cadera / hip - Active Congress.......

JUEVES / THURSDAY
166
08.00 - 12.00 h
CADERA / HIP
Acetábulo
Acetabulum
Moderador / Moderator: Luís Azorin, Xavier Flores
PREOPERATIVE EVALUATION
OF THE BONE LOSS
W. Paprosky
Rush Arthritis & Orthopaedic Institute
St. Luke’s Medical Center
Chicago, Illinois, USA
THE ROLE OF BONEGRAFTING
IN ACETABULAR OSTEOLYSIS
C. H. Rorabeck, MD
Health Sciences Centre, Ontario, Canada
Modularity in total hip arthroplasty has allowed
for the retention of well fi xed components
during revision surgery. In particular,
osteolysis, polyethylene wear, or impingement
are increasingly being treated with an
isolated polyethylene liner exchange, leaving
in place well in-grown acetabular and femoral
components. The purpose of this study was
to examine the clinical and radiographic results
of isolated polyethylene liner exchange
surgery and determine its effectiveness in a
clinical setting.
Twenty-four hips (23 patients) were treated
with isolated polyethylene liner and modular
femoral head exchange for polyethylene
wear and osteolysis or impingement. All
surgeries were performed through the direct
lateral approach. All patients were followed
clinically and radiographically with a mean
follow up of 31 months (range 6 to 100
months). Patients who underwent revision for
recurrent dislocation were excluded. Clinical
results were assessed using the Harris Hip
score and Western Ontario and McMaster
Universities (WOMAC) index. A computer-assisted
method was employed to quantitatively
determine lesional area on radiographs for
those patients who presented with osteolysis.
All accessible osteolytic lesions were bone
grafted at the time of liner exchange.
Progressive acetabular osteolysis was identifi
ed in 18 hips, 15 of which required bone
grafting. Preoperatively, the mean area of
osteolysis from anteroposterior radiographs
was 542.9 mm2 while that determined on
lateral radiographs was 794.7 mm2. All lesions
have either regressed or resolved since
the procedure. Clinically Harris Hip Scores
improved post-operatively by an average of
14.1 points from 69.3 to 84.1, while WOMAC
scores improved by 15.3 points. Two patients
required a subsequent revision. None of the
hips have dislocated since the liner exchange
procedure performed via the direct lateral
approach.
CONCLUSION
Isolated liner exchange with or without bone