoracic. Breach rates are similar to other reports using other techniques; none were clinically significant. The advantage of this technique is the use of only PA fluoroscopy for placing all the wires percutaneously.
This study assessed the efficacy of highly porous cups in revision total hip arthroplasty for Paprosky types II and III acetabular bone loss. The authors identified 33 acetabular revisions in 29 patients from a prospective database (66% type III, 7 with pelvic dissociation). Initial stability was achieved with interference fit between the anterior inferior iliac spine, pubis, and ischium with cups that were 2 to 4 mm larger than the reamed acetabulum and augmented with multiple screw fixations without allograft or wedges. At mean follow-up of 6 years (range, 2.7-7.7 years) after revision surgery, no dislocation, infection, or reoperation was noted. Mean satisfaction score was 6±3.2. Mean anteversion and abduction angles were 43°±4.6° and 21.5°±4.4°, respectively. Complications included limp in 13% of patients, wound issues in 10%, and heterotopic ossification in 17%. Osteointegration was seen in all cups, without any migration. Mean overall osteointegration, based on the average percentage of the 3 zones in both views, was 55%±21% (range, 25%-95%). The most osteointegration was seen in zone I (superior) and zone VI (posterior), and the least osseointegration was seen in zone II (medial) and zone IV (anterior). This method can provide reproducible results in acetabular revision arthroplasty.
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