The Treatment Of Bone Defect And Selection Of Prosthesis In Revision Total Hip Replacement

Objective:1.To summarize the reason of total hip replacement.2.To investigate the treatment of bone defect and selection of prosthesis in revision total hip replacement.Data and Methods:1. General information:Between December 2004 and December 2009, a total of 39 hips in 39 patients underwent the revisions of the total hip replacement. Among the patients,20were male and19were female, with their ages ranging from 28 to 73 years and an average age of 53.6 years. The reasons of primary operations include fracture of femoral neck(16),ischemic necrosis of the femoral head(20) and ankylosing spondylitis(3).11 of these underwent the femoral head arthroplasty,and 28 of these underwent total hip replacement. The time between the primary operation and the revision of the total hip replacement ranged from 5month to 18 years, with an average age of 55.33 months.2. Methods:Summarize the reasons of revisions of the total hip replacement,and discuss the types of prosthesis of RTHR.Results: 1.The reasons for revisions in the cases were as follows:aseptic loosening (79.48%),dislocation of the prosthesis (7.69%),infection (7.69%) and fracture (5.13%) after the primary operation.2.The type of prosthesis:acetabular prosthesis:cemented prosthesis (3); cementless prosthesis (33), only femoral was revised and primary acetabular prosthesis was kept in 3 case; femoral prosthesis:cemented prosthesis (5), cementless prosthesis (31), only acetabulum was revised and primary femoral prosthesis was kept in 3 case; 3. The treatment of bone defect:bone graft is the preferred treatment for the acetabular and femoral defect;4. The Harris scores before operation ranged from 24.2-59.3,with an average of 41.3,and scores after operation ranged from 66.1-89.4,with an average of 77.7. The differences between peroperation and postoperation were significant.Conclusion:1. Aseptic loosening of prosthesis was the main reason on revision total hip arthoplasty.2. Cementless prosthesis are suitable for the majority of revision total hip replacement.3. 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.