摘要:

Due to their similarity to the major mineral constituent of bone, synthetic ceramic hydroxylapatite implants have been shown to provide strong attachment to hard tissue via chemical bonding mechanisms. This unique property has been utilized for over a decade in experimental and clinical applications of hard tissue augmentation and reconstruction. Recently, hydroxylapatite coatings have been investigated as mechanisms to provide fixation of metallic implant devices to bone. Clinical experience using HA coated revision stemmed prostheses supports the positive findings of earlier animal investigations, where decreased time to healing and the development of stress-transferring trabeculae to the implant surface were observed despite minor imprecisions in the initial fit.

ISSN:0885-9698    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Revision of failed total hip surgery using methylmethacrylate has led to early failure. A new technique using a biologic ingrowth fernoral component with bone grafting is presented Early results after two to three years' follow-up show excellent incorporation of the bone graft into the femur, with a solidly fixed prosthesis and good clinical results. Bone stock is being replenished rather than destroyed in difficult revision cases. Long-term results are expected to be favorable due to the continued stress transfer to the bone allowed by biologic ingrowth.

ISSN:0885-9698    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To date, cementless revision surgery has been as much an art as a science. A classification is presented that types revisions according to bone quality. The anatomic porous replacement (APR) socket is used in all Type 1 and 2 revisions and most Type 3 revisions except when 100% of the cup is supported by bone graft. In this situation, a bipolar component is selected. The use of the classification allows preoperative planning of stem type and need for bone graft. A primary APR stem can be used for Types 1 and 2a. An APR long-stem revision is used for Type 2b and Types 3a, 3b, and 3c. The most critical factor required for a stable fit (preventing subsidence) and proximal fixation is a match of the proximal and distal fill. The proximal stem has rotational stability when anteroposterior fit is as good as medial-lateral fit.

ISSN:0885-9698    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Successful cement removal continues to be the most challenging part of cemented hip arthroplasty revisions. A wide variety of instruments and implants are necessary to meet the diverse situations that may arise in revision arthroplasties. Femoral cement removal is divided into two parts, the proximal femur and the distal femur. A window in the femur is a safe method of gaining access to the cement if the distal cement is bulbous or fills the entire femur. Procedures for the removal of the femoral and acetabular components are presented. Techniques for a trochanteric osteotomy, as described by Charnley and Mueller, are also presented, although the authors' experience has shown that few cases require a trochanteric osteotomy.

ISSN:0885-9698    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

An approach is presented to the repair of pelvic defects encountered primarily in the cementless revision of the acetabulum. A classification is presented that not only indicates the position and extent of the defect, but also gives the surgeon a concept of the fixation that will be necessary when bone grafting is attempted. It is also suggested that by reducing defects to a classification such as this, the eventual outcomes and results of repair can be studied more accurately. It is no longer adequate to lump all revisions into one category; the severity and extent of defects need to be taken into account when considering the final outcome. The outcome of stage I and II repairs may be as good as, if not better than, primary repairs; whereas stage III repairs, which require massive bone grafting, present tremendous technical challenges to the surgeon and require substantial allograft in many instances. It is perhaps appropriate that these cases be evaluated as separate entities.

ISSN:0885-9698    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Bone deficiencies of the acetabulum are encountered more frequently as the follow-up time for hip arthroplasties increases. The management of these deficiencies is discussed in detail. A classification system is described. Radiographic staging, preoperative planning, grafting requirements, and fixation methods are thoroughly detailed. The scientific basis of bone grafting for acetabular defects is outlined to enhance understanding of the techniques.

ISSN:0885-9698    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Total hip replacement surgery in the face of major acetabular bone loss is at high risk of early loosening unless the bone stock is properly reconstructed. Six types of acetabular deficiencies are identified for which unique autograft and allograft techniques are used. These are superolateral, superior, posterior, medial or protrusio, combined or global, and pelvic discontinuity. Several different types of acetabular components can be successfully used in each type. The various acetabular defects encountered are described, along with the current method of reconstruction and case examples.

ISSN:0885-9698    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Management of the failed acetabulum following cemented total hip replacement is a challenging problem. With the advent of cementless technology it is possible to reconstitute the bony architecture about the acetabulum and create a biologic environment conducive to cementless fixation. The technical demands of this particular process of reconstructive hip surgery require an appreciation of both the various types of bony defects as well as the selection of the appropriate prosthetic devices, which not only maintain fixation but also support adjunct biologic bone grafting techniques. Sophisticated instrumentation and a prosthetic inventory that will address the issues of fixation and prosthetic stability are required.Rehabilitation and patient management are essential in order to create the appropriate environment for an ultimately biologic steady state. These issues of hip surgery are presented with an emphasis on prosthetic selection, technical considerations, and rehabilitation.

ISSN:0885-9698    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A bipolar prosthesis can be used in revision hip surgery, permitting the use of bone-grafting techniques to restore bone stock. This procedure can relieve pain on the acetabular side of the joint and can enhance bone stock for another conversion if necessary.A review of 19 hips operated on in this manner revealed that after two years, the average postoperative Harris Hip Rating was 84, compared with 44 preoperatively. At follow-up, there were no pending revisions, and bone graft incorporation was seen in all cases.

ISSN:0885-9698    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0885-9698    

出版商:OVID    

年代:1987

数据来源: OVID