García-Anaya LE, Negrete-Corona J, Jiménez-Aquino JM

Language: Spanish
References: 8
Page: 212-217
PDF size: 168.90 Kb.

ABSTRACT

Introduction: Coxarthrosis is considered as an increasingly frequent condition that will lead to an important demand for primary total hip arthroplasty in the coming decades and this, in turn, will increase the number of revision hip arthroplasties. The most common indications for revision are component loosening, hip instability and infection, with involvement of the acetabular component in more than 50% of revision procedures. Acetabular bone loss is one of the major challenges of revision hip arthroplasty. Objectives: To determine, by means of imaging studies, allograft osseointegration using the AAOS radiographic scales, the performance grade of the affected hip using the Harris Hip Score (HHS), and patient personal satisfaction, as well as identify and describe complications. Material and methods: Observational, longitudinal, retrospective, descriptive, basic, clinical trial. The records of patients subjected to revision hip arthroplasty who experienced prosthetic loosening and had an acetabular defect treated with structured bone allograft between January 2007 and April 2012 were selected. Patients were followed-up at 6 and 12 months and compared with controls. Results: The total number of patients was 18, 61% females and 39% males. Age range was 47-79 years. The acetabular defect grade was as follows: 44.4% were IIB; 44.4% were IIC, and 11.2% were III, according to the Paprosky classification. The HHS went from 27 to 72.3 at one year. Osseointegration was 100% in 9 patients, 75% in 6, and 50% in 3 patients. One patient had acute periprosthetic infection. Conclusions: This method represents a good treatment option for acetabular defects, as it provides significant improvement according to the HHS and proper allograft osseointegration, which helps patients increase their bone stock for future revision procedures.

REFERENCES

1. Canale S, Beaty J: Campbell’s Operative Orthopaedics, Arthroplasty; 11th Ed. Mosby.; 2008.

2. Granados RR, Díez GMP, Coronado ZR, Chávez AD: Análisis estadístico de la patología quirúrgica coxofemoral en el Instituto Nacional de Rehabilitación. Rev Mex Med Fis Rehab. 2007; 19: 63-8.

3. Deirmengian GK, Zmistowski B, O’Neil JT, Hozack WJ: Management of acetabular bone loss in revision total hip arthroplasty. J Bone Joint Surg Am. 2011; 93(19): 1842-52.

4. Lieberman. J: Advanced reconstruction hip: Uncemented acetabular revision. 1st Edition. USA, 2005: 317-27.

5. Gross AE , Blackley H, Wong P, Saleh K, Woodgate I: The use of allografts in orthopaedic surgery. Part II: the role of allografts in revision arthroplasty of the hip. J Bone Joint Surg Am. 2002; 84(4): 655-67.

6. Gómez F. Artroplastía total de cadera. Factores biológicos. México, Mcgraw-Hill; 2000: 33-45.

7. Bauer R, Kershbaumer F, Poisel S: Cadera y fémur. Cirugía ortopédica. Revisión de la artroplastía total de Cadera, p. 336-46.

8. Schreurs BW, Thien TM, de Waal Malefijt MC, Buma P, Veth RP, et al: Acetabular revision with impacted bone graft and a cemented cup in rheumatoid arthritis. J Bone Joint Surg Am. 2003; 85-A(4): 647-52.