Clinical Evaluation of Canine Acetabular Fractures Stabilized with an Acetabular Plate

A retrospective study of 14 dogs with one or more acetabular fractures stabilized with an acetabular plate was conducted. Twelve of the 14 dogs had additional orthopedic injuries. Follow-up was longer than 6 months. Eleven dogs were evaluated by assessment of radiographs, lameness, mid-thigh circumference, coxofemoral joint range of motion, crepitus, and pain. Varying degrees of osteoarthrosis were noted radiographically at follow-up. Ten of 12 dogs examined had occasional or no clinical lameness. In 10 of 12 dogs, mid-thigh circumference was less on the limb that sustained the acetabular fracture. Nonunion was diagnosed in one plated acetabulum in which two screws had broken. A return to normal or nearly normal function was observed when there were no more than two orthopedic injuries.     

Acetabular osteochondrosis dissecans in a foal

Osteochondrosis affecting the acetabula in horses is rarely reported. Osteochondrosis dissecans in foals only a few weeks old is also an uncommon finding. Lesions compatible with osteochondrosis dissecans in the acetabulum were found to be the cause of a chronic coxofemoral lameness in a 3-week-old Arabian filly. The history, physical examination findings, joint fluid analysis, gross pathologic and histopathologic findings are described.     

Biomechanical Evaluation of Acetabular Cup Implantation in Cementless Total Hip Arthroplasty

Objective: To report biomechanical properties of the Biologic Fixation System (BFX) acetabular cup impacted into a normal canine pelvis and to compare the effect of implant positioned to and beyond the medial acetabular wall. Study Design: In vitro cadaveric study. Animals: Hemipelves of mature, large‐breed dogs (n=6). Methods: For each dog, 1 hemipelvis was reamed to the depth of the acetabular wall (group A) and 1 was reamed an additional 6 mm after penetration of the medial cortex of the acetabulum (group B). The hemipelves were implanted with acetabular cups and loaded in compression through a matching femoral prosthetic component until failure. Specimen stiffness, and failure displacement, load, and energy were determined from load and displacement data and results between groups compared with a paired t‐test. Results: Mean failure load was greater in group A (3812 ± 391 N) than group B (2924 ± 316 N; P<.014). No other differences (P>.05) were observed between groups. Bone fracture (n=5) and cup displacement (1) occurred in group A whereas in group B there were 3 fractures and 3 cup displacements. Conclusions: Although medial placement of the BFX cup affected compressive failure loads, failure loads for both groups exceeded normal physiologic loads. Clinical Relevance: Medial positioning of the acetabular cup does not appear to compromise acetabular implant‐pelvic stability under normal physiologic loads. Because arthroplasty candidates often have abnormal acetabular architecture, mechanical properties of the cup placed in acetabula without a dorsal rim should be investigated.     

Quantitative Ingrowth Analysis of a Porous-coated Acetabular Component in a Canine Model

Histomorphometric analysis of bone ingrowth into a porous-coated acetabular component was evaluated in a canine model. A total of nine prostheses were evaluated, 3 at 6 months, 3 at 12 months, and 3 at 24 months after implantation. All implants were grossly stable at the time of retrieval. The mean percentage of bone ingrowth was 12% at 6 months, 24% at 12 months, and 24% at 24 months. Narrow radiolucent lines noted on microradiographs were more evident at the 6 month time period than at the 12 or 24 month time periods. Bone ingrowth into a porous-coated acetabular component in a weight-bearing model may continue beyond the 6 month time period, and early evaluation of bone ingrowth may underestimate final bone ingrowth.     

