We retrospectively reviewed 56 patients (71 hips) treated by total replacement for severe disability after pelvic irradiation. Symptoms were associated with various radiological lesions due to irradiation, including atraumatic femoral-neck fracture, osteonecrosis of the femoral head or of the acetabulum, and radiation osteitis of the whole pelvis. From 1970 to 1982 we used standard cemented components in 49 hips and had a high rate of acetabular loosening (52%) at a mean follow-up of 69 months. This was probably due to the mechanical insufficiency of irradiated periacetabular bone. From 1983 to 1990 we routinely used acetabular reinforcement rings. The rate of aseptic acetabular loosening in 22 hips at a mean follow-up of 40 months was 19%, but there were two septic loosenings emphasising the risk of infection in these patients. When total replacement is required for an irradiated hip, we recommend reinforcement of the acetabulum using a metallic ring, but there is still an increased risk of infection and in difficult cases such as severe acetabular destruction or soft-tissue or vascular injuries, a Girdlestone procedure may be indicated.

The vascularization of the extensor digitorum brevis is ensured on its deep aspect by branches of the anterior tibial artery, but also by a lateral arterial arch anastomosing with these branches. The lateral vascular arch of the extensor digitorum brevis was constantly found in 37 anatomic specimens: 17 formolized and 20 fresh. This arch derives from the perforating peroneal branch, the terminal anterior branch of the peroneal artery. Its variable caliber, assessed by arteriography of the foot, seemed adequate for the peroneal artery to serve as a pedicle for the extensor digitorum brevis without interruption of the anterior-tibial axis.

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