Between 2001 and 2010, 120 cases of femoral revisions were done, these cases were treated by one of the following three techniques; the first one is revision by long stem cemented, the second is revision by long stem cementless with the use of oscar system through endofemoral application and the third is revision by long stem cementless via Wagner osteotomy, one of these patients was treated by long stem cemented as primary treatment due to proximal femoral deficiency. All of the long stem revisions were treated without the use of strut cortical allograft as this type of graft is not available in Egypt. The choice of the implant depends on the type of the primary prosthesis, bone quality, proximal femoral deficiency and the technique of removal.
Between 2002 and 2009, 15 patients with periprosthetic fractures of the femur and the acetabulum either intraoperative or perioperative fracures were treated. The intraoperative femoral fracture was treated by circulage and longer stems with excellent results, the postoperative femoral fracture was treated by cable plate systems or revision arthroplasty without the use of cortical strut allograft, all the cases are treated according to Vancouver classification. There are tow cases of intraoperative acetabular fractures, the first one was treated by block autograft and cemented cup, the other one treated by multihole cementless cup as internal plating. The postoperative acetabular fractures are spontaneous fractures due to osteolysis and treated by impaction or allograftwith metal support either by rings or meshes.
40 patients affected by primary and secondary acetabular bone stock defect that were operated using cemented and cementless hip replacement. Bone defect was classified according to American Academy of orthopaedic surgery, different types of bone graft techniques and metal reinforcement were used. Geometrical position of the acetabular component, cup integration, hip center and graft interposition were assessed, 95% of the cups were in the desired position with graft incorporation and remodeled with one case of partial sciatic affection, most of reconstructions in primary hips were done with cementless cups but most of reconstructions in defects following loosening were treated by cemented cups. The results depend on the stability of the graft, cementing technique as well as cup position.