Biomechanical Comparison of Two Plating Techniques for Fixation of Acetabular Osteotomies in Dogs

OBJECTIVE: To compare the failure properties of a 5-hole, 2.7-mm curved acetabular plate (AP) to a 5-hole, 3.5-mm reconstruction plate (RP) when applied to acetabular osteotomies. STUDY DESIGN: Cadaver study. ANIMALS OR SAMPLE POPULATION: Pelves of 8 mature, large-breed dogs. METHODS: A 5-hole, 2.7-mm AP and a 5-hole, 3.5-mm RP were contoured and applied to the dorsal acetabulum of each pelvis. A central acetabular fracture was simulated after plate application by a transverse osteotomy with a fine saw. Each acetabulum was loaded in a weight-bearing direction. A load-deformation curve was produced for each construct, and biomechanical properties of the AP and RP were compared with the Student's paired t-test. A P value of < .05 was considered significant. RESULTS: For the AP and RP composite respectively, the mean +/- SD maximum load to failure was 2,721 +/- 632 N and 2,488 +/- 800 N, the stiffness was 4.8 +/- 1.8 N/m and 5.3 +/- 1.9 N/m, and the energy absorbed was 15.1 +/- 5.2 Nm and 16.3 +/- 8.3 Nm. None of these differences was statistically significant. CONCLUSIONS: Both fixation techniques provided comparable strength, stiffness, and energy absorbed under the loading conditions of this study. CLINICAL RELEVANCE: Because of the relative ease of application, the 2.7-mm curved AP may be the practical choice for acetabular fracture repair in large dogs.     

Descriptive Histomorphometric Ingrowth Analysis of the Zurich Cementless Canine Total Hip Acetabular Component

Objectives— To (1) determine bone contact with the outer surface and ingrowth into the perforated outer shell of the Kyon acetabular component at 2, 6, and 12 months after total hip replacement (THR) and (2) determine correlation between radiographic lucency surrounding the cup–bone interface and bone contact and ingrowth.
Study Design— Experimental study.
Animals— Large breed dogs (n=11) with and without hip dysplasia.
Methods— Force platform gait analysis was performed preoperatively and 2, 6, and 12 months after THR. Curvilinear length of lucency (CLL) was measured on pelvic radiographs. Tissue contact with the outer cup and ingrowth into the cup were determined histomorphometrically at 2, 6, and 12 months.
Results— Peak vertical force and vertical impulse of the treated and control hind limb were not significantly different at any time. Median bone contact with the outer cup surface was 77%, 48%, and 76% at 2, 6, and 12 months, respectively. Median bone ingrowth into the cup perforations was 50%, 20%, and 44% at 2, 6, and 12 months, respectively. Median bone ingrowth to the inner cup surface was minimal at any time. CLL did not correlate with bone ingrowth.
Conclusions— Bone ingrowth into cup perforations occurred in each dog and was already present 2 months after THR, but most of the inner cup space remained vacant.
Clinical Relevance— Radiographic lucency surrounding the cup–bone interface does not allow assessment of bone contact with the outer surface or bone ingrowth into the Kyon cup in dogs without clinical problems.     

Acetabular component orientation as an indicator of implant luxation in cemented total hip arthroplasty

OBJECTIVE: To determine the sensitivity and specificity with which acetabular component angles of inclination and version could be used, alone or in combination, to predict luxation of cemented total hip arthroplasties (THA). STUDY DESIGN: Comparison of retrospectively selected cases and controls SAMPLE POPULATION: All THA performed at the University of Florida between 1991 and 1998 with the BioMedtrix system and for which at least 2 months of radiographic follow-up were available. All THA performed at the University of Georgia with the BioMedtrix system which subsequently luxated. METHODS: Acetabular component inclination angle (IA) and acetabular version angle (VA) were determined for each THA. Data were grouped according to outcome - luxation or no luxation - with the luxated cases from the 2 institutions pooled. Receiver operator characteristic (ROC) analysis was used to evaluate decision rules for using IA and VA as tests for detecting postoperative luxation. Sensitivity and specificity for luxation and 95% confidence bounds were computed with selected values of IA and VA as cut-points. RESULTS: The nonluxation group consisted of 68 THA with a median follow-up time of 5 months (range, 2-60 months). The luxation group consisted of 12 THA with a mean time to luxation of 36 days. The nonluxation group had a mean +/- standard deviation (SD) IA and VA of 40.3 degrees +/- 8.9 degrees and 71.1 +/- 13.6 degrees, respectively, whereas the luxation group had a mean +/- SD IA and VA of 34.7 degrees +/- 12.6 degrees and 72.9 degrees +/- 16.6 degrees, respectively. An IA cut-point of 37.8 degrees achieved 58.3% sensitivity and 57.4% specificity. A VA cut-point of 73 degrees achieved 75.0% sensitivity and 51.5% specificity. IA and VA considered simultaneously achieved a 50.0% sensitivity and 88.2% specificity. CONCLUSIONS AND CLINICAL RELEVANCE: ROC analysis indicated that both IA and VA considered individually or simultaneously were poor indicators of luxation. Although extreme values of IA may predict luxation with high specificity, the potential for luxation cannot be excluded based on apparently appropriate values of IA and VA. The results of this study also indicate that a successful outcome is possible with a wide range of acetabular component positions.     

