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By G. Akrabor. Philander Smith College. 2017.

The early results of this acetabuloplasty were promising but did not provide order lozol 1,5mg amex, in the longer term, better results than those that have been obtained with bulk autograft bone. Some long-term studies have reported high rates of failure of the acetabular component related to bone graft resorption [22,23], although this complication did not occur in other reports [23–26]. In the current series, neither resorption of the graft nor acetabular loosening occurred in the absence of polyethylene wear and periacetabular osteolysis. We believe that graft resorption occurs primarily in association with osteolysis induced by polyethylene wear debris particles. The fate of uncemented sockets in the long term in the case of periacetabular osteolysis is debatable. Muscle releases associated with tenotomies have been advocated to expose the true acetabulum properly or reduce the hip. Great attention was always paid to retaining all the periarticular muscles. Bringing down the hip to the level of the true acetabulum and limb lengthening to 7cm always was THA for Crowe Developmental Hip Dysplasia 217 possible, provided that the entire articular capsule, scar tissue, osteophytes, and, when present, a shelf were removed. Retention of all the periarticular muscles results in better hip function, however, and protects the nerves and vessels against excessive elongation. This retention might be the reason for only 1 transient peroneal nerve palsy occurring in the current series, despite the fact that 30 limbs were lengthened more than 4cm. The risk of nerve palsy increases in the case of high dislocation with a lengthening superior to 4cm, and it has been recommended that limb lengthening be limited to 4cm or even 2cm. We believe that limb lengthening greater than 4cm can be safe, provided that tension in the sciatic nerve is assessed intraoperatively and reduction of the hip is performed with the limb in adduction, the hip slightly flexed, and the knee flexed by 90°. Bringing down the hip to the level of the dysplastic true acetabulum, which is located lower than a normal acetabulum, requires shortening of the femur. Some have advo- cated the use of a diaphyseal resection, so as not to exceed 4cm in lengthening.

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