The Goal of Ensuring the Stability of our Reconstruction

Dr. Alfredo Rodriguez, Hospital Universitari Sant Joan, Reus, Spain

Hip revision surgery is still a challenging procedure. On the acetabular side, bony defects sometimes need important reconstruction using allograft or Trabecular Metal™ augments to treat the structural defects. Femoral revision implants permit us an important choice of devices allowing femoral reconstruction of basic biomechanic hip parameters such as leg length and anteversion. In between, we need to recover mobility and, most importantly, stability to have a sufficient functional result for the patient. Acetabular reconstruction needs a cup well fixed on the augment reconstruction and bone. The cup will receive a modular polyethylene inlay to achieve complete acetabular reconstruction. On the femoral side, we need a prosthetic head totally compatible on the conus parameters in order to ensure stability and to avoid corrosion problems or fractures. In these difficult surgeries, final stability will be achieved depending upon the quality of soft tissues and muscular insertions.

Clinical experience demonstrates that we have been able to obtain better intrinsic prosthetic hip stability using large diameter heads.1 Dual mobility cups have been used for more than 40 years and allow us to achieve stability in those cases. The idea of using dual mobility cups with Trabecular Metal augments on the acetabular side and a long, straight or modular stem on the femoral side allows achievement of the goal of ensuring the stability of our reconstruction.

This is especially true in big, soft tissue defects such as tumors, second stage infection or in technically demanding procedures with multiple revisions on both sides of the hip. In such cases, clinical and radiological short-term results can be successful.

  1. Chen, AF. Hozack, WJ. Orthop. Clin. North Am,, 2014 vol. 45(3) pp. 275-86. 2. Gunther, KP. Et al. Danish Oper Orthop Traumatol, 2014 vol. 26(2) pp. 141-55

 

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