Results of Screw/Wire/Polymethylmethacrylate Composite Fixation for Acetabular Fracture Repair in 14 Dogs

Objective- To assess the clinical results in dogs with acetabular fractures stabilized using a screw-wire-polymethylmethacrylate (SWP) composite fixation.
Study Design- A retrospective study of client-owned dogs with acetabular fractures.
Animals- Fourteen dogs ranging in age from 4 to 95 months (mean, 34 ±25 months; median, 25 months) and body weight from 8 to 39 kg (mean, 25 ±6 kg; median, 27 kg).
Methods- Medical records and radiographs were retrospectively evaluated to determine location of the fracture, presence of preexisting degenerative joint disease, accuracy of fracture reduction and complications associated with surgery. Long-term results were evaluated by subjective assessment of lameness, elicitation of pain and/or crepitus on manipulation of the coxofemoral joint, measurements of pelvic limb circumference, coxofemoral joint goniometric measurements, and radiographic evaluation.
Results- Fracture reduction was considered anatomic in 13 dogs. At the time of the last follow-up evaluation (mean, 347 ±261 days; median, 380 days) 10 dogs were sound on the affected limb, three dogs had a subtle weight-bearing lameness of the affected limb, and the remaining dog had a consistent non-weight-bearing lameness of the affected limb. Mild (n = 10) or moderate (n = 1) degenerative changes of the affected coxofemoral joint attributed to the acetabular fracture and its repair were noted on the follow-up radiographs in 11 dogs. Limb circumference of the affected limb ranged from -8.2% to +10.8% (mean, -0.8 ±4.2%; median, -0.7%) of the contralateral limb.
Conclusions- The SWP composite fixation consistently maintained anatomic reduction, was associated with few complications, and yielded satisfactory clinical results.
Clinical Relevance- The SWP composite fixation technique would seem to be an acceptable means of stabilizing acetabular fractures in dogs.     

Use of Reconstruction Plates for the Repair of Segmental llial Fractures Involving Acetabular Comminution in Four Dogs

Four dogs (27.3–31.8 kg) with ilial body fractures associated with various degrees of acetabular comminution were treated using internal fixation. Anatomic reduction and internal fixation were achieved using a long 2.7 mm reconstruction plate on the hemipelvis. Based on the patient's pelvic radiographs, the reconstruction plate was precontoured before surgery to precisely fit a bony pelvis of similar size and shape. Excellent anatomic reduction of the fractures was achieved in all four dogs. Three dogs recovered uneventfully and regained full function of the affected leg. In one dog with comminution of the acetabulum, reduction of the most caudally located fracture was not maintained. Severe osteoarthritis developed, and excision arthroplasty was performed.
Reconstruction plates offer greater versatility than dynamic compression plates in the treatment of complex pelvic fractures such as ilial body fractures with acetabular comminution. The technique of precontouring the reconstruction plate prior to surgery decreases intraoperative time and corrects minor discrepancies in reduction.     

