orthopedics-2018-posters-accepted-abstracts

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Volume 13

Journal of Orthopaedics Trauma Surgery and Related Research

ISSN: 1897-2276

Orthopedics 2018

March 08-09, 2018

March 08-09, 2018 London, UK

International Conference on

Orthopedics, Trauma and Rheumatology

J Orthop Trauma Surg Rel Res 2018, Volume 13

Regeneration of severe femoral bone defects due to hip revision surgery

Rudiger Volkmann

General Hospital Bad Hersfeld, Germany

Introduction & Aim:

Revision after hip joint replacement failures can be associated with high grade bone defects. Especially after one

and more changing procedures patients suffer from the loss of periprosthetic bone substance which is essential for the fixation of the

next hip implant. Reliable primary implant stabilization and a successful regeneration of the femoral bone for secondary implant fixation

is the aim of our operative strategy. New cement less, modular hip revision stem with proximal plasma spray coating and an additional

dicalcium phosphate surface layer was studied with this technique and compared with our previous results with a non-modular long

hip stem.

Materials & Method:

In high grade femoral bone defects (Paprosky 3-4) the treatment principle is based on a transfemoral approach

and high primary stability by press fit fixation of a long revision stem. The proximal bone shell remains in contact with the surrounding

tissue to support the healing mechanism of the fractured and osteotomized femur. Distal interlocking with one or two screws is routinely

used for a reliable implant fixation. After proximal bone regeneration

WAGNER) and bone remodeling the distal interlocking

bolts are removed to switch the load introduction from the distal to the proximal part of the femur. The clinical and radiological outcome

of this procedure is analyzed in a prospective study within 40 patients (evidence EAST Level II) using the above mentioned new implant

device. The results are compared with a previous study group treated in equal method using a non-modular hip revision stem.

Result:

After 3.3 years, all 40 patients were available for follow-up. Femoral bone defects grade-3a occurs in 45%, grade-3b in 35% and

grade-4 in 15% classification. The middle age at time of surgery was 73 years, 35% had more than one revision interventions and 15%

has three and more. Two cases had to be re-revised. All the others showed successful femoral bone remodeling. In 86% of these cases, the

distal interlocking could be removed. Screw removal was done at an average time of 14 months. The majority results were comparable

with the previous used implant device. The axial stem subsidence of the femoral implant after interlocking bolt removal was at an average

value of 3.5 mm which was found in the comparison group at 5.0 mm.

Conclusion:

The early results of this study demonstrate femoral bone remodeling, which seems to be more influenced by the fracture

healing mechanism of the transfemoral approach and the reliable distal implant fixation, which is used temporary. Any connection

between the femoral bone remodeling and the coating surface from point of view mono block or modular device could not be found.

However, the improved stem subsidence might be influenced by a better implant fitting due to modularity options.