The classic: Treatment of malum coxae senilis, old slipped upper femoral epiphysis, intrapelvic protrusion of the acetabulum, and coxa plana by means of acetabuloplasty. 1936

Abstract

This Classic Article is a reprint of the original work by M. N. Smith-Petersen, Treatment of Malum Coxae Senilis, Old Slipped Upper Femoral Epiphysis, Intrapelvic Protrusion of the Acetabulum, and Coxa Plana by Means of Acetabuloplasty. An accompanying biographical sketch of M. N. Smith-Petersen, MD, is available at DOI 10.1007/s11999-008-0671-z. This article is ©1936 by the Journal of Bone and Joint Surgery, Inc. and is reprinted with permission from Smith-Petersen MN. Treatment of Malum Coxae Senilis, Old Slipped Upper Capital Femoral Epiphysis, Intrapelvic Protrusion of the Acetabulum, and Coxae Plana by Means of Acetabuloplasty. J Bone Joint Surg Am. 1936;18:869–880.

Fig. 1

Diagrams demonstrating the amount of bone which must be removed from the acetabulum or from the neck of the femur in order to produce the same improvement in the range of motion. This amount of bone may be easily spared from the acetabulum, but not from the neck of the femur.

Fig. 2

The incision extends along the anterior third of the ilium and curves mesially along the lateral border of the sartorius.

Fig. 3

Exposure of the anterior superior spine, of the lateral border of the sartorius, and of the mesial border of the tensor fasciae latae. Between these muscles is a compartment of fat with the rectus femoris as its floor.

Fig. 4

Reflection of the abdominal oblique, sartorius, and iliopsoas muscles mesially, exposing the anterior aspect of the hip joint.

Fig. 5

Showing the line of osteotomy of the anterior acetabular wall immediately below the attachment of the direct head of the rectus femoris.

Fig. 6

Result of plastic procedure: exposure of the mesial portion of the femoral head and of the anterior femoral neck.

Fig. 7

Preoperative roentgenogram showing definite protrusion of the acetabula, more marked on the left than on the right.

Fig. 8

Fig. 9

Fig. 10

Fig. 11

Preoperative roentgenogram showing proliferative changes with thinning of the joint cartilage.

Fig. 12

Postoperative roentgenogram. The line of osteotomy of the acetabulum is indicated by arrows.

Fig. 13

Fig. 14

Fig. 15

Fig. 16

Preoperative roentgenogram showing hypertrophic changes with thinning of the joint cartilage.

Fig. 17

Postoperative roentgenogram. Not much change is demonstrable.

Fig. 18

Fig. 19

Fig. 20

Fig. 21

Characteristic appearance of specimen removed, consisting of: a, acetabular wall; b, attached capsule. 1 shows the specimen as viewed from the outside; 2 shows the intra-articular synovial surface.