Successful Cementless Cup Reimplantation Using Cortical Bone Graft Augmentation after an Acetabular Fracture and Cup Displacement

Objective— To report repair of a periprosthetic acetabular fracture with concurrent component displacement after cementless total hip arthroplasty (THA).
Study Design— Clinical case report.
Animals— Dog (n=1) with an acetabular fracture after THA.
Methods— Acetabular repair was performed on a highly comminuted periprosthetic acetabular fracture after cementless THA. A bulk, structural corticocancellous autograft from the ipsilateral ilial wing was used for repair and reconstruction of the dorsal acetabular wall before reimplantation of a cementless acetabular component.
Results— Repair of a periprosthetic acetabular fracture with a bulk structural autograft was successful in reconstruction of the dorsal acetabular wall and in reestablishing a stable, functional cementless THA acetabular prosthesis.
Conclusions— Structural corticocancellous autografts from the ilium can be successfully used in repair of periprosthetic acetabular fractures after THA.
Clinical Relevance— Structural corticocancellous grafting from the ilium can be considered as a treatment option for repair of periprosthetic acetabular fractures after THA.     

Acetabular ventroversion with double pelvic osteotomy versus triple pelvic osteotomy: a cadaveric study in dogs

Objective: To determine which of 3 different plate angles (20°, 25°, 30°) used in double pelvic osteotomy (DPO) would result in the most similar acetabular angle (AA) achieved with a 20° triple pelvic osteotomy (TPO) technique in dogs. Study Design: Experimental anatomic study. Animals: Cadaveric canine pelves (n=8). Methods: Transverse plane computed tomographic images of cadaveric pelves with intact sacroiliac joints, mounted in a custom jig, were made (baseline) and again after DPO (20°, 25°, 30°) and TPO (20°) and pelvic angles measured in 6 transverse planes. Pelvic angles of the 3 DPO techniques were compared with TPO using concordance correlation to determine which DPO angle resulted in an acetabular ventroversion angle closest to TPO. Results: Mean ± SD AAs were 32.89 ± 2.23 (baseline), 47.39 ± 4.39 (20° DPO), 51.43 ± 5.06 (25° DPO), 54.75 ± 4.38 (30° DPO), and 50.20 ± 5.76 (20° TPO). Concordance correlations for the AA compared with 20° TPO were 0.027 (baseline), 0.721 (20° DPO), 0.902 (25° DPO), and 0.593 (30° DPO). A concordance correlation of ≥0.8 indicates good correlation. Conclusions: A 25° DPO is most similar in acetabular ventroversion to 20° TPO (concordance correlation, 0.902).     

A Biomechanical Evaluation and Assessment of the Accuracy of Reduction of Two Methods of Acetabular Osteotomy Fixation in Dogs

Objective—To compare the accuracy of reduction, biomechanical characteristics, and mode of failure of two methods of acetabular osteotomy repair. Study Design—Acetabular osteotomies were created in 16 paired hemipelves and stabilized with a screw/wire/polymethylmethacrylate composite fixation technique (SWP) or a 2-mm veterinary acetabular plate (VAP). Eight intact hemipelves were used as controls. Sample Population—Twelve canine cadavers. Methods—Accuracy of osteotomy reduction was evaluated grossly and by measurement of articular incongruencies formed in polyvinylsiloxane impression casts. Acetabula were loaded in modified bending until failure using a universal testing machine. Data from load-deformation curves were used to determine the biomechanical characteristics of the repaired and intact acetabula. Mode of failure was evaluated grossly and radiographically. Results—Osteotomy reduction was superior in acetabula stabilized with SWP. Mean values ± standard deviation for load at failure and stiffness of the intact acetabula were 2,796 ± 152.9 N and 267.5 ±61.9 N/mm. Corresponding values for SWP and VAP were 1,192 ± 202.7 N and 136.3 ± 76.5 N/mm, and 1,100.5 ± 331.6 N and 110.0 ± 51.3 N/mm, respectively. The mean load at failure and stiffness of intact acetabula was significantly greater than acetabula stabilized with SWP or VAP. There was no significant difference between SWP and VAP for load at failure or stiffness. Failure of acetabula stabilized with SWP occurred by fracture of the polymethylmethacrylate and ventrolateral bending of the wires. Acetabula stabilized with VAP failed by ventrolateral twisting of the plate and bending of the caudal screws. Conclusions—SWP and VAP provide comparable rigidity, however, the SWP facilitates more accurate osteotomy reduction. Clinical Relevance—These findings support the use of the SWP technique as an alternative method of acetabular fracture repair.     

