Tratamiento para artroplastías totales de cadera infectadas: 3 tiempos quirúrgicos en un período de hospitalización (técnica T-3/1) / Treatment of the infected Hip replacement: 3 surgical times in one hospital stay (T-3/1)

Resumen: Antecedentes: El impacto de una infección articular periprotésica crónica, la variabilidad en los índices de recidiva y la falta de consenso en cuanto a cuál es la mejor forma para tratarla obligan a buscar alternativas. ¿Tiene la alternativa aquí propuesta una tasa de recidiva al menos igual o menor que los métodos ahora usados? Material y métodos: Se estudiaron retrospectivamente 15 pacientes adultos. Analizamos variables relacionadas con el huésped, implante, germen, diagnóstico y la tasa de recidiva. Se describe el protocolo de tratamiento y la técnica quirúrgica. Resultados: De los 15 pacientes uno se perdió cuando cumplió 48 meses de seguimiento. En otro se retiró definitivamente el implante. Dos fallecieron a los 36 y 40 meses después del recambio y en uno había duda de reinfección. Tres presentaron recidiva y fueron reintervenidos con la misma técnica. Al final del seguimiento 100% de los pacientes vivos se encontraban asintomáticos. Conclusiones: La técnica T-3 en 1 (3 tiempos quirúrgicos en un solo período de hospitalización) ofrece resultados comparables con los índices de éxito en recambios en uno o dos tiempos. La principal ventaja es que hay una mayor seguridad de haber efectuado una limpieza efectiva, lo que permite iniciar una rehabilitación inmediata sin tener que esperar semanas o meses para un reimplante definitivo como en el recambio en dos tiempos. Cada paciente debe tratarse en forma individual según los factores de riesgo de recidiva y las recomendaciones por parte de los paneles de expertos. Se propone una Tabla de decisiones para prescribir las técnicas de erradicación actualmente disponibles.

Abstract: Background: The impacts of chronic periprosthetic joint infection, variability in rates of recurrence and the lack of consensus as to what is the best way to treat it, require using alternatives. Does the alternative proposed here has a recurrence rate at least equal to or less than the methods used now? Material and methods: We were retrospectively studied 15 adult patients and analyze variables related to the host, implant, germ, diagnosis and recurrence rate. The surgical technique treatment protocol it's described. Results: Of the 15 patients, one was lost when he was 48 months follow up. In another the implant is definitely retreat. 2 died at 36 and 40 months after the replacement, there was doubt one of reinfection. Three recurred and were re-operated with the same technique. At follow-up cut, 100% of living patients are asymptomatic with out recurrence. Conclusions: The T-3 in 1 surgical technic (three times in one period of hospitalization) provides comparable results with success rates in one or two times. The main advantage is that there is greater confidence that you have making effective cleaning, launch an immediate rehabilitation, without having to wait weeks or months for a definitive reimplantation as 2 times replacement. Each patient should be treated individually according to risk factors of recurrence and recommendations made by expert panels. A decision table is proposed to prescribe eradication techniques currently available.

Revision Hip Arthroplasty with a Cementless Femoral Stem / 대한고관절학회지

PURPOSE: To evaluate the clinical and radiographic results of patients who received revision total hip arthroplasty using cementless femoral stems. MATERIALS AND METHODS: This study included 26 patients who underwent revision total hip arthroplasty using a cementless femoral stems in our hospital, between Jan 2000 and May 2010, and were able to be evaluated in the final follow-up. The mean age was 63.8 years at the time of the revision surgery, and the follow up period was an average of 45 months. The causes of revision were aseptic loosening in 11 cases, periprosthetic fracture in 6 cases, femoral osteolysis in 6 cases, and infection in 3 cases. The radiologic results were evaluated in term of subsidence, loosening, and the stress shielding. The clinical results were evaluated by the Harris hip score and thigh pain. RESULTS: Harris hip score improved from 41.2 points preoperatively to 85.8 points at the final follow-up. There were 5 cases that complained of thigh pain at the last follow-up. Subsidence of femoral stem of more than 10 mm was observed in 3 cases. Stress shielding was noticed in 6 hips. The 3 grafted strut allografts were completely fused with the host bone. Complications included 2 cases of intraoperative periprosthetic fracture and 3 cases of dislocation. CONCLUSION: We obtained favorable clinical and radiologic outcomes in revision total hip arthroplasty using a cementless femoral stems. However, thigh pain and stress shielding resulted from the diameter of femoral stem being too large.

