Distally locked stem for complex femoral revision

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• 作者：Henri Migaud ; Antoine Gabrion ; Patrice Mertl
• 关键词：hip prosthesis ; loosening ; peri-prosthetic fracture ; osteolysis ; septic loosening ; peri-prosthetic bone loss
• 刊名：Operative Techniques in Orthopaedics
• 出版年：2004
• 出版时间：April 2004
• 年：2004
• 卷：14
• 期：2
• 页码：130-136
• 全文大小：589 K

文摘

Distally locked stems were introduced in France in 1988 to address complex femoral revisions of hip replacements. These complex revisions involve severe femoral bone loss (secondary to osteolysis with extension to the femoral shaft) or femoral shaft fractures that could not be adequately treated by a conventional cemented or cementless stem. The goal of this specific design is to provide an excellent stability during the surgery by means of the locking mechanism and to enhance the bone reconstruction (without bone grafting) by obtaining an intimate contact between the living bone and the proximal HA-coating. A combination of a posterolateral and transfemoral approach is recommended to facilitate, without compromising femoral vascular supply, the complete removal of the prior implants and to modify the femoral diameter until an intimate contact is obtained between the bone and the stem. In a preliminary report, the 2-year and 8-year survival rates were 93 % and 90 % , respectively, considering a reoperation for any reason as the endpoint. Moreover, the severity of the preoperative bone loss or the occurrence of a periprosthetic fracture did not influence these outcomes. Distally locked stems are mainly indicated to treat complex femoral revisions but should also be considered in addressing the problem of femoral deviations combined with loosening. The clinical success of these implants in situations of serious bone deficiency is reason to extend their indications with success to less complex revision procedures.