A Modified Extensile Anterior Approach to the Acetabulum for Severe Acetabular Defects
| Autor: | Kristoff Corten, Joseph T. Moskal, Jonathan Yerasimides, Ronald Driesen, Baris B Koc |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
musculoskeletal diseases
Adult Joint Instability Male Reoperation medicine.medical_specialty medicine.medical_treatment Arthroplasty Replacement Hip Aseptic loosening 03 medical and health sciences 0302 clinical medicine Imaging Three-Dimensional Postoperative Complications Medicine Humans Orthopedics and Sports Medicine Orthopedic Procedures 030212 general & internal medicine Postoperative Period Pelvis Aged Aged 80 and over 030222 orthopedics Hip business.industry Soft tissue Acetabulum Middle Aged equipment and supplies Arthroplasty Reconstruction method Surgery Biomechanical Phenomena medicine.anatomical_structure Orthopedic surgery Female Hip Joint Anterior approach Hip Prosthesis business Tomography X-Ray Computed Porosity Follow-Up Studies |
| Zdroj: | Orthopedics. 41(2) |
| ISSN: | 1938-2367 |
| Popis: | A modified extensile Smith–Petersen approach was used to access the acetabulum and pelvis in cases with complex acetabular defects requiring extensive reconstructions. Between 2010 and 2014, a total of 49 hips (48 patients) with a variety of acetabular defects were reconstructed using highly porous hemispherical acetabular cups and different reconstruction methods. Preoperative diagnoses included isolated aseptic loosening of the acetabular component, aseptic loosening of both acetabular and femoral components, infection, and other. Five patients (5 hips) died prior to the 2-year follow-up, with death being unrelated to the index operation. Mean follow-up of the remaining 44 hips was 40 months. There were no intraoperative complications. Ten patients had postoperative complications; all occurred within the first 12 months postoperatively. Complications occurred in 30% and 70% of type 2 and type 3 defects, respectively. Half of the complications were treated nonoperatively. The all-cause reoperation rate was 10%. All implants were radiographically stable. The modified extensile anterior approach to the acetabulum and pelvis is safe and allows for excellent exposure and successful reconstruction of bony defects. The exposure is less successful in addressing instability due to abductor or soft tissue deficiencies, with a re-revision rate of 4% to a constrained liner for recurrent instability. Seventy percent of all complications and 83% of all dislocations occurred in the Paprosky type 3 defect group. To decrease complications with a complex acetabular defect and associated deficiency of the abductor mechanism and soft tissue constraints, a constrained liner or dual mobility socket should be considered to simultaneously address both bony defects and soft tissue deficiencies. [ Orthopedics. 2018; 41(2):e194–e201.] |
| Databáze: | OpenAIRE |
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