| Objective:Compare windowing the femur diaphysis,ETO and non-osteotomy for difficulty hip implants extraction in revision surgery to evaluate clinical efficacy.Methods:1.A retrospective analysis was made in the data of 18 patients(18 hips)with primary hip arthroplasty and treated with windowing the femur diaphysis for implants removal between January 2014 and March 2019.Nineteen patients(19 hips)without windowing the femur diaphysis for implants removal associated with femur revision surgery at the same stage were chosen as control group:10 of those treated with ETO in the in revision surgery and 9 cemented case treated without osteotomy to remove cement in revision surgery.2.Windowing method:Based on X-ray image and preoperative measurement to determine the length of the implant and bone growth area or bone cement sleeve,mark the position of the window opening with lectrocoagulation electrotome,and use drill to draw the four corners along the mark.Make a femoral window osteotomy to ensure that each osteotomy surface is a 60° slope so that the anatomical reduction can be achieved when the osteotomy block is replanted.The end of the window should exceed the distal end of the cement or the plug of the cement for bone cement stems in primary surgery.The end of the window beyond the distal end of the prosthetic bone growth for cementless stem in primary surgery.The length and width of the window depends on the size of the prosthesis and the medullary cavity.Through the window and remove the bone cement between the cortical bone and the prosthesis or the bone that has grown in under direct vision.If the prosthesis still difficult to remove,then retrogradely strike at the end of the prosthesis retrogradely with remover.After the prosthesis is removed,carefully remove all bone cement.Extend the window proximally or distally if necessary.Use cementless stem for revision surgery if feasible to press-fit the new stem in the proximal femur,if not use extensively porous-coated stem and the length of the prosthesis exceeds the end of the window.Carefully observe fracture or perforation,replant the osteotomy bone block.If there were bone defects,use autologous bone or allogeneic bone graft.Use with Vicryl suture for fixation instead cables or wire.3.?Record the operation time,blood loss and postoperative complications.The patients had their postoperative examination 6 week after surgery,and 3 months,6 months,and annually.Those who fail to return to the hospital for routine review should be followed up by telephone.?The Harris score was used to evaluate the hip function and the visual analogue scale(VAS)score was used to evaluate the pain degree of hip,the abductor muscle strength was evaluated by the Medical Research Council scale.?Using radiographic follow-up to evaluate windowing lids re-osseointegrated and implant position.Compare the X-rays each review,observe bone loss around the prosthesis,stem subsided,implant loose prosthesis and infection.?Assess and record the complications related to fixation using a cable or wire cable.4.Enter the above data into the computer,and use SPSS 22.0 statistical software to perform statistical analysis on operation time,blood loss,Harris score,VAS score,and abductor strength score data of the two groups of patients.The data are expressed as mean± standard deviation.The independent t-test was used for comparison;the test level was ?=0.05.Results:?The operation time of the windowing group(180.55 ± 20.50)mins was shorter than that of the non-osteotomy group(222.22±17.87)mins,the difference has statistical meaning;there was no statistically difference compared with the ETO group(178.00 ± 22.50)mins.The blood loss in the windowed group(822.22 ±163.79)mL was lower than that in the non-osteotomy group(1055.55±101.37),the difference has statistically meaning;there was no statistically difference compared with compared with the ETO group(760.00± 179.19)ml.?At 6 months and 1 year after operation,there was no statistically difference in Harris score,abductor strength and VAS score between the windowing group and the non-osteotomy group.At 6 months after surgery,the Harris score in the windowing group was higher than that in the ETO group,and has statistical meaning;because patients who used ETO technology avoided early abduction function exercises,it was inconvenient to measure the abductor strength score at that time;At one year,the abduction muscle strength score of the windowing group was higher than that of the ETO g group,and has statistical meaning;there was no statistical difference between the Harris score and the VAS score.?Postoperative subsidence was observed in two instances,but was irrelevant for implant stability during follow-up.They subsided 5mm and 7mm in the first 3 months,and no further subside was seen after 6 months of follow-up.X-ray showed that all cortical lids were re-osseointegrated.No fracture nonunion or obvious deformity was seen.Healing.One year after surgery,all patients were able to walk with weight bearing.There were no indications for other revision surgery during follow-up in all case.No implant loosening,infection,or cortical lids migration was seen? No complications related to fixation using a cable or wire cable was seen during short-term follow-up.Conclusion:1.Compared with cases removed bone without osteotomy for revision surgery,the femoral windowing can significantly shorten the operation time and reduce blood loss,and there is no significant difference in hip function in short-term follow-up.2.In windowing technique,the proximal of the femur with the muscle insertions remain intact,so it can avoid the complications like cortical lids migration and the displacement of the osteotomy block during the early exercise of the hip.Short-term follow-up showed that the hip function was better than the ETO group.3.The osteotomized fragment in window technique is smaller than ETO,so it can be fixed without cable wire or titanium band and avoid related complications. |
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