Stefanini Niccolò, Pederiva Davide, Brunello Matteo, Geraci Giuseppe, Pilla Federico, Capozzi Enrico, Di Martino Alberto, Faldini Cesare
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
University of Bologna, Bologna, Italy.
Arch Orthop Trauma Surg. 2025 Jun 25;145(1):354. doi: 10.1007/s00402-025-05961-2.
Total Hip Arthroplasty (THA) is one of the most successful procedures in orthopedic surgery. Today, arthroplasties are performed using minimally invasive techniques, with excellent long-term outcomes. However, complex cases, such as dysplastic hips, acetabular fractures, or revision surgeries involving bone loss, continue to represent significant challenges for surgeons in achieving primary stability. In such situations, acetabular screws can be used to improve stability, although this increases technical difficulties and the risk of neurovascular complications. This review aims to describe the optimal techniques for acetabular screw placement in THA, focusing on ensuring primary stability while minimizing risks. It also discusses the safe zones for screw placement based on acetabular anatomy and evaluates different acetabular component designs. A narrative review of the literature was conducted, addressing acetabular screw placement in the ilium, ischium, and pubic bone. A clock-face method and graphics are used to illustrate the optimal entry points for screws. The risk associated with various zones (e.g., the "death zone" and "caution zone") is highlighted. The iliac bone offers the best tolerance for screw placement, with a wide range of safe angles, whereas the ischium and pubis present narrower safety angles due to proximity to vital structures. Progressively more invasive types of prostheses are also discussed for severe cases of bone loss and reduced stability. The review emphasizes the importance of surgeon expertise and anatomical knowledge, particularly in high-complexity cases where bone stock is severely compromised.
Proper acetabular component selection and placement and screw fixation techniques are crucial for the success of both difficult primary and revision THA. Surgeons must be aware of the technical difficulties and the anatomical variations that can occur in difficult cases, to avoid complications, namely neurovascular injuries.
全髋关节置换术（THA）是骨科手术中最成功的手术之一。如今，关节置换术采用微创技术进行，长期效果良好。然而，复杂病例，如发育不良性髋关节、髋臼骨折或涉及骨量丢失的翻修手术，对于外科医生实现初次稳定性而言仍然是重大挑战。在这种情况下，可使用髋臼螺钉来提高稳定性，尽管这会增加技术难度和神经血管并发症的风险。本综述旨在描述THA中髋臼螺钉置入的最佳技术，重点是确保初次稳定性同时将风险降至最低。它还基于髋臼解剖结构讨论了螺钉置入的安全区域，并评估了不同的髋臼假体设计。对相关文献进行了叙述性综述，涉及髋臼螺钉在髂骨、坐骨和耻骨中的置入情况。采用钟面法和图形来说明螺钉的最佳置入点。强调了与各个区域（如“死亡区”和“谨慎区”）相关的风险。髂骨对螺钉置入的耐受性最佳，安全角度范围广，而坐骨和耻骨由于靠近重要结构，安全角度较窄。对于骨量丢失严重和稳定性降低的严重病例，还讨论了侵入性逐渐增加的假体类型。本综述强调了外科医生专业知识和解剖学知识的重要性，特别是在骨量严重受损的高复杂性病例中。
正确选择和放置髋臼假体以及螺钉固定技术对于困难的初次和翻修THA的成功至关重要。外科医生必须意识到困难病例中可能出现的技术难题和解剖变异，以避免并发症，即神经血管损伤。
