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

MIÉRCOLES / WEDNESDAY
84
15.15 - 18.30 h
CADERA / HIP
Cadera de revisión / Hip revision
Moderador: Antonio Coscujuela
SURGICAL TECHNIQUES IN REVISION
HIP ARTHROPLASTY
Peter McLardy-Smith and the Oxford Hip & Knee Group
Nuffielsd Orthopaedic Centre,
Oxford (Great Britian)
Revision hip arthroplasty is an increasingly important problem
with numbers and technical difficulty increasing. One of the
major challenges is bone loss and successful outcome is inversely
related to the extent of bone deficiency.
In the femur weakened or absent bone can be by passed
by devices which rely on distal fixation in the diaphysis, but
this will lead to proximal stress shielding and further weakening
of remaining proximal femoral bone. Impaction allografting
is an established technique aiming to reconstitute the proximal
femoral bone by cementing a polished tapered wedge in to
the graft construct. This paper describes the use of a specific
modular device (the Oxford Universal Hip) in which the metaphyseal
portion slides over the diaphyseal stem, but is not
fixed to its surface so that it is free to sink or rotate on the
stem. The stem can therefore by bypass distal defects and
the bone impaction is needed only in the metaphyseal portion,
where the load transfer occurs.
Using this technique we have studied 173 hips, in which
there were severe metaphyseal defects (Paprosky Grade
3A or worse). Using the Oxford Hip Score there was a highly
significant improvement in score post operatively and the
worst case survivorship is 93%. A mean of only 1.8 femoral
heads were required for the impaction grafting. Post operative
fractures at the tip of the previous failed prosthesis are
eliminated by the long stem and because the polished wedge
was cemented into the graft construct, local antibiotics
delivery is enabled from the cement.
CEMENT-IN-CEMENT REVISION
-DECREASING THE MORBIDITY OF
REVISION SURGERY
A. John Timperley
Princess Elisabeth Orthopeadic Hospital,
Exeter (Great Britain)
IMPACTED BONE GRAFT
IN FEMORAL REVISION
Aaron G. Rosenberg MD
Professor of Orthopaedic Surgery Rush Medical College
Chicago, Illinois (USA)
The revision technique of of impacting allograft bone chips
into the proximal femoral canal and then using cement to fix
the stem in the newly “created” allograft neo-endosteal canal
allows for better cement fixation at the endosteal surface by
improving the quality of the bone present for cement interdigitation
while allowing for bone stock restoration to the
upper end of the femur. This is a particularly appropriate
technique in the patient who has substantially compromised
endosteal bone stock or substantial endosteal expansion
(the so called patulous proximal femur). This technique may
also be helpful when used above long distal cement columns
that may be difficult to remove and can be used to support
the bone packing above. The procedure is technique dependent,
requires appropriate equipment and should be used
after appropriate training.
Several centers have reported intermediate-term results,
most often using stems of a similar geometry: a double-