The Treatment Of Bone Defect And Curative Effect Analysis In Revision Of Total Hip Replacement

Objective:Through the analysis of postoperative follow-up total hip replacement cases,to investigatethe causes of revision and the treatment of various types of bone defects,to evaluate the clinicalapplication effect.Methods:We retrospectively reviewed48patients,who had been operated in the Second department of ourOrthopedic,losing access in2patients,46patients(47hips)of residual bone defect treatment andfollow-up analysis.Follow-up22males(23hips) and24females,renovated aged46to92years,mean71years,Which left26hips,21right hips.Initial reason for hipreplacement:Osteonecrosis of the Femoral Head12patients,ankylosing spondylitis11hips,rheumatoid arthritis8hips,Osteoarthritis6hips,developmental dysplasia of hip4hips,Femoral neck fracture3hips,Intertrochanteric fractures3hips.The renovated main reasonincluding:aseptic loosening32patients,periprosthetic femoral fracture7patients,septic loosening5patients,habitual dislocation2patients(3hips).Initial hip replacement renovation operativetime was0.3years to17years,an average of about10years. The survival duration from the firstoperation to the revision was less than1year for4hip,2～5years for8hips,6～10years for9hips and10～15years for26hips.Be renovated by selecting the appropriate method,follow-upresults to the Harris hip score,the location of the pain visual analog scales,and X-ray hipprosthesis and the surrounding bone changes as the evaluation index,and the related literature toanalyze the efficacy. Results:1. Total hip replacement reasons mainly includes:aseptic loosening,periprostheticfemoral fracture,septic loosening and habitual dislocations,aseptic loosening is the most commonoriginal.2.46cases of48patients were followed up,lost access in2cases,follow-up time13to68months,with an average follow-up of29months,Harris hip score by total hip replacement(53.15+11.41)points(29~67points) increased to renovated after12months(91.23+3.43)(83~98)(P<0.05);Average visual analog scales(VAS) was raised to the renovation of12months aftersurgery(1.2+1.2)points(0~3)(P <0.05),before total hip arthroplasty (7.8+1.1)points(5~10).3. In the process of renovation,by choosing appropriate prosthesis and givecorresponding treatment can effectively restore bone graft around the hip bone mass,the stabilityof the reconstruction of the hip joint,to improve the function of the hip.To found duringfollow-up the periprosthetic bone graft at bone healing,no prosthesis happen again signs ofloosening,3patients v. hip pain discomfort,4cases of deep venous thrombosis,2cases of sciaticnerve injury,and six months after the self-healing.4. According to the Vancouver typing take a different approach for renovation in theperiprosthetic femoral fracture,this group of seven patients were followed up for patients withfractures healed,no infection and fracture fixation complications.5. The5cases of infected patients,intraoperative bacterial culture found cases ofE.coli,one case of Bowman Acinetobacter, three cases no significant bacterial growth.Phase IIrevision surgery,no recurrence of infection in the short-term follow-up,around the hip painsignificantly reduced,the function also improved.The hip to Hariss on average increased by totalhip arthroplasty(51.20±8.34)points(43to64)to renovation after12months(92.20±4.02)points(86to97)(P <0.05) pain visual analog scale(VAS)from an average of total hiparthroplasty(8.0±0.7)points(7-9)after renovation reduced to12months(2.4±0.9)points(1to3)(P<0.05).Conclusion:Total hip replacement procedures,depending on the overhaul reason and adopt differentways of renovation,can significantly alleviate pain and improve the function of the hip,hip recentfollow-up curative effect are satisfied.