The Effect of Plate Luting on Reduction Accuracy and Biomechanics of Acetabular Osteotomies Stabilized With 2.7-mm Reconstruction Plates

OBJECTIVE: To compare the accuracy of reduction and biomechanical characteristics of acetabular osteotomies repaired with luted and nonluted reconstruction plates. STUDY DESIGN: In vitro study. ANIMALS: Pelves removed from 12 adult greyhounds. METHODS: Acetabular osteotomies were created and repaired with a 6-hole, 2.7-mm reconstruction plates in 24 cadaver hemipelves. Ten hemipelves each were assigned to group I and group II. An impression cast of each acetabulum in group I was made before luting (preluting cast). Group I plates were then elevated, luted, and replaced. A second cast of each acetabulum in group I was then made (postluting cast). Step, gap, and total areas of articular osteotomy incongruence were determined from the casts. Group I (luted plate repairs) and group II (nonluted plate repairs) hemipelves were loaded ventral-to-dorsal using a materials-testing machine. Stiffness, yield load, and maximal load sustained were determined. RESULTS: Mean gap and total area of articular osteotomy incongruence for group I preluted plate repairs (7.1 mm(2) and 8.6 mm(2), respectively) were significantly greater than for group I postluted plate repairs (4.1 mm(2) and 5.1 mm(2), respectively). Mean stiffness and maximal load for group I (681 N/mm and 2,555 N, respectively) were significantly greater than for group II (360 N/mm and 1,730 N, respectively). Mean step area and mean load at yield values were not significantly different between groups. CONCLUSIONS: Luted plate repairs of osteotomized acetabulae result in improved reduction and are stiffer and stronger than nonluted plate repairs. CLINICAL SIGNIFICANCE: Plate luting may improve the accuracy of reduction of acetabular fractures where anatomic reduction is required. Plate luting may also increase the stiffness and strength of fracture repairs and arthrodeses.     

A Biomechanical Comparison of Screw and Wire Fixation With and Without Polymethylmethacrylate Re-Enforcement for Acetabular Osteotomy Stabilization in Dogs

