Ernesto Pintore Clinica Malzoni Agropoli - Italie. Aseptic loosening of Hip Prostheses. Prosthetic Surgery = Life quality. AIM OF REVISION SURGERY. GOOD FUNCTION QUALITY OF LIFE. TECHNICALLY DIFFICULT VARIETY OF IMPLANTS LEARNING CURVE INSTRUMENTS. RECENT PROGRESS:
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Agropoli - Italie
VARIETY OF IMPLANTS
-IMPROVED CEMENTING TECHNIQUE
“Aseptic loosening of one or both components, fracture of a component, recurrent dislocation of the hip, fracture of the femoral shaft.”
Callaghan JJ; Salvati E.A. et al.
FEMORAL BONE STOCK
Poor: if the thickness of either aspect of the cortex on the AP x-ray had decreased by 50%, along a 10 cm segment of femoral stem, compared with the original arthroplasty, or if the thickness of both aspect of the cortex had decreased this amount along a 5 cm segment
- START UP HECITANCY
The wear debris is responsible of a local inflammatory reaction with histyocytes and mast cells proliferation, that leads to osteolysis and loosening of the implant.
Only an accurate reconstruction of the
anatomy can allow a good result in the
revision surgery ( Bone bank)
ALTHOUGH MODIFICATION AND IMPROVING OF CEMENTING TECHNIQUE HAVE DECREASED THE INCIDENCE OF FEMORAL AND ACETABULAR LOOSENING IN THR, THRE IS NO EVIDENCE DEMONSTRATING BENEFITS IN REVISION SURGERY WITH THE CEMENT.
Engh C.; Glassman A.
(Instructional course lecture 1991)
NO IMPLANT MIGRATION
ADAPTIVE REMODELING OF THE SURROUNDING BONE
-Extensevely porous coated
RESULTS OF UNCEMENTED REVISIONS(C. Engh - A. Glassman)
80,7% of bone ingrowth
12,3% of stable fibrous tissue
3,5% unstable implants re-revised
Aseptic loosening of a Bousquet cup 6 years later
Revision with uncemented cup and auto-homograft
Revision surgery is technically difficult and requires an experienced surgeon and economic means to achieve the most performant devices.
There are many complications and the results are not always good.
The learning curve is long
but despite this we beleave
that this is the surgery wich
we have to develop in the