Effect Analysis Of Revision Hip Arthroplasty

Background and ObjectiveRevision of total hip arthroplasy (RTHA) is the reoperation after total hiparthroplasty(THA) because of prosthetic loosening, infection, dislocation and theother reasons that inducing lower quality of patients’s life. These operations consist ofrevision of acetabular cup, revision of femoral component and revision of total hipprosthetic. For recent30years, with the promotion of techniques and equipment,more THA were performed, and thus more RTHA are needed. RTHAs are much morecomplex and call for higher skills from surgeons because of the chaos in localanatomy, bone defection and substantial infections, so the complexity may satisfypatients less. RTHAs also combine with higher possibility of complications, likeparaprosthetic infections, prosthetic dislocation, thrombosis, nerve paralysis,paraprosthetic fraction. Researches had proved less satisfaction in RTHA withcemented prosthetic and better result in non-cemented prosthetics，Which makesmany surgeons inclining to use biological prosthesis during joint revisionsurgery.Bone defection is made up by bone transplantation instead of cements.Although the use of cementless prosthesis has its obvious limitations in the clinical,for elderly patients with osteoporosis, low joint activities, joint infection and bonedefects serious etc. still requires the use of antibiotic bone cement. The purpose ofRTHA is to (1) release pain (2) prevent bone loss (3) restore bone tissue (4) rebuild anatomy and function of hip joint. Our research, through short term follow-ups of ourRTHA patients, is to discuss the repair of bone defection and rebuild of hip joint inRTHA.MethodSince2007.1to2013.12,38RTHA were performed in our hospital, including26males and12females,17cases for left sides and21cases for right sides. The averageage is63.5(43-75). For diagnosis for the primary THA,17cases are femoral headnecrosis,9cases are osteoarthritis after dysplasia of hip joint,7cases are femoralneck fracture,5cases are hip joint stiffness following ankylosing spondylitis. Theaverage revision time is8.2(5-16) years.16cemented prosthetics and22non-cemented prosthetics were performed in primary THA. For reasons of the RTHA,2cases are for femoral fracture,14cases are for subsidence of the femoralcomponents,11cases are for cup dislocation,10cases are for cup and femoralcomponents dislocation,1case is for paraprosthetic infection. All cases havesignificant pain which is aggravated in walking,28patients are combined with hipmovements impair. All cases have bone defection,24cases are with severe bonedefection, they are classified based on Paprosky Classification:8cases of type I,12cases are type II,4cases type III.27patients have bone defection in their femoralside, based on Paprosky Classification,12cases are type I,9cases are type II,6casesare type III. Different strategy were conduct depends on Paprosky classification. Forthe acetabular part, only normal non-cemented cups were used in8cases of PaproskyI class. Impacting bone shaft combined with a larger diameter cup were used in6cases of Paprosky IIA patients. Impacting bone shaft with Jumbo cups were used in3cases of Paprosky IIB and IIC, and used3screw to assist fixation. We trimedallogeneic structure bone of the distal femur according to the shape of acetabularbone defect, then implanted it to the top of the acetabular bone defects, then fixed itby three cancellous bone screws. Finally,acetabular structure bone was filed so that itmatches the cup surface, then we used the biological hemispherical acetabular cup topress in1case of IIIA patients. Titanium mesh repaired the defect bone at thebottom of the acetabulum, then suppressed the bone layer by layer. Finally we selected the acetabular reinforcement ring and Cementless acetabular to fasten in3cases of IIIA patients.For the femoral part, normal non-cemented stem were used inPaprosky I patient, long-stem parasthesis were used in6cases of Paprosky II patientswith bone shaft impaction.3cases of patients with type Paprosky Ⅱ, considering itsolder, severe osteoporosis, less activity, were fixed by cementless Long-handledprosthesis in the surgery.6cases of Paprosky IIIA patients are implanted in modularfemoral prosthesis. Harris score system were used to assess patients’ joint function,SPSS were used for statistic analyses.ResultsAll38patients were well followed up for6months to7.1years,5.6years onaverage.5cases were found deep vein thrombosis and got anti-coagulation therapy.34patients had their pain relieved, they can walk without assist.3got partial painremission with cripple.1case had their operation leg8mm less than the normal one.In the last follow up,1case showed undesirable healing in their plain film,1cup and2femoral part showed paraprosthetic bone dissolve, no other complication werefound. The preoperation average Harris score was36.5±6.9, and in the last follow-up,a average of89.3±7.3scores were tested, with52.8±7.1scores improved. Accordingto these,15cases got excellent results,16cases are good,6cases are normal,1caseis bad.Conclusion1. RTHA can significantly release pain, restore joint function, improve patientslife quality, help patients get a better function in their hip joint.2. In the RTHAs,the choice of biological prosthesis is fixed and satisfactory inmost cases.3. In the RTHAs, properly repair bone defection and selected the right type ofprosthetic can help get a better result.