Objective— Compare the biomechanical characteristics of screw and wire fixation with and without polymethylmethacrylate (PMMA) re-enforcement for acetabular osteotomy stabilization in dogs. Animals— Pelves removed from 8 adult mixed breed dogs weighing between 25 and 30 kg. Procedure— The pubic symphysis of each pelvis was split and a central transverse acetabular osteotomy was performed. One hemipelvis from each dog was stabilized with the composite fixation (interfragmentary Kirschner wire, two screws and a figure-of-eight orthopedic wire with PMMA). The contralateral hemipelves was stabilized with an interfragmentary Kirschner wire, two screws, and a figure-of-eight orthopedic wire without PMMA. All hemipelves were tested in bending by using a materials testing machine at a cross head speed of 5 mm/min. An extensometer was placed on the dorsomedial surface of the hemipelves centered over acetabular osteotomy to record distraction of the osteotomy during loading. A load/deformation curve and a load/distraction curve was produced for each hemipelvis. The slope for the initial linear portion of the load/deformation curve and the load/distraction curve, yield load and maximum load sustained were compared between repair groups using a paired t-test with P < .05 considered significant. Results— The slope of the load/deformation curve was significantly greater (P= .001 ) for hemipelves stabilized with the composite fixation (mean ± SD: 69 ± 18 N/mm) compared with hemipelves stabilized without PMMA (mean ± SD: 39 ± 8 N/mm). There was no significant difference (P= .593 ) between repair groups in the slope of the load/distraction curves as measured on the extensometer. Yield load was significantly greater (P= .0002 ) for hemipelves stabilized with the composite fixation (mean ± SD: 184 ± 25 N) compared to hemipelves stabilized without PMMA (mean ± SD: 74 ± 12 N). Maximum load sustained was also significantly greater (P= .013 ) for hemipelves stabilized with the composite fixation (mean ± SD: 396 ± 71 N) compared to hemipelves stabilized without PMMA (mean ± SD: 265 ± 94 N). Failure of hemipelves stabilized with the composite fixation occurred primarily by ventrolateral bending of the cranial and caudal pelvic segments at the osteotomy site. Failure of hemipelves stabilized without PMMA occurred by ventrolateral bending of the cranial and caudal pelvic segments at the osteotomy site with pronounced concurrent ventrolateral rotation of the cranial pelvic segment. Conclusion— PMMA improves the mechanical characteristics of acetabular fracture fixation, at least in part by neutralization of rotational forces. The results of this study justify use of PMMA as a component of the composite fixation when repairing acetabular fractures.     

Ex Vivo Biomechanical Comparison of the 2.4 mm UniLOCK® Reconstruction Plate Using 2.4 mm Locking Versus Standard Screws for Fixation of Acetabular Osteotomy in Dogs

Objective— To compare the accuracy of reduction and the biomechanical characteristics of canine acetabular osteotomies stabilized with locking versus standard screws in a locking plate. Study Design— Ex vivo biomechanical study. Sample Population— Cadaveric canine hemipelves and corresponding femurs (n=10 paired). Methods— Transverse acetabular osteotomies stabilized with 5‐hole 2.4 mm uniLOCK^® reconstruction plates using either 2.4 mm locking monocortical or standard bicortical screw fixation (Synthes^® Maxillofacial). Fracture reduction was assessed directly (craniocaudal acetabular width measurements and gross observation) and indirectly (impression casts). All constructs were fatigue‐tested, followed by acute destructive testing. All outcome measures (mean±SD) were evaluated for significance (P<.05) using paired t‐tests. Results— Craniocaudal acetabular diameters before and after fixation were not significantly different (21.9±1.2 and 21.5±1.2 mm; P=.45). No significant differences were observed in acetabular width differences between pre‐ and postoperative fixation between groups (locking ?0.4±0.4 mm; standard ?0.4±0.3 mm; P=.76). Grossly, there was no significant difference in the repairs and impression casts did not reveal a significant (P=.75) difference in congruency between the groups. No significant differences were found in fracture gap between groups either dorsally (locking 0.38±0.23 mm versus standard 0.22±0.05 mm; P=.30) or ventrally (locking 0.80±0.79 mm versus standard 0.35±0.13 mm; P=.23), and maximum change in amplitude dorsally (locking 0.96±2.15 mm versus standard 0.92±0.89 mm; P=.96) or ventrally (locking 2.02±2.93 mm versus standard 0.15±0.81 mm; P=.25). There were no significant differences in stiffness (locking 241±46 N/mm versus standard 283±209 N/mm; P=.64) or load to failure (locking 1077±950 N versus standard 811±248 N; P=.49). Conclusion— No significant differences were found between pelves stabilized with locking monocortical screw fixation or standard bicortical screw fixation with respect to joint congruity, displacement of fracture gap after cyclic loading, construct stiffness, or ultimate load to failure. Clinical Relevance— There is no apparent advantage of locking plate fixation over standard plate fixation of 2‐piece ex vivo acetabular fractures using the 2.4 mm uniLOCK^® reconstruction plate.