Abstract
The pre operative evaluation of the degree of osteolisys in cotyle revision in a prothesis is very important in order to plan the best surgical treatment.
In these cases above the traditional radiological and scintigrafic exams we have achieved a evaluation techniques bases on D.E.X.A. This technique allows obtaining data on the periprotheses bone stock. These are the criterion of choice of the revision protheses, keepin’ in consideration data acquired by D.E.X.A.:
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GIR 1 (loosening and acetabular widing with persistence of walls). If the cotyle is uncemented and the biological age of the patient allows, we use to treat with a first implant press fit uncemented cotyle.
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GIR 2 (loosening and acetabular deformation with losing a wall): uncemented with or without screws or conical screw first implant cotyle.
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GIR 3 (loosening and acetabular deformation with losing of one ore more columns and the bottom): oval cotyles with or without bone grafts.
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GIR 4 (massive periacetabular loss): oval review components with peripheral supports and obturatory ring, associated or not with bone grafts. As extrema ratio we use a McMinn cotyle.
Conclusions: As a conclusion we can maintain that these indication may supply satisfactory datas thanks to the deep pre operative evaluation by DEXA. We have to keep in consideration that this pathology must be considered urgent: as soon as the operation is achieved the better bone stock will be available to the surgeon. The use of many kind of uncemented cotyle allows us, today more than ever, to restore the correct center of rotation without the risk of further mobilizations.
The abstracts were prepared by Nico Verdonschot. Correspondence should be addressed to him at Orthopaedic Research Laboratory, University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
