Ene 29

Reemplazo total de cadera no cementada sin osteotomía femoral en pacientes con displasia grave del desarrollo de la cadera: resultados mínimo de 15 años clínicos y radiológicos / Cementless total hip replacement without femoral osteotomy in patients with severe developmental dysplasia of the hip: minimum 15-year clinical and radiological results

Fuente
Este artículo es originalmente publicado en:
http://www.ncbi.nlm.nih.gov/pubmed/25371455
http://www.bjj.boneandjoint.org.uk/content/96-B/11/1449.long

De:
Imbuldeniya AM1, Walter WL1, Zicat BA1, Walter WK1.
 Bone Joint J. 2014 Nov;96-B(11):1449-54. doi: 10.1302/0301-620X.96B11.33698.

Todos los derechos reservados para:
 
Copyright © 2015 THE BRITISH EDITORIAL SOCIETY OF BONE & JOINT SURGERY All Rights Reserved.

Abstract

We describe the clinical and radiological results of cementless primary total hip replacement (THR) in 25 patients (18 women and seven men; 30 THRs) with severe developmental dysplasia of the hip (DDH). Their mean age at surgery was 47 years (23 to 89). In all, 21 hips had Crowe type III dysplasia and nine had Crowe type IV. Cementless acetabular components with standard polyethylene liners were introduced as close to the level of the true acetabulum as possible. The modular cementless S-ROM femoral component was used with a low resection of the femoral neck. A total of 21 patients (25 THRs) were available for review at a mean follow-up of 18.7 years (15.8 to 21.8). The mean modified Harris hip score improved from 46 points pre-operatively to 90 at final follow up (p < 0.001). A total of 15 patients (17 THRs; 57%) underwent revision of the acetabular component at a mean of 14.6 years (7 to 20.8), all for osteolysis. Two patients (two THRs) had symptomatic loosening. No patient underwent femoral revision. Survival with revision of either component for any indication was 81% at 15 years (95% CI 60.1 to 92.3), with 21 patients at risk. This technique may reduce the need for femoral osteotomy in severe DDH, while providing a good long-term functional result.

©2014 The British Editorial Society of Bone & Joint Surgery.

KEYWORDS:

Arthroplasty; DDH; Hip centre; Uncemented; dysplasia; hip

Resumen

Se describen los resultados clínicos y radiológicos de reemplazo total de cadera no cementada primaria (THR) en 25 pacientes (18 mujeres y siete hombres; 30 THRS) con displasia grave del desarrollo de la cadera (DDC). La edad media en el momento de la cirugía fue de 47 años (23-89). En total, 21 caderas tenido Crowe tipo III displasia y nueve tenían Crowe tipo IV. Componentes acetabulares no cementados con forros de polietileno estándar fueron introducidos como cercano al nivel del verdadero acetábulo como sea posible. El componente femoral modular cementada S-ROM se utiliza la mínima resección del cuello femoral. Un total de 21 pacientes (25 THRS) estaban disponibles para su revisión en un seguimiento medio de 18,7 años (15,8-21,8). La media modificada Harris hip puntuación mejoró de 46 puntos antes de la operación a 90 al final del seguimiento (p <0,001). Un total de 15 pacientes (17 THRS; 57%) se sometieron a revisión del componente acetabular en una media de 14,6 años (7-20,8), todo por osteólisis. Dos pacientes (dos THRS) tenían aflojamiento sintomático. Ningún paciente fue sometido a revisión femoral. Supervivencia con la revisión de cualquier componente para cualquier indicación fue del 81% a los 15 años (IC 95%: 60,1-92,3), con 21 pacientes en situación de riesgo. Esta técnica puede reducir la necesidad de osteotomía femoral en DDH severa, mientras que proporciona un buen resultado funcional a largo plazo.

© 2014 La Sociedad editorial británica de Bone & Joint Surgery.
PALABRAS CLAVE:

La artroplastia; DDH; Centro cadera; no cementada; displasia; cadera

PMID:

 

25371455

 

[PubMed – indexed for MEDLINE]

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