Notas / Notes - Active Congress.......

MIÉRCOLES / WEDNESDAY
72
3. Harris WH, Crothers O, Oh I: Total hip replacement and
femoral head bone grafting for severe acetabular
deficiency in adults. J.Bone Joint Surg 1977;59-A:752-
5.
4. Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT,
Zacharakis N: Congenital hip disease in adults: Classification
of acetabular deficiencias and operative
treatment with acetabuloplasty combined with total hip
arthroplasty. J.Bone Joint Surg 1996;78:683-692.
5. Paavilainen T: Total hip replacement for developmental
dysplasia of the hip. Acta Orthop Scand 1997;68:77-84.
6. Cabanela ME: Total Hip Arthroplasty: Degenerative
Dysplasia of the Hip. In: Advanced Reconstruction Hip.
Ed: Lieberman J, Berry D. AAOS. 2005:115-20.
7. Slooff TJJH, Huiskes R, van Horn J, Lemmens AJ.: Bone
grafting in total hip replacement for acetabular protrusion.
Acta Orthop Scand 1984;55:593-6.
8. Yasgur D, Stuchin S, Adler E, DiCesare P.: Subtrochanteric
Femoral Shortening Osteotomy in Total Hip
Arthroplasty for High-riding Developmental Dislocation
of the Hip. J. Arthroplasty 1997;12:880-7.
9. Rorabeck C, Burnet SJ: Total Hip Arthroplasty: High Hip
Dislocation. In: Advanced Reconstruction Hip. Ed: Lieberman
J, Berry D. AAOS. 2005:121-9.
10. lkka Helenius, Ville Remes, Kaj Tallroth, Jari Peltonen,
Mikko Poussa, and Timo Paavilainen
Total Hip Arthroplasty in Diastrophic Dysplasia
J. Bone Joint Surg. Am., Mar 2003;85:441-447.
32. Caveiro N: Experiencia personal con la ATC en DDH.
Libro de resúmenes. SPOT Vilamoura 2007
HIP RESURFACING ARTHROPLASTY IN
DYSPLASTIC HIPS
Michael Menge
St. Marienkrankenhaus,
Ludwigshafen (Germany)
BACKGROUND
The long term prognosis of total hip replacement (THR) is
poor in younger patients. Therefore bone sparing techniques
as resurfacing of the femoral head have become very popular
in Germany. As patients with congenital dysplasia of the hip
(CDH) very often develop early osteoarthrosis there might
be the possibility to use this procedure in anatomically difficult
cases. The purpose of this study was to evaluate the possibilities
and the problems in resurfacing dysplastic hips.
METHOD
Between 1999 and 2006 more than 1.500 patients received
a MoM resurfacing of the hip, from which 91 patients (6%)
suffered from severe secondary osteoarthrosis after mild or
severe CDH. The rate of dysplastic hips in our total hip replacement
(THR) group was less because the high number
of degenerative coxarthrosis of the elderly: 177 out of 6875
cases (2.6%). The mean age from our CDH patients was
47.7 years (30.7 – 64.9). In most cases the posterior approach
was used, only two surgeons of our staff preferred the lateral
approach.
RESULTS
In most cases the resurfacing of the head was not the
problem but the fixation of the acetabular socket in a shallow
acetabulum with bone defects mostly at the anterior rim. Two
devices worked fairly well in these circumstances: The BHR
and the Icon dysplasia cup with additional fixation screws
from the upper rim. We additionally tried the ESKA Bionik
system offering a modular socket allowing screw fixation of
the outer shell then covered by a metallic liner. In dysplatic
acetabula the missing macro- and microstructure at the central
back of the ESKA sockets let to a higher revision rate.
Typical cases and problems will be demonstrated.
CONCLUSIONS
Our 9-year experiences with MoM resurfacing procedures in
young patients with osteoarthrosis are excellent. In CDH the
resurfacing procedure may be extremely difficult and there
were more complications, especially loosening of the socket
or femoral nerve palsies due to the missing ventral wall of
the acetabulum. There was a revision rate of 10% in the cases
with severe dysplastic acetabula. In the majority the patients
will profit from good function and in the future in case
of revision from preserved bone stock at the femoral side.
CHARNLEY LOW-FRICTIONAL
TORQUE ARTHROPLASTY. FOLLOW-UP
TO 38 YEARS.
PROBLEMS AND SOLUTIONS
B. M. Wroblewski, P. D. Siney, P. A. Fleming
The John Charnley Research Institute, Wrightington Hospital,
Hall Lane, Appley Bridge Near Wigan (Great Britain)
We studied survivorship after Charnley low-frictional torque
arthroplasty with revision as the end point.
Between November 1962 and June 2005, 22,066 primary
operations had been carried out at Wrightington Hospital by
over 330 surgeons. By June 2006, 1001 (4.5%) hips had been
revised.
Survivorship analysis at 38 years with revision as the end
point was: Infection 95%, dislocation 98%, fractured stem
88.6%, loose stem 72.5% and loose cup 53,7%.