Management of Osteolysis around a Stable Harris-Galante Acetabular Cup: Retention vs Revision of the Acetabular Component

PURPOSE: We analyzed and compared 30 clinical cases of acetabular osteolysis around a stably fixed acetabular cup, and this was managed by changing the liner along with retaining or revising the cup. MATERIALS AND METHODS: We analyzed 30 patients who underwent acetabular component revision or retention with a bone graft for osteolysis around a stably fixed Harris-Galante acetabular cup and these patients were followed up for more than 2 years. There were 7 cases with a conserved the acetabular cup and only the liner was changed, and 23 cases with a totally revised acetabular component. We compared the size of the acetabular cup, the thickness of the polyethylene liner, the progression of osteolysis and the clinical outcomes. RESULTS: The Harris hip score was improved in both groups. In the retention group, during an average of 59.9 months of follow up, 7 cases showed stable fixation and 3 cases showed locally advanced osteolysis. In the revision group, during an average of 57.2 months of follow up, all 20 cementless acetabular cups showed stable fixation. CONCLUSION: We suggest that in patients with osteolysis around the stable cementless acetabular cup, both methods show satisfactory clinical outcomes. But considering recurrence of osteolysis, cup revision is more reliable than changing the liner with a bone graft.

Combined Continuous Psoas Compartment Block and Sciatic Nerve Block for Revision Arthroplasty of the Hip in a Patient with Ankylosing Spondylitis : A case report / 대한마취과학회지

Ankylosing spondylitis is a chronic and systemic disease invloving the axial skeleton. In patient with involved cervical spine of the ankylosing spondylitis, endotracheal intubation by direct laryngoscope may be difficult or impossible because they have a limitation of cervical movement and anatomical anomalies. Additionally, ossification of the interspinous ligaments and the formation of bony bridges (syndesmophytes) between vertebrae, resulting in a classic "bamboo spine" appearance make difficult or impossible placement of an epidural or spinal needle. We report a case of a patient with long standing ankylosing spondylitis who underwent revision arthroplasty of the hip using combined continuous psoas compartment block and sciatic nerve block.

Changes of bone mineral density of the proximal femur in patients with revision total hip arthroplasty / 中国矫形外科杂志

[Objective]To understand the changes of periprosthetic bone mineral density(BMD) of the proximal femur in patients with failed hip arthroplasty by measuring with dual energy X-ray absorptiometry(DEXA). [Method]Periprosthetic BMD was determined in 9 patients with revision total hip arthroplasty by dual energy X-ray absorptiometry(DEXA),defining regions of interest according to Gruen(1~7),and comparing the operation side with the nonoperation side.Clinic results of the cases were evaluated according to Harris Hip Score(HHS).[Result]The mean HHS was 61 points in 9 patients at this follow-up examination.There was a significant decrease(8.9%~27.6 %) in BMD in every Gruen zone as compared with the nonoperation side.[Conclusion]The bone loss in the proximal femur in patients with failed hip arthroplasty is significant,and the pattern of bone loss around failed hip arthroplasty may be different from the typical remodeling seen after successful hip arthroplasty.

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.

Intrapelvic Pseudocyst After Total Hip Arthroplasty: A Case Report / 대한정형외과학회잡지

Many uncemented acetabular components use transfixation screws to stabilize the acetabular component until ingrowth of bone occurs. But the use of transacetabular screw fixation in total hip arthroplasty could increase the incidence of intrapelvic complications including neurovascular injury, extrinsic compression and erosion of intrapelvic organs. Metal debris was attributed to corrosion or fretting between screw and metal shell may lead to pelvic osteolysis. A foreign body reaction to metal and polyethylene wear debris in a loose acetahular component eroded the medial wall of the acetabulum and produced an intrapelvic mass. We experienced a case of intrapelvic pseudocyst in a failed total hip arthroplasty. The cyst communicated with hip joint through the transacetabular fixation screw which was placed near the center of the acetahulum.