摘要:

SummaryRevision total hip arthroplasty remains one of the most challenging procedures for the orthopaedic surgeon. The number and complexity of revision cases is likely to increase dramatically in the upcoming years as the population ages. Thorough preoperative planning is crucial to minimize operating room time and maximize patient outcome. While templating the radiographs and selecting the implants remain critical components of the preoperative process, other elements include a thorough history and physical examination, proper radiographic evaluation, assessment of bone deficiencies, medical clearance, assessment of infection, choice of anesthesia, blood management, preparation for prevention of heterotopic ossification, and frank discussion with the patient about outcome. The above steps in the preoperative process are discussed with illustrative case studies, experience of the authors, and review of the literature.

ISSN:0885-9698    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

SummaryRevision total hip replacement is a challenging surgical procedure. While the surgical approach during a primary THA is usually straightforward, the approach during a revision surgery can be tedious and fraught with potential difficulties. A successful revision hip replacement begins with patient selection and greatly depends on preoperative planning in addition to a careful, well-exposed surgical approach. Today, nearly 20% of an estimated 120,000 THAs are revision surgeries. This article focuses on the essential considerations that should hopefully optimize the surgical exposure in a revision total hip replacement. The two most common approaches, the posterior approach and the direct lateral approach are discussed, as are the basic techniques of femoral osteotomies. Within each section, techniques that are particularly important for exposures during a revision hip replacement procedure are detailed.

ISSN:0885-9698    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

SummaryManagement of acetabular deficiency in revision hip arthroplasty can be extremely challenging. A successful outcome requires careful preoperative planning, identification of complex defects, and stable reconstruction. Acetabular deficiencies are classified according to clinical radiographs, anticipated bone loss during removal of implants, and intraoperative assessment of host bone stock. Before reconstruction of the acetabulum, pelvic discontinuity must be addressed. Management principles include the use of porous press-fit components for simple defects. More complex reconstructions may require segmental bone grafting, acetabular cage reconstruction, and the use of a high hip center and asymmetric cups. Type IIIB defects are reconstructed using acetabular allograft transplant techniques with successful outcomes. The authors review the current techniques along with their preferences for reconstruction.

ISSN:0885-9698    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

SummaryRecurrent instability after total hip replacement is a complex problem with extensive literature detailing multiple etiologies and solutions. It has been shown that the success of surgical management depends on the identification of the etiology. Unfortunately, in certain situations, there may not be an optimal solution for dealing with the cause, or the etiology may remain unidentified. In these cases, the success rate of surgical management of unstable total hip replacement is only 40 to 50%. Constrained acetabular liners were developed to address the problem of recurrent instability by holding the femoral head captive within the socket. The authors’ experience with attaining joint stability using one type of constrained liner has far surpassed the success rates achieved by other means. The intermediate follow-up after implantation of a constrained liner has not demonstrated significant rates of component wear or loosening. The authors reserve the use of a constrained liner for situations in which there are inadequate soft tissue, a deficient abductor mechanism, or neuromuscular disorders. Poor patient compliance or instability without a clear etiology are relative indications for its use.

ISSN:0885-9698    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

SummaryRevision total hip arthroplasty procedures can be very difficult. Efficient femoral component exposure and removal with minimal bone destruction is a very important part of the procedure. Enlightened preoperative planning allows the surgeon to attack the problem in the best possible way. There are many tools that can facilitate the procedure, and many are illustrated. Cemented stems offer different challenges than cementless stems; a joint surgeon must be familiar with ways of dealing with both situations. Many techniques are discussed that will allow a surgeon to expose and remove the femoral component, allowing the surgeon to then progress to reconstruction.

ISSN:0885-9698    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

SummarySeveral alternatives exist for revision of a failed femoral component after total hip arthroplasty when that failure occurs in association with severe bone stock deficiency. Cemented implants, cementless implants, proximal femoral replacement prostheses, and bulk allograft–prosthetic composites all have been described. Cancellous impaction allografting with cement is an additional alternative for femoral revision that can be used if bone stock is compromised. This technique involves creating a “neo-endosteum” by packing cancellous bone graft into the femoral canal and inserting a cemented prosthesis into the reconstructed femur. This review covers the history, indications, surgical technique, complications, and published clinical results of femoral impaction allografting.

ISSN:0885-9698    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

SummarySince its introduction in 1984, the S-ROM stem (DePuy Orthopaedics, Warsaw, IN) has been a useful implant for cementless femoral revision in total hip arthroplasty. Modularity of the stem and sleeve provides numerous combinations to maximize proximal and distal canal fill. In addition to enhancing initial implant stability, the stem modularity can accommodate variation in length, offset, and version. Risks of modularity such as implant fracture, dissociation, metallic fretting, and osteolysis seem to be very low, and clinical studies have documented success in middle term follow-up.

ISSN:0885-9698    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

SummaryVenous thromboembolism is the third most common vascular disease following acute ischemic attacks and cerebrovascular accidents. Approximately 90% of clinically important pulmonary embolisms arise from proximal deep venous thrombosis of the lower extremities, and it is estimated that pulmonary embolism results in 5 to 10% of all hospital deaths in the United States annually. Even so, thromboembolic disease continues to pose a major threat for patients undergoing lower extremity surgery. Prevention of thromboembolic disease is essential to avoid the morbidity and mortality associated with this condition. The authors provide information on risk factors associated with thromboembolic disease and discuss current diagnostic methods. In addition, treatments and prophylactic regimens are reviewed and evaluated.

ISSN:0885-9698    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

SummaryPeriprosthetic fracture represents a serious complication of both primary and revision total hip arthroplasty. The incidence of periprosthetic fracture is increasing. The risk factors for periprosthetic fracture must be appreciated to help prevent both intra- and postoperative fracture. Acetabular fractures are rare, and relatively little data exist in the literature regarding them. When dealing with periprosthetic femoral fractures, the Vancouver classification system allows an accurate description of all the important features of a periprosthetic fracture, based on the location of the fracture, the stability of the implant, and the quality of the surrounding bone stock. Treatment of periprosthetic femoral fractures is based on the type of fracture. Stable trochanteric fractures may be treated nonoperatively. Shaft fractures at the level of the implant may be treated with internal fixation when the implant is stable. Shaft fractures with an unstable implant may be treated with either revision arthroplasty or revision with proximal femoral replacement, depending on the quality of the remaining bone stock. Shaft fractures well distal to the implant may be treated with standard methods of internal fixation. The physiologic status of the patient should always be considered because operative treatment of these fractures is complex and associated with a relatively high complication rate.

ISSN:0885-9698    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

SummaryThough one of the most common and dangerous complications in the early years of total hip replacement, the incidence of infection has dramatically decreased. In revision total hip replacement, it is essential to differentiate aseptic loosening and infected total hip replacements. The c-reactive protein level and aspiration culture and white blood cell count are crucial parameters to differentiate an aseptic and septic revision. The intraoperative frozen section offers additional information during the procedure. Bone scans, leukocyte scans, and immunoglobulin G scintigraphy are reserved for inconclusive cases. Although Girdlestone resection arthroplasty has been used in the past, two-stage reimplantation is the gold standard for the treatment of infected total hip replacements today. One-stage revision, or debridement without implant removal, might be indicated in selected patients. In life threatening or intractable hip infection, when patient or limb viability is at risk, hip disarticulation should be considered.

ISSN:0885-9698    

出版商:OVID    

年代:2001

数据来源: OVID