Fashioning of an Anterolateral Femoral Bony Lid for Revision Hip Arthroplasty
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Wolfram Thomas 1, Sascha Thomas 2, Luca Lucente ~
- چاپ و سال / کشور: 2002
Description
ObJective Safe removal of a loosened or broken femoral stem together with cement particles and soft tissues. Preparation of the implant bed under direct vision and exact fitting of the new stem. Restoration of pain-free hip motion. Indications Exchange of loosened or broken femoral stem, its simple extraction being impossible or fraught with complications and time-consuming. Contraindications Exchange procedures that can be performed without resorting to an anterolateral bony lid. Surgical Technique Anterolateral approach over the extent of the femoral stem plus cement plug. Fashioning of an anterolateral bony lid (approximately one third of the shaft circumference). The remaining part of the lateral cortex remains undisturbed. If at all possible, a proximal bony ring should be preserved. Distal part of the lid is shaped like a keel. Removal of stem, cement, granulation tissue, and necrotic bone. Reconstruction of the bed for the new femorat stem. All bony cavities are cleaned with a burr and filled with autogenous or allogenic bone. Insertion of revision stem protruding proximally by 1 cm. Closure of the lid. Stabilization with three cerclage wires. Final stable seating of the stem by gentle hammer blows. Results This approach was used in 49 patients (average age 65 years [26-98 years]). Two patients died of unrelated causes, two could not be reached. The remaining 30 women and 15 men were followed up for 8.4years (1-14 years). The average Harris hip score improved from 36 to 84 points. All osteotomies consolidated.
Orthopedics and Traumatology
