Complex revision hip arthroplasty for aseptic implant instability with 3D-modeling

Abstract

The increasing number of hip replacement surgeries in the worldwide practice causes the progressive increase in revision cases. The treatment of patients with instability of the hip implants requires the individual approach, taking into account the size of the defect, the loss of bone mass and the structural state of the bone in each case. Objective. To show the technical opportunities of the revision cementless implants in combination with 3D-modeling for the treatment of acetabulum massive defects. Methods. It was shown the cli­nical case of hip replacement surgery of the patient with the aseptic instability of endoprosthesis components. A 3D-model of the pelvis and femur was created on the basis of the СT scan in order to make an analysis of bone tissue defects and to select the exact size of implant components for revision surgery. Results. It was suggested a standardized methodology of the preoperative examination to make the high-tech operation easier and maximally effective. It is necessary not only to take into account the results of the X- ray analysis, but also to pay attention to all changes in the damaged segments. It was shown that the real plastic model make the work of the surgeon easier during all steps of the treatment. The opportunity to use the standard revision components for the restoration of the complex geometrically shaped bone was demonstrated with the good nearest clinical and radiological and functional results. Conclusions. The success of the revision arthroplasty depends on the carefully preoperative planning, the maximum approximation of the parameters of the artificial joint to the anatomical parameters of the patient and biomechanics of the hip join. No less important is the individual recovery program during the postoperative period.