Anterior Longitudinal Strip Osteotomy Of Proximal Femur In Revision Total Hip Arthroplasty

Objective To study the application and clinical result of anterior longitudinal strip osteotomy of proximal femur (ALSO) in hip joint revision, and discuss the influence of the clinical curative effect by the different femoral osteotomies way for femoral component extraction in the short termMethods ALSO is applied to artificial hi p revision surgery by the same surgeon from February2007to August2011, with27cases (male in12cases, female in15cases, total27hips), an average of64.1±6.6years. Case Inclusion Criteria:revision is performed after total hip arthroplasty due to attrition, aseptic loosening and other reasons, with anterior longitudinal split osteotomy for femoral component extraction.Case exclusion criteria:hip rivision with biological infection; two-stage revision; the use of bone cement prosthesis.Biological fixed combined-type femoral prosthesis is applied, cutting hone slot about1.4cm wide,1013cm length, residual lacunar bone defect filled with particle autogenous or allograft bone, reset osteotomies pieces firm fixed with ti tanium cable or steel wirering. A mean follow-up of12months is adopted, with four categories of evaluation indexes recorded respectively: a) Function evaluation index (hip functional scores before and after surgery, the abductor muscle function scores);b) Trauma evaluation index (pain scores, operation time, intraoperation bleeding and postoperative lead flow);c) Prosthesis position evaluation index (prosthesis loosening and sinking imaging evaluation)d) Cutting bone heal ing index (healing interval and healing rate).The statistical analysis of the results is performed with SPSS19.0, with preoperative and postoperative quantitative data using matching design material t inspection, the inspection standards two-tailed d value=0.05.Results27patients except one case lost have been followed up for12.4±3.0months, operation time2.96±0.62h (2.00-4.00h), intraoperation bleeding463.5±224.3ml (300-1500ml), postoperative lead flow436.3±131.4ml (250.0-750.0ml). The Harris score before operation is47.2±8.3points (30.0-65.0points) and that after operation is86.1±4.9points (78-94points), excellent (>90) in8cases, good (80～89) in14cases, fair (70～79) in3cases, no poor cases (<70). The fine rate is88.0%, P=0.0123(0.05. There is no limited hip abduction, with muscle strength ranks4-5grade, one-week pain score1.27±0.92points (0-3points). Postoperative hip X-ray is taken regularly and femoral osteotomy place heals well, healing time24.65±3.93weeks (18.0-32.0weeks),100%union rate, and prosthesis sinks0.52±0.54mm (2.00-0.52mm). No infection, dislocation, steel wire surge, prosthesis loosening is found due to this technique.Conclusion Short-term follow-up show that ALSO in total hip revision procedures is an convenient, reliable and effective method, facilitating the femoral prosthesis exposure and taken out, femoral medullary cavity side clearing up and reconstruction, with higher Harris scoring fine rate and bone healing rate, less complications.