Cementless Revision Total Hip Arthroplasty Using Modular Distal Fixation Stem / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to retrospectively evaluate the results of modular distal fixation stem for the proximal femoral deficiency in revision total hip arthroplasty. MATERIALS AND METHODS: Thirty five patients (36 hips) were followed for more than 24 months after the revision total hip arthroplasty using modular distal fixation stem between December 1998 and May 2002. The preoperative diagnoses included 27 cases of aseptic loosening, 7 cases of septic loosening, and 2 periprosthetic fractures. The femoral deficiencies classified according to Paprosky classification: Type II 3 cases, Type IIIA 14 cases, Type IIIB 8 cases, and Type IV 11 cases. RESULTS: The average Harris hip score improved from 39.5 points to 89.4 points. The average subsidence of the femoral component was 1.3 mm (range, 0-10 mm). All 36 hips had stable fixations, which were 30 cases by bony ingrowth and 6 cases by stable fibrous ingrowth. Postoperative complications included 3 cases of posterior dislocation, 1 case of heterotopic ossification, 1 case of deep vein thrombosis, and 1 case of reactivated infection. CONCLUSION: Cementless revision total hip arthroplasty using modular distal fixation stem showed good short-term results in the face of the deficient proximal bony support, and it appears to be a effective surgical option in this difficult revisional total hip cases.

Reconstruction of Proximal Femoral Bone Loss using Autogenous Unicortical Iliac Bone Plate in Revision Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: Since 1995, we have reconstructed defects of the proximal femoral bone with the autogenous unicortical iliac bone by revision hip arthroplasty. We report the preliminary results of this method. MATERIALS AND METHODS: Among cases of revision hip arthroplasty reconstructed with autogenous unicortical iliac bone graft between March 1995 and December 1997, we studied 45 cases, which had been followed for more than 2 years. The loss of femoral bone was classified using AAOS classification. Twenty four cases belonged to level 1, segmental type and 21 cases belonged to level 1, segmental with level 2 cavitary type. We documented the healing process of grafted bone by simple radiography every 6 months and evaluated clinical results by Harris scoring. RESULTS: The average Harris score improved from 67.2 to 79.5. Radiological union was found at an average 4.5 months, and complete union at an average 19 months. There were 2 cases of loosening, 4 prolonged pain on the bone-harvested site, 3 trochanteric nonunion, one sciatic nerve palsy and one pulmonary embolism. CONCLUSION: Small sized defects of the proximal femur are reconstructed satisfactorily by using autogenous unicortical iliac bone graft in revision hip arthroplasty.