Некоторые аспекты ревизионного эндопротезирования тазобедренного сустава. Пластика костных дефектов губчатыми аллоплантами

Abstract

Purpose To compare the incidence of hip implant loosening in cemented and uncemented fixation, to work out the recommendations for bone cement removal from the femoral canal and to evaluate the efficiency of using spacers and the proposed technique of filling the bone defect of the acetabular components. Materials and Methods The authors present the analysis of indications for performing revision hip arthroplasty and the relative frequency of performance after using the implants with uncemented and cemented fixation. Twenty eight (84.8%) out of 33 patients with implant instability had implants with cemented fixation. The authors focus on the need of sparing removal of the primary implant. A technique of bone cement removal from the femoral canal with the preservation of the proximal femur is proposed. The use of allogenic spongy bone grafts produced from the utilized femoral heads at the FSBI All-Russia Centre of Ophthalmic and Plastic Surgery of the RF Ministry of Health (Ufa) is offered for bone defect plasty Results Among 33 patients, good results were obtained in 23 patients (80-100 points according to W.H. Harris score) with the outcome of functional joints at follow-ups (range: 3 to 8 years), and fair outcomes in four (4) patients. The implant stem sinking developed in two patients within one year after surgery that required the replacement of the stem. The outcomes were good at follow-ups of five to seven years. Conclusion The presented technical solutions for performing revision hip arthroplasty can be used in orthopaedic practice.