To the Editor:

Abstract

I read with interest the recent article “Safe Screw Placement in Acetabular Revision Surgery,” Journal of Arthroplasty Vol. 16, No. 8. The authors provide good information with their review of the proximity of vascular and neurologic structures to the innominate bone. I personally question, however, if telling surgeons not to place screws in certain areas of the acetabulum is a good policy in teaching hip surgery. For me, the primary determinant of the direction where screws should be placed is where the best bone is. In the case of primary hip arthroplasty, and definitely in the case of revision arthroplasty, the fixation the screw obtains in the bone is a paramount factor. Certainly the surgeon also needs to know the soft tissue anatomy and needs to avoid injuring soft tissue structures, but I would say that at times screws need to be placed in dangerous directions in order to obtain the best bone. Safe screw placement in acetabular revision surgeryThe Journal of ArthroplastyVol. 16Issue 8PreviewRevision of an acetabular component with extensive bone loss is a procedure that sometimes includes allografting or the placement of an unusually sized or positioned uncemented acetabular component. We evaluated the quadrant system used to guide screw placement in primary uncemented total hip surgery in the high hip center, jumbo component, and 3 designs of reinforcement rings. We used 14 pairs of cadaver hemipelves, which were prepared by removing all soft tissues except the medial neurovascular structures. Full-Text PDF