Review And Analysis Of Revision Of Total Hip Replacement

Objective: To investigate the reasons,short-term effects and techniques of the revison of the total hip replacement through the review and analysis of the operations performed in our departmen during the past 14 years.Data and Methods: 1.general information:Between August 2004 and March 2009, a total of 28 hips in 27 patients underwent the revisions of the total hip replacement. Among the patients, 13 were male and 14were female, with their ages ranging from 28 to 72 years and an average age of 54.8 years. The bilateral arthroplasty was performed in 1 patient and the unilateral arthroplasty in 26 patients(13 left and 13 right). The reasons of primary operations include fracture of femoral neck(13),ischemic necrosis of the femoral head(14) and ankylosing spondylitis(3).7 of these underwent the femoral head arthroplasty,and 20 of these underwent total hip replacement. Prosthesis used in the primary operation included 15 bone-cement type and 12 biological fixation type.The time between the primary operation and the revison of the total hip replacement ranged from 1month to 18 years, with an average age of 58.8 months.2.Methods:Review the reasons of revisons of the total hip replacement,and discuss the short-term effects and technical considerations.Results :1. Ther are no occurrence of infection,injury of blood vessel and nerve and DVT after operation in two weeks.2.The reasons for revisions in the cases were as follows: aseptic loosening (20,70.08%),dislocation of the prosthesis (2,7.4%),infection (4,14.82%) and fracture (1,3.7%) after the primary operation.3. All the patients were followed up for 2 months to 2 years(averaged 1.5 years ). Ther are no occurrence of dislocating , lossing and fracture of the prosthesis. One of them recieived endo fixture because of delayed healing,and one of them had fracture of femoral shaft due to falling down,while the good results were achieved in the others.4.Complications during operation were fracture around the prosthesis of femur(PFF) in three persons,and post-operative complication was fracture of femoral graft in one person because of falling down from the bed.5. The Harris scores before operation ranged from 21. 8-61. 6,with an average of 40. 7,and scores after operation ranged from 62. 2-87. 8,with an average of 76. 8. The differences between peroperation and postoperation were significant.Conclusion: The main cause of revision after total hip replacement is aseptic loosening. The methods to repair and reconstruct the acetabulum and femur should be chosen properly,and the types of prosthesis are also very important. Most of the patients can obtain satisfactory recent clinical results as long as there were full preparations before operation and careful monitoring during and after operation. The long term effects remain to be analyzed.