Abstract
Several hundred Joint Replacement Surgeries have been done by surgeons (Gustilo/Leagogo) of the Philippine Orthopedic Institute in the Philippines since its inception over 20 years ago. Revision surgery of failed cemented hip replacement, have been increasing in the last decade, which is the subject of this report. The average total cost of revision hip surgery in the Philippines ranges from PEP 800 000 to PEP 1 000 000 or USD 20 000 to USD 25 000.
All medical records of the patients were reviewed to determine the following:
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Etiology
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Duration from index surgery
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Common anatomical pathology and amount of leg length discrepancy encountered.
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Revision implants used and use of allograft.
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Postoperative course and complications
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Preliminary results (How many are ambulatory with or without assistive device).
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Analysis of x-ray at last follow-up.
A total of sixty nine (69) patients were included in the study. Sixty eight percent (68%) of the patients (47 out of 69) underwent revision due to aseptic loosening of components (femoral or acetabular). Nine (9) patients (13%) developed infection. Six (6) patients (9%) developed protrusio acetabuli that necessitated revision. Peri-prosthetic fracture was noted in four (4) patients (6%). Three (3) patients had hip dislocation (4%) prior to revision. Average number of years from index surgery is 9 years (2–18years).
Fifty nine (59) patients (86%) underwent cemented total hip prior to revision while ten (10) patients (14%) underwent cemented partial hip replacement prior to revision. Fifty six (56) patients (81%) have shortening on the affected side with an average of 3cm (1–6cm). Forty five (45) patients (65%) had proximal femoral bone loss requiring structural allograft. Thirty one (31) patients (45%) had acetabular defect (Paprosky Types I & II).
In sixty five (65) patients (94%), Active LockTM Cementless Hip Revision System was used. All patients were allowed full weight-bearing after revision surgery. Four patients (6%) developed acute post-op infection. Two patients (3%) had dislocation after revision surgery. At short-term follow-up of one year or more, only 5 patients were ambulating with assistive device. The rest are ambulatory, without aid and are symptom free.
Follow-up radiographs showed implants in excellent alignment, no signs of loosening, migration or subsidence.
The main reason for revision hip arthroplasty in the Philippines is aseptic loosening (68%) followed by infection (13 %). The use of long non-cemented, calcar-replacing curved revision stem, and strut allograft on the femoral side; jumbo, cementless acetabular socket and a high hip center on the acetabular side, addressed the problem of anatomic pathologies as a result of failed, cemented THR. There is no association between cause for revision with gender and age of the patients.
Correspondence should be addressed to Diane Przepiorski at ISTA, PO Box 6564, Auburn, CA 95604, USA. Phone: +1 916-454-9884; Fax: +1 916-454-9882; E-mail: ista@pacbell.net
