Les révisions de prothèse totale de hanche pour complications aseptiques

Abstract

Aseptic complications can compromise the results of total hip arthroplasty (THA) and require partial or total revision. The most frequent are loosening, usually combined with peri-prosthetic osteolysis, isolated osteolysis, instability and peri-prosthetic fractures. Unexplained pain is not, in principle, an indication for revision. Revisions are technically demanding. They require more complex instrumentation and revision components and greater surgical expertise than primary implantations. For these reasons, they should be performed in reference centers. The number of elderly patients with comorbidities is increasing, which requires experienced anesthesiologists. Morbidity and mortality rates are higher than after primary implantations. The most devastating complications of revision surgery are infection, followed by mechanical complications due to removal of well-fixed components and implantation of the new components, hematoma due to surgical bleeding and anticoagulation therapy, thrombo-embolism disease and comorbidities decompensation. Patients and their relatives should be carefully informed of these risks. Results of revision surgery are satisfactory but residual muscle weakness in not unfrequent and explains persistent limp, especially in re-revisions. Recent improvements include modular metallic acetabular revision augments and well-designed revision stems which permit to face extensive bone loss. They could improve revision THA survivorship. Customized components, designed with the help of 3D printing, are very rarely indicated.