Clinical Analysis Of Causes And Methods For Total Hip Arthroplasty Revision Summary

Objective: Revision of total hip arthroplasty is the surgery to fix artificial hip dysfunction caused by prosthetic infection,prosthetic fractures,prosthesis loosening,sinking and repeated wear and tear etc.after total hip arthroplasty.Over the past 20 years,along with rapid economic growth,people's living standards gradual improved,new technologies,new materials,research and development breakthroughs and innovation,thus the demand of total hip arthroplasty has greatly increased,there for the demand of revision has also increased,importance of total hip arthroplasty revision is more than ever.Because of anatomical disorder(for example,sciatic nerve and scar tissue adhesion),original prosthesis remove difficulty,acetabulum and femur bone defect,the surgical difficulty and skill application of revision is much higher than first hip arthroplasty.The purpose of this study is through retrospective analyze the total hip arthroplasty revision of our hospital in recent 5 years,and respectively analyze the reasons for revision,prosthesis of revision in clinical application,short term follow-up and relevant revision technology,thereby help to improve the success rate and effectiveness of total hip arthroplasty revision.Methods: Retrospective analysis 85 cases revision total hip arthroplasty from January 2010 to December 2015 at orthopedics of Hebei Medical University Third Hospital,among them are 35 male and 50 female,from age29 to 86,average age 61.82,right hip arthroplasty 38 cases and left hip arthroplasty 47 cases.The reasons for their first hip arthroplasty: 1 case of rheumatoid arthritis,2 cases of giant-cell tumor of bone at proximal femur,1case of ankylosing spondylitis and left hip stiffness,2 cases of traumatic osteoarthritis,32 cases of femoral neck fracture,44 cases of femoral head aseptic necrosis,1 case of hip tuberculosis,2 cases of acetabular dysplasia.The prosthesis of their first hip arthroplasty: 46 cases of biotype hip prosthesis,18 cases of bone cement prosthesis,21 cases of hybrid prostheses for total hip.Time between their first hip arthroplasty and revision: 19 cases in one year,10 cases are 1 to 3 years,11 cases of 3 to 5 years and 45 cases over 5 years.Causes of revision: 52 cases of aseptic loosening,8 cases of prosthetic joint infection,1 case of prosthetic fracture(lining fragmentation),1 case of prosthesis head fragmentation,13 cases of prosthesis habitual dislocation,10 cases of periprosthetic fracture.Acetabular revision: 23 cases of revision with biotype TOP acetabular cup(impaction bone grafting)and highly cross-linked polyethylene liner,51 cases of titanium mesh reinforcement ring(impaction bone grafting for acetabular bone defect)fixed with bone cement,11 cases of biotype large acetabular cup.Revision of the femoral side: 33 cases of bone cement stem,50 cases of non-bone cement stem(35 cases of Link MP Hip Stem,10 cases of biotype microporous wide coating distal fixation cone prosthesis,5 cases of biotype microporous proximal coating).Follow-up patients to evaluate hip function by harris hip score and radiology test,and evaluate the clinical efficacy of total hip arthroplasty revision.Results: All patients above has been followed up,average follow-up is30.2 months,12 patients had limb venous thrombosis after revision,treat with therapeutic dose anticoagulant,4 weeks later,color doppler ultrasound examination for both deep vein of lower limbs shows thrombosis recanalization.1 patient had posterior dislocation of the prosthesis 1 month after revision,thus applied closed reduction failed,than applied open reduction and adductor muscle release surgery,and gave patient brace fixed nail shoes for 3 months.The patient could walk with a crutch by the time of last follow-up.Wound healing well for rest of patients,prosthetic position and bone around fixed well,no fracture,loose,shift,sinking,osteolysis and other complications around prosthesis.Hip function has been greatly improved.All Harris Hip Score after last follow-up: before revision 30.07 in average(10-53.29),after revision 90.32 in average(78-96),significantly improved after revision.There are 55 cases of excellent,28 cases of good,2 cases of fineand no poor cases.Different between harris hip score before and after revision has statistical significance(P<0.05).All patient wound healing well,no dislocation,no infection,and hip function has been greatly improved.Conclusion: Aseptic loosening of prosthesis is the main reason of revision,secondly is infection of prosthesis.Acetabular wall defect and femoral bone loss are the primary difficulty during the revision.Should be fully prepared for possible situation and accident during revision and reasonably choice prosthesis based on bone defect,also apply artificial total hip arthroplasty revision as soon as possible after THA failed.The revision of artificial total hip arthroplasty gave patients stable and well-functioning artificial hip once again,thereby lift the pain,restore their hip function and improve life quality of patients.