Mid-term results of previously cemented hip arthroplasties revised with uncemented modular femoral components: a retrospective study.

BACKGROUND: We evaluated the mid-term results of previously cemented hip arthroplasties revised with uncemented modular femoral components. METHODS: The study included 40 patients (36 females (90 %) and 4 males (10 %), mean age 67.6 years, range 39-87 years) who underwent revision of a previously cemented hip prosthesis with an uncemented modular femoral stem between 2005 and 2009. The indications for revision were femoral aseptic loosening in 38 (95 %) cases and acetabular protrusion in 2 (5 %). According to the Paprosky classification, the femoral defect was type 1 in 10 (25 %) patients, type 2 in 16 (40 %), type 3a in 11 (27.5 %), type 3b in 2 (5 %) and type 4 in 1 (2.5 %). The Harris hip score was used for the clinical evaluation. Femoral vertical subsidence, the cortical index and femoral stem stability were assessed radiologically. The mean follow-up period was 84 months (range 61-95 months). RESULTS: The mean Harris hip score was 41.4 (range 35.4-44.4) preoperatively and 80.9 (range 65.6-98.3) at the final follow-up examination (p < 0.05). Mean vertical subsidence was 5.7 mm (range 2.5-10.5 mm) in seven (17.5 %) patients. Stable bone fixation was observed in 38 (95 %) patients, fibrous stable fixation in 2 (5 %) and no instability in any patient. Radiographs taken during the early postoperative period revealed that the cortical index was a mean of 1.34 (range 1.11-1.73) and a mean of 1.55 on the final follow-up radiographic examinations (range 1.16-1.91) (p < 0.01). CONCLUSIONS: Satisfactory results were achieved using uncemented modular femoral components during revision of previously cemented femoral components. Many modular femoral stems provide primary stability by filling femoral bone losses and help determine stem length, offset and anteversion.

[Combined spinal epidural anesthesia in a patient with advanced kyphoscoliosis]. / Ileri derecede kifoskolyotik hastada kombine spinal epidural anestezi deneyimimiz.

Kyphoscoliosis is a progressive disease that worsens with age. While applying anesthesia, kyphosis and/or scoliosis can lead to difficulty in both during endotracheal intubation and also performing regional interventional technics. In addition to aging and the direct effects of deformity such as neurological deficities and immobility; deterioration in cardiopulmonary functions can also develop in these patients. In this case, we aimed to report combined spinal epidural anesthesia experience in a-60-year-old woman with advanced kyphoscoliosis who underwent left femur periprostetic fracture operation. Spinal anesthesia was performed through L3-L4 intervertebral space by single dose of 10 mg %0.5 hyperbaric bupivacaine and epidural catheter was taken in for additional anesthesia and postoperative analgesia. Sufficient sensorial and motor block was provided and sensorial block was highen up to T6 dermatome level. There was no complication during the peroperative period and succesful anesthesia was established. Finally we conclude that combined spinal epidural anesthesia is a good alternative to general anesthesia in both reducing and preventing hemodynamic and respiratory complications for an elderly patient with kyphoscoliosis.