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Revision arthroplasty with an isoelastic uncemented femoral stem

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Summary

We carried out 102 hip revision arthroplasties using an uncemented isoelastic femoral stem on 92 patients between 1985 and 1989. The proximal femoral bone stock had deteriorated in 45%. Eleven patients died during the mean follow up of 5.7 years. The femoral component has been revised again for loosening in 13, for infection in 5 and for dislocation in 3. Radiographs of 70 hips showed incipient migration at 3 months in 20, and at the time of review 27 hips had migrated 5 mm or more. Nine stems had migrated more than 8 mm and were judged to be loose. There were 11 fractures before operation and 15 during operation; they all healed. Slight cortical hypertrophy of not more than 2 mm was present in most cases. Three patients (4 hips) were excluded because of severe systemic illness. Of the remaining 66 hips, the clinical outcome was excellent in 18%, good in 50%, fair in 26% and poor in 6%. The isoelastic stem is associated with poor primary fixation which is indicated by early subsidence. The results, with a total failure rate of 33%, are unsatisfactory and the isoelastic femoral stem used in this series cannot be recommended for revision operations.

Résumé

Entre 1985 et 1989 furent réalisées 102 reprises d'arthroplasties de hanche sur 92 patients en utilisant un tige fémorale isoélastique. Dans 45% des cas la métaphyse fémorale était détériorée. 11 des patients sont décédés pendant le suivi moyen de 5,7 années. Le composant fémoral a été-révisé pour prise de jeu dans 13 cas, pour infection dans 5 cas et pour dislocation dans 3 cas. Un examen radiologique de 70 hanches révéla une migration de 5 millimètres ou plus dans 27 hanches et un début de migration fut détecté dans 20 hanches. Neuf tiges subirent une migration de plus 8 mm et furent jugées comme descellées de facon certaine. Toutes les fractures (11 préopératoires et 15 preopératoires) guérirent sans problème. Dans la plupart des cas une légère hypertrophie corticale ń excédant pas 2 mm était observable radiographiquement. 3 patients furent exclus de l'évaluation clinique par suite d'une maladie générale sévère. Parmi les 66 hanches restantes la fonction fut excellente dans 18% des cas, bonne dans 50%, passable dans 26% et mauvaise dans 6% des cas selon l'échelle des résultats de D'Aubigne-Postel. Le problème de la tige isoélastique est la déficience de la fixation primaire, comme l'indique le grand nombre de problèmes précoces. Les resultats montrant une proportion d'échec globale de 33% sont non-satisfaisants et la tige isoélatique utilisée dans cette étude ne peut pas être recommandé pour une révision primaire de hanche.

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Authors and Affiliations

  1. Department of Surgery, Oulu University Hospital, FIN-90220, Oulu, Finland

    T. J. Niinimäki, J. P. Puranen & P. K. A. Jalovaara

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  1. T. J. Niinimäki
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  2. J. P. Puranen
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  3. P. K. A. Jalovaara
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Niinimäki, T.J., Puranen, J.P. & Jalovaara, P.K.A. Revision arthroplasty with an isoelastic uncemented femoral stem. International Orthopaedics 19, 298–303 (1995). https://doi.org/10.1007/BF00181114

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