Revision surgery in total hip arthroplasty

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書誌事項

Revision surgery in total hip arthroplasty

B.M. Wroblewski

Springer-Verlag, c1990

  • : us
  • : gw

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注記

Includes bibliographical references and index

内容説明・目次

内容説明

Revision surgery. A practical approach to problems and com- plications of total hip arthroplasty. Based on the study of long term results and operative techniques evolved over 20 years experience in this field of work.

目次

1 Introduction.- Section I: Complications Leading to Revision Surgery.- 2 Haematoma.- The Role of Anaesthesia.- Classification of Haematoma.- Superficial Haematoma.- Deep Haematoma.- Infected Haematoma.- 3 Problems Arising from an Inadequate Exposure.- What is Required at the Time of the Exposure?.- Exposure of the Acetabulum.- Exposure of the Medullary Canal.- Preservation of the Integrity of the Abductors.- 4 Trochanteric Osteotomy and Problems Resulting from It.- Trochanteric Osteotomy.- Problems Related to Trochanteric Osteotomy.- Increased Blood Loss and Operating Time.- Trochanteric Bursitis (or Trochanteric Pain).- Trochanteric Non-union.- Pain.- Limp.- Dislocation.- 5 Dislocation.- The Mechanism of Dislocation.- Impingement.- Distraction.- Dislocation Following Primary Surgery.- Loss of the Abductor Mechanism.- Shortening of the Limb.- Malorientation of the Components.- Practical Approach to Dislocation: Non-operative Methods.- Operative Procedures.- Recent Advances.- 6 Infection.- Incidence of Deep Infection.- The Size of the Sample Studied.- The Length of the Follow-up.- Deep Sepsis in Osteoarthritis.- Deep Sepsis in Rheumatoid Arthritis.- Deep Sepsis Following Previous Hip Surgery.- Patients at Risk for Deep Sepsis.- Males with Post-operative Urinary Retention, Catheterization and Prostatectomy.- Diabetics.- Patients with Psoriasis.- Prevention of Deep Infection.- Review of the Use of ALAC in Total Hip Arthroplasty.- Leaching out from Acrylic Bone Cement.- Revisions for Deep Sepsis Using Plain Acrylic Cement.- Revisions for Deep Sepsis Using ALAC (Palacos plus 0.5 g Gentamicin).- Release of Gentamicin from Acrylic Cement: Ex Vivo Study.- Comparison of Plain CMW Acrylic Cement and ALAC (Palacos plus 0.5 g Gentamicin).- Diagnosis of Deep Infection.- Classification of Infection.- Late Infection.- Management of Deep Infection.- Conservative.- Operative - One- or Two-Stage Revision?.- The Principles of One-Stage Revision for Deep Infection.- Results of Revisions for Deep Infection.- The Use of Antibiotic-Loaded Acrylic Beads.- The Concept.- Clinical Use.- 7 Loosening of the Components.- What is Required for Component Fixation?.- Containment and Pressurization of Cement.- Socket Fixation.- The Femur.- 8 The Socket: Changes at the Bone-Cement Interface.- Demarcation of the Socket.- Socket Migration.- Correlation Between Radiographic Appearances and the Clinical Results.- Correlation Between Radiographic Appearances and the Operative Findings.- Correlation Between the Depth of Socket Wear and the Incidence of Socket Migration.- Correlation Between Radiographic Appearances and Long-Term Clinical Results.- Socket Demarcation and Loosening.- Surgical Technique.- Socket Wear.- Natural History of the Hip Condition.- 9 Loosening of the Socket.- The Time Lag Between Primary and Revision Surgery.- The Correlation Between the Clinical, the Radiological and the Operative Findings.- Wear of the Socket: The Mechanical and Histological Changes Resulting from It.- 10 Wear of the Socket.- Radiographic Measurement of Socket Wear.- Wear Measurement of Explanted Sockets.- Correlation Between Real and Radiographic Wear Measurements.- Direction of Wear.- Impingement.- The Effect of Cement Ingress into the Socket.- Reduced Diameter Neck Stem.- Mechanical Testing of the Reduced Neck Stem.- Summary.- 11 Tissue Reaction to High-Density Polyethylene Wear Particles.- Teflon.- High-Density Polyethylene.- 12 Metal Backing of the Socket.- 13 Loosening of the Stem.- Intramedullary Bone Block.- The Pacheco Study.- Unchanged Radiographic Appearances.- Demarcation of Distal Femoral Cement.- Separation of the Stem from Cement.- Fracture of the Femoral Cement at the Tip of the Stem.- Endosteal Cavitation of the Femoral Cortex.- Position of the Stem Within the Medullary Canal.- Previous Hip Surgery.- Primary to Revision Surgery.- Radiological Appearances of Failure of Stem Fixation.- Patterns of Failure of Stem Fixation.- Slip of the Stem Within the Cement Mantle.- Slip of the Stem-Cement Complex Within the Medullary Canal.- Tilt of the Stem.- Tilt of the Stem-Cement Complex.- Pivoting of the Implant Within the Cement.- Pivoting of the Implant Within the Bone.