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52/365 good radiographs are key, now for a systematic approach to assessment
Firstly, some acetabular radiographer anatomy
1 iliopubic line - the ant column
2 ilioischial line - the post column
3 the acetabular fossa
4 the teardrop - medial inferior socket
5 post wall
6 ant wall
1 iliopubic line - the ant column
2 ilioischial line - the post column
3 the acetabular fossa
4 the teardrop - medial inferior socket
5 post wall
6 ant wall
Assess the bone deficiency or excess. Where is it? If a deficient acetabulum: is it contained (intact front, back, medial, superior walls) or uncontained. This should feed into the type of reconstruction, the prosthesis and the need for bone graft.
51/365 Good planning is essential and to perform good planning you need good images. Don’t settle for less and accept what you know isn’t good enough. Sometimes the radiography dept don’t understand what you need. Time spent with them is time well spent.
‘Recent’ is a relative term. Typically we say within six months but any change in symptoms or exam finding at preop probably deserves a repeat image.
Internally rotating the legs (toes inwards) improves the true AP image of the proximal femur. The normal femur is anteverted so assessing offset is difficult. You never over estimate the offset. If anything it will be under. Err on the side of increasing offset.
7/365 What is bone cement? It's a polymer, a chain of 'mer' units - MMA, methylmethacrylate - and is therefore known as PMMA or, more commonly, under one of the trade names below.
The inert effect of PMMA in the human body was first noticed by Harold Ridley, an ophthalmic surgeon, who looked after pilots after WW2, removing shrapnel from their eyes. He noticed that pilots who flew behind glass canopies developed an aggressive foreign body reaction
However, Spitfire pilots who flew behind their streamlined canopies made from Lucite/ Perspex, produced no foreign body reaction around the fragments of PMMA. This prompted him to make the first intraocular lenses out of PMMA.
