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

Objective：The reconstruction of acetabulum and femoral bone defect comes with more andmore revision of total hip arthroplasty. This paper retrospectively analyzed theshort-term curative effect of the reconstruction of bone defects in revision of total hiparthroplasty, investigate the reasons of operation, summarise the experiences andprovide experience and the theoretical basis for surgeries in the future.Method:We follow up69patients that have revision of total hip arthroplasty in ourdepartment from June2007to August2014. Three of these patients have died ofillness and five loss to follow-up for address changes.61patients (31cases forwomen,30cases for men) were selected with an average follow-up of30monthsfinally. The average age is34. Review Harris score and Visual analogue scores ofpreoperative and postoperative on the affected side, the causes of primary total hiparthroplasty and the overhaul distance first replacement. According to the imageinformation, we classify the defect of the acetabulum and femur bone. Analysis therecovery of hip joint function preoperative and postoperative and reconstructionstrategy of every classification.Results:1、 Ischemic necrosis of femoral head is the main reason of the first artificial hipreplacement, but there is a clear difference between men and women, women tend towith femoral neck fracture. The most common cause of the renovation is a prostheticaseptic loosening.2、47in61patients underwent total hip revision procedures,8patients underwentacetabulum revision procedures and6patients underwent femoral lateral revisionsurgery.21cases of Paprosky Ⅰ of acetabular defect,the main reconstruction ofbone defect is common acetabular prosthesis.18cases of Paprosky Ⅱ, the main strategy of reconstruction of bone defect is oversized creatures acetabularprosthesis or add particles graft to revision.16cases of Paprosky Ⅲ, the mainreconstruction of bone defect is common acetabular prosthesis Cage＋bonecement prosthesis＋granular bone graft or use bone cement composite metal mesh.All these methods can get better results. Paprosky Ⅰof femoral bone defect is16cases,14cases of Paprosky Ⅱ,13cases of Paprosky Ⅲ,10cases of PaproskyⅣ. For femoral defect limited proximal femur (Ⅰ, partial Ⅱ) can use ordinary orextensively coated prosthesis. Defects widely and involving the femur narrow(Ⅲ,Ⅳ),group matches prosthesis＋bone graft technology can achieve good reconstruction.Custom-made tumor prosthesis can be used in the proximal femur huge defect.Cement prosthesis can be widely applied in acetabular and femoral bone.3、 In follow-up of61cases of patients, the Hariss score of affected side which wentrevision of total hip replacement in short-term follow-up (32.87±19.42months) wasimproved from renovation of preoperative (42.46±13.69) minutes (15-76score) torenovation after the last follow-up(82.92±18.47) minutes (6-100score)(P＜0.05).Pain visual analogue scale (VAS) also have a satisfactory result. The average scoredecreased from renovation of preoperative (4.67±1.74) minutes (1-8score) torenovation after the last follow-up(1.2±1.84) minutes (0-8score)(P＜0.05).4、Combined with in the last follow-up and postoperative X-ray found that the bothlegs length of most of patients is equal or less than2cm. But there are two cases ofpatients with leg length difference of about4cm. Femoral eccentric torque and frontrake had a good recovery. Bone graft all were osseous healing. One of prosthesis hasloose signs again.4cases of postoperative complained discomfort and continued painand one of them can only stay in bed case of severe pain.1cases has symptoms ofsciatic nerve damage, but the symptom of pain disappeared after surgery.1cases offollow-up postoperative acute infection given incision debridement and drainage andhad a good recovery after operation. There are3cases of patients with sinusformation.Conclusion:Revision of total hip replacement surgery according to different types of bonedefect take a different method of bone defect reconstruction, which can effectively restore the hip joint function and relieve patients’ pain symptoms. Short-termfollow-up curative effect is satisfied.