- Pivoting of the Stem-Cement Complex.- The Sequelae of Failure of Stem Fixation.- Lack or Loss of Proximal Support in the Presence of Good Distal Fixation.- Endosteal Cavitation.- 14 Fracture of the Stem.- Patients? Function.- Patients? Weight and Time to Fracture.- Surgical Technique.- Radiographic Appearances.- Fracture of the Femoral Cement.- Endosteal Cavitation of the Femur.- Early Radiographic Signs of Failure of Stem Fixation.- Position of the Stem Within the Medullary Canal.- Comparison of Cases from Two Sources.- The Mechanism of Fracture of the Stem in Total Hip Arthroplasty.- Obliquity of the Fracture.- Bending of the Proximal Fragment.- Fracture Wave.- Fracture Lip.- The Level of Fracture of the Stem.- Fracture of the Stem Following Revision Surgery.- The Pattern.- The Specimens.- Radiographs.- Mechanism of Stem Fracture.- Experimental Confirmation.- Clinical Implications.- Recent Developments.- Fracture of the Stem in the Uncemented Metal-to-Metal Arthroplasty.- 15 Fracture of the Shaft of the Femur.- 16 Heterotopic Ossification.- Proposed Definition.- The Incidence.- The Site.- The Extent.- Inclusion of Cancellous Bone in the Operative Site.- Periosteal Stripping.- Excision.- Section II: Practical Approach to Revision Surgery.- 17 Timing of Revision Surgery.- Problems to be Anticipated at Follow-up.- Deep Infection.- Dislocation.- Fracture of the Stem.- Loosening of the Stem.- Loosening of the Socket.- Correlation Between Radiological Appearances and Clinical Function.- 18 Assessment of the Patient.- Assessment of the Arthritic Hip.- Assessment of a Patient with Failed Total Hip Arthroplasty.- Clinical History.- Pain in Failed Total Hip Arthroplasty.- Function..- Straight Leg Raising.- Local Examination.- Special Investigations.- Discussion with the Patient.- Anaesthetic Assessment.- 19 Instrumentation for Revision Surgery.- The Diagnosis.- The Availability of the Instruments and the Components.- Removal of Trochanteric Wires.- Trochanteric Osteotomy.- Mobilization of the Proximal Femur and Dislocation.- Extraction of the Femoral Stem.- Socket Exposure, Testing and Extraction.- Removal of the Femoral Cement.- Removal of the Distal Cement Plug.- Extraction of the Complete Cement Mantle from the Medullary Canal.- Extraction of the Distal Fragment of Fractured Stem.- 20 Selection of Components.- The Acetabulum.- The Femur.- 21 Revision Surgery: The Technique.- Positioning the Patient.- The Incision.- Incision in the Deep Fascia.- The Landmarks.- Removal of the Trochanteric Wires.- The Claw Hammer Method.- The Sardine-Can Method.- Exposure of the Hip Joint.- Trochanteric Osteotomy.- Examination of the Components.- Exposure and Examination of the Acetabular Cavity.- Preparation of the Acetabulum and Fixation of the Socket.- 22 Revision with Trochanteric Non-union: Reattachment of the Un-united Trochanter.- The Series.- 23 The Femur.- Extraction of the Femoral Component.- Removal of the Acrylic Cement.- The Proximal Part.- The Middle Part.- The Distal Part.- Femoral Cement Restrictors.- Removal of Fibrous or Pyogenic Granulation Tissue from the Bone-Cement Junction.- Removal of a Thin Layer of Condensed Cancellous Bone.- Excavation of the Lesser Trochanter.- Selection of a Femoral Stem and Trial Reduction.- Trial Reduction.- Distal Closure of the Medullary Canal and Stem Insertion.- Reattachment of the Greater Trochanter.- Reattachment of the Greater Trochanter when the Stem has not Been Changed.- 24 Loss of Bone Stock.- Acetabular Defects.- Central Acetabular Deficiencies.- Superior Acetabular Defects.- Disruption of the Acetabular Rim.- Support and Reinforcement Rings.- Future Developments.- Femoral Defects.- Minor Femoral Deficiencies.- Major Deficiencies of the Proximal Femur.- Practical Approach: The Modular Stem System.- Future Developments.- 25 Wound Closure.- The Acetabulum, Femur and Total Hip Components.- The Capsule, the Abductors, the Greater Trochanter and the Vastus Group of Muscles.- The Deep Fascia.- Subcutaneous Fat.- The Skin.- The Use of Drains.- 26 Post-operative Management.- Section III: The Ultimate Challenge of Surgery.- 27 Girdlestone Pseudarthrosis for a Failed Total Hip Arthroplasty.- Indications for Pseudarthrosis.- The Operative Procedure.- Post-operative Management.- Clinical Results.- Conclusion.- 28 Pulmonary Embolism.- Prediction.- Prevention.- Treatment.- Reviews of Pulmonary Emboli Trends.- Yearly Variations in Incidence.- Seasonal Variations in Incidence.- Variations in the Incidence Between Different Patient Groups.- The Incidence of Fatal Pulmonary Emboli During the Post-operative Period.- Mortality Due to Causes Other than Pulmonary Embolism.- Section IV: Conclusions.- 29 Conclusions.- References.

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