[Reconstruction of Large Femoral Defects in Exchange Operations Following Artificial Hip Replacement]

Overview

Journal Unfallchirurgie

Specialty Critical Care

Date 1989 Feb 1

PMID 2652844

Authors

M Roesgen

U Heitemeyer

G HIERHOLZER

Affiliations

Soon will be listed here.

Abstract

Loosening of the implant is one of the most serious complication in case of total hip replacement. It is caused by the growth of a secondary cancellous channel and in destroyed bone cement. From 1981 to 1986 we operated 63 patients to exchange a loosened hip prosthesis. With 15 patients we have seen a severe damage of the femur shaft. Big parts of the bone tube were missed. To insert the new stem we had to reconstruct the proximal femur and the calcar region by autogenous cortico-cancellous bone grafts in seven cases. In three cases a large defect of the lateral femur cortex was reconstructed by extended cancellous bone graft. In five cases we found a cominuted fracture of the femur shaft. The osteosynthesis was performed by plating. The screws were inserted through the bone into the stem. They find a very strong grip in the polyacetal material. 14 of 15 patients operated in this manner could achieve a walking ability. Most of them improved one step higher in the evaluation scheme according to Merle d'Aubigne. One patient suffering from a septic loosening showed a severe exacerbation with septicemia and ended in a disarticulation of the hip joint. The so called isoelastic prosthesis gives a chance to reconstruct the femur tube. It allows unhindered calcification of bone graft and acts as a forming model for new bone. With this we are able to restore the movement of hip joint as well as weight bearing and working ability of the limb. Additional osteosynthesis is possible to perform.(ABSTRACT TRUNCATED AT 250 WORDS)

References

Ritschl P, Kotz R . Fractures of the proximal femur in patients with total hip endoprostheses. Arch Orthop Trauma Surg (1978). 1986; 104(6):392-7. DOI: 10.1007/BF00454440. View

Brand R, Pedersen D, Yoder S . How definition of "loosening" affects the incidence of loose total hip reconstructions. Clin Orthop Relat Res. 1986; (210):185-91. View

McGann W, Mankin H, Harris W . Massive allografting for severe failed total hip replacement. J Bone Joint Surg Am. 1986; 68(1):4-12. View

Aldinger G, Mitzkat K . [The effect of aging on endoprostheses]. Z Orthop Ihre Grenzgeb. 1986; 124(4):392-5. View

Schweiberer L, Eitel F, Betz A . [Cancellous bone transplantation]. Chirurg. 1982; 53(4):195-200. View

Delling G, Kofeldt C, Engelbrecht E . [Bone and border zone changes in the use of bone cements--long-term studies of human biopsy, surgical and autopsy material]. Aktuelle Probl Chir Orthop. 1987; 31:163-71. View

Willert H, Ludwig J, Semlitsch M . Reaction of bone to methacrylate after hip arthroplasty: a long-term gross, light microscopic, and scanning electron microscopic study. J Bone Joint Surg Am. 1974; 56(7):1368-82. View

Decker S . [The special problem of the replacement operation in cement-free prostheses]. Langenbecks Arch Chir. 1987; 372:477-80. DOI: 10.1007/BF01297866. View

Ecke H, Neubert C, Haas R, Rehm K, Volkel W, Schultheis K . [Results in autologous bone chip grafting - a treatment period of eleven years]. Unfallchirurgie. 1982; 8(6):392-8. DOI: 10.1007/BF02585567. View

10.

Draenert K, Rudigier J . [Histomorphology of the bone-cement contact. Experimental phenomenology of the osseous reconstruction processes. I]. Chirurg. 1978; 49(5):276-85. View

11.

CHARNLEY J . The reaction of bone to self-curing acrylic cement. A long-term histological study in man. J Bone Joint Surg Br. 1970; 52(2):340-53. View

12.

HIERHOLZER G, Heitemeyer U . [Surgical hip joint replacement with a cement-free fixation technic--indications, technic and results]. Langenbecks Arch Chir. 1987; 372:465-9. DOI: 10.1007/BF01297864. View

13.

Johanson N, Callaghan J, Salvati E, Merkow R . 14-year follow-up study of a patient with massive calcar resorption. A case report. Clin Orthop Relat Res. 1986; (213):189-96. View

14.

Claes L . [Theoretical principles of the cement-free prosthetic technic]. Langenbecks Arch Chir. 1987; 372:441-6. DOI: 10.1007/BF01297861. View

15.

Kuner E, WEYAND F, Domres B . [Functional capacity of autologous spongiosa in the treatment of bone disorders]. Monatsschr Unfallheilkd Versicher Versorg Verkehrsmed. 1972; 75(5):189-202. View

16.

DAUBIGNE R, Postel M . Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954; 36-A(3):451-75. View

17.

LEITZ G . [Simple alloplastic treatment of severe hip dysplasias and replacement operations in extreme loosening]. Z Orthop Ihre Grenzgeb. 1985; 123(3):278-82. DOI: 10.1055/s-2008-1045150. View