Abstract
In case of revision of an acetabular component, it is difficult to get stable fixation if a serious loss of bone substance is present. Among proposed systems, the use of an acetabular component with an iliac stem seems to be a good solution. The stem, positioned along the physiological lines of load, allows a good primary stability by tranforming most of the tangential stresses into peaks of pressure, and so avoiding loosening. The stemmed-cup, then, allows an optimal restoration of the rotation centre, in association to the technique of impaction grafting. The grafts, if correctly pressurized, are not overloaded (and reabsorbed) but they integrate, recreating a good bone stock.
In our retrospective study of 368 cases (92 for CDH), 276 revision cases have been re-examined with a high percentage of good results (93%).
Despite the good clinical results reported in this and in other studies, the surgical approach is considered difficult and limits the use of this technique. Potential adverse events are damages to the sacro-iliac joint, intra-operatory fractures, false roads with perforation of the bone and therefore the risk of possible vascular damage. The introduction of a completely cannulated instrumentation, united to a correct operating technique, has shown that such fears can be considered unfounded.
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Santori, F.S., Santori, N., Piciocco, P. et al. La nuova coppa a stelo iliaco nelle revisioni acetabolari. LO SCAL 23, 118–125 (2009). https://doi.org/10.1007/s11639-009-0033-y
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DOI: https://doi.org/10.1007/s11639-009-0033-y