Surgical tactics in the revision of the hip prosthesis pin.

Parallel to the rise in the number of primary hip arthroplasties the number of complications is also increasing, especially aseptic loosening of cemented implants and uncemented implants with a smooth surface. The loosening of the implant is very often accompanied by the destruction of bone stock, which requires reconstruction.
On the base of 217 cases operated in the years 1997-2000 the authors present the methods of treating deficits in the proximal femur using special instruments, bone transplants, reconstructive systems, and revision prostheses. The so-called biological attitude to the problem is preferred. Operative tactics are presented in respect to bone deficits classified according to Mallory.

Surgical tactics in revision operations of the hip acetabulum.

Surgical tactics in acetabulum revisions is based on 2 elements. The first of these is the assessment of the patient's general health (age, clinical status, and concomitant diseases). Adequate planning makes it possible to avoid further complications, such as problems with bone transplant incorporation and subsequent mobility of the acetabulum. The second element is the assessment of bone stock deficits, especially in the acetabular ring. Although it is possible to determine the extent of bone deficits intraoperatively, in preoperative planning we use conventional X-rays, CT scans, and - in cases of advanced protrusion - angiography. The subsequent surgical technique is planned on the basis of the bone deficits as classified by Paprosky.
In the reconstruction of deficit we use different methods and implant cement or cementless acetabula, depending on the patient's age and the bone quality. In certain cases supporting metal rings, mesh, or other implants are used. To fill the deficit we implant frozen, radiated allogenic bone transplants, morselized or as solid blocks.
The revision operation is planned to reconstruct the joint axis on the same level as on the opposite side to restore the off-set. 338 patients with acetabular loosening were operated in the years 1997-2000.
The material indicates the need for the so-called biological attitude to the problem.

Outcome of revision hip arthroplasty.

Background. Clinical material collected from 1989 to 1999 from three orthopedic centers is discussed: the Orthopedic Clinic at the Center for Postgraduate Medical Education in Otwock, the Orthopedic Clinic at the Lublin Academy of Medicine, and the Orthopedic Clinic at the Warsaw Academy of Medicine.
Material and methods. During this period 511 patients with an average age of 66 were treated. The authors explain the reasons for aseptic loosening of hip prostheses, the types of implants replaced, and the methods of surgical treatment.
Analysis of results. The importance of correct surgical technique and modern cementing methods during primary arthroplasty for the duration of good prosthesis functioning is discussed. A good outcome from revision arthroplasty can be expected only when the decision to treat is made early. The authors confirm the usability of impacted camcellous allografts for revision hip arthroplasty. Complications during and after surgery are also discussed. Difficulties in the clinical and radiological evaluation of treatment outcomes caused by differing criteria used in each orthopedic treatment are also discussed in this article.
Conclusions. In the conclusion the authors propose rules for surgical treatment to reduce the number of revision procedures.