Le revisioni acetabolari con cemento in compressione armato nei difetti di grado II e III dell’AIR

Abstract

The work describes a new technique to reconstruct the acetabulum in the course of aseptic re-prosthesing of the hip. Two hundred and eighty six (286) patients — from 1996 to 2008; aged between 65 and 86 — were treated because of an acetabular component mobilization (80% cemented cup, 20% uncemented cup) with several degrees of bone loss, always with serious reabsorption of the superior dome of the acetabulum. The surgical technique during reconstruction of the bone loss of the superior dome of the acetabulum consists in the application of acrylic cement under compression, first with appropriate surgical instruments; then the ring was reinforced with screws through the acrylic cement and fixed on the bone. Two hundred and twenty one (221) patients were visited and checked every six months and X-ray examinations were performed. None of the patients reported clinical symptoms related to the acetabulum. X-ray images show that a restabilization of the rotation center of the hip was achieved in 92% of cases. No mobilization of the new prosthetic device was evidenced. Only in 6 patients X-rays show a radiolucent line at the cement-bone interface, which occurred during the first six months after the surgical intervention but did not progress afterwards. While examining the results obtained using this new technique, it is worthwhile to evaluate them in comparison to those in massive transplants or bone chips transplants, procedures employed in the reconstruction of the acetabulum in patients older than 70 or afflicted by such pathologies as cancer, renal and hepatic disorders, hematological and immune diseases. We often see in those patients that bone transplant is only partially restored, with risk of a later prosthesis mobilization. Another advantage of this technique is the fast execution of the procedure once the educational stage has been accomplished.