ABSTRACT
Introducción: El objetivo de este estudio retrospectivo fue observar el comportamiento de un tallo modular de fijación proximal y anclaje distal en revisiones de cadera con defectos femorales II y IIIA (Paprosky), evaluando la estabilidad protésica y articular, la restauración del offset y la diferencia de longitud. Materiales y Métodos: Se analizaron 22 revisiones de reemplazos totales de cadera. Doce mujeres y 10 hombres (edad promedio 62.38 años). El seguimiento promedio fue de 62 meses. El tallo femoral utilizado fue S-ROM® (Depuy, Johnson & Johnson). Los defectos óseos femorales fueron 15 de tipo II y 7 de tipo IIIA de Paprosky. Para la evaluación clínica se utilizó el puntaje de cadera de Harris. En las radiografías, se analizó el comportamiento del tallo, su integración, la diferencia de longitud y el offset femoral, y se consideró correcta una diferencia <5 mm. Resultados: El offset fue restaurado en 16 (72,3%) casos y la longitud de miembros se restauró en 15 (68,2%). Hubo un solo hundimiento del tallo, y de acuerdo con la clasificación de Engh, se observaron 17 (77,27%) uniones óseas. Se produjeron siete (31,8%) complicaciones, dos luxaciones que requirieron revisión, cuatro fracturas intraoperatorias y una paresia de ciático poplíteo externo. Conclusiones: Este tallo impresiona ser una alternativa válida para resolver un problema complejo. Por su versatilidad, permite resolver mecánicamente el defecto óseo, devuelve la longitud al miembro y el offset a la articulación, con un índice de complicaciones aceptables.
Background: The purpose of this retrospective analysis was to observe the outcomes of a modular hip system in revision total hip arthroplasty with Paprosky types II and IIIA femoral bone defects, evaluating their performance, offset restoration and leg length discrepancy correction. Methods: Twenty-two revision total hip arthroplasties were analyzed in 12 women and 10 men (average age 62.38 years). The average follow-up was 62 months. Femoral stems S-ROM® (Depuy, Johnson & Johnson) were used. Paprosky femoral bone deficit were 15 types II and 7 IIIA. Clinical evaluation was performed using the Harris Hip Score, while Engh lassification was used for stem fixation. Offset restoration, leg length discrepancy (a difference <5 mm was considered correct) and hip stability were evaluated radiographically. Results: Offset was properly restored in 16 (72.3%) cases and the leg length was matched in 15 (68.2%). There was a single stem subsidence and according to Engh classification, proximal bone ingrowth fixation was obtained in 17 (77.27%) patients. There were 7 (31.8%) complications: two dislocations that required revision, four intraoperative fractures and a lateral popliteal nerve paresis. Conclusions: S-ROM® modular system seems to be a valid alternative to solve a complex problem. Its versatility allows to optimize hip stability, leg length equalization and offset restoration in revision total hip arthroplasty, showing an acceptable complication rate.
Subject(s)
Adult , Middle Aged , Arthroplasty, Replacement, Hip/adverse effects , Leg Length Inequality , Retrospective Studies , Follow-Up Studies , ReoperationABSTRACT
Purpose: This study examined the clinical and radiographic outcomes of uncemented bipolar hemiarthroplasty for femoral neck fractures in elderly patients with osteoporosis Materials and Methods: Between March 2002 and July 2004, 48 uncemented bipolar hemiarthroplasty procedures (Zweymuller, Plus Orthopedics AG, Rotkreuz, Switzerland) for femoral neck fractures were performed in 47 patients older than 75 years of age. Of the 48 patients, 1 patient died during the follow-up period. There were 11 men and 36 women. The mean age of the patients at the time of surgery was 81 years (range, 75 ~ 94 years), and the mean follow up period was 42 months(range, 24 ~ 58 months). The bone mineral density and canal flare index of the proximal femur were measured in all patients. Results: The mean bone mineral density (T score) was -3.9 points (range, -2.9 ~ -5.3) and the proximal femoral morphology showed stove pipe shapes in 33 hips. At the last follow up, the mean Harris hip scores and visual analogue scale score was 85 (range, 75~93) and 2.7 (range, 1 ~ 6)points, respectively. Inguinal pain was observed in thirteen hips, among which the degree of pain was moderate in 1 and mild in 12. Radiologically, none of the stems showed evidence of osteolysis and aseptic loosening, and remained well osseointegrated without subsidence. Conclusion: Uncemented bipolar hemiarthroplasty using a Zweymuller stem in elderly patients associated with osteoporosis can provide favorable clinical and radiographic results because the stem imparts good primary stability due to its rectangular tapered shape and long-term secondary stability due to excellent osseointegration on the gritblasted surface.