Objective result was graded according to HSS score. The differences between ‘one-stage’ and ‘two stage’ groups were checked by t-test of variance.
For One Stage group, postoperative subjective satisfaction was reported by 78% of patients and HSS increased from 49.9 to 81.4. Average arc of motion was 93°. There were 4 patients with recurrent infection (20%), 2 of them were treated with antibiotics and 2 needed second revision (10%). For Two Stage group, postoperative subjective satisfaction was reported by 82% of patients and HSS increased from 47.3 to 78.6. Average arc of motion was 85°. No re-infection was recorded in this group. No significant difference between the two groups was found in relation to postoperative HSS score and arc of motion. However, remarkable difference is reported regarding reinfection rate.
The need for better durability and longevity in total hip arthroplasty in high demand patients is a constant challenge. For this purpose a metal-on-metal prosthesis with improved tribology was developed. Our early results of using this system are presented.
4 patients had bilateral THR. There were 3 revision cases due to loosening of cemented cup and 3 post surgical hip procedures. The etiology of the hip pathology was OA in 23, AVN in 10, CDH in 3, two post surgical procedures and one Paget’s disease. The THR prosthesis system consisted of a Wagner type uncemented cup with a factory-assembled Metasul inlay. An uncemented collarless hydroxypaptite coated, Spotorno stem, with a modular 28mm head was used. Long stem was used in 3 cases and reinforcement cage in one. Additional screws (average of 3,4) were used for primary cup fixation. The anterolateral approach, laying either supine or on the side was performed. Average hospitalization time was 12 days. Full weight bearing was allowed as tolerated. Results: The average follow-up was 30 months. Average Harris Hip Score pre-operatively was 45 (15-74) and post-operatively 75 (15–99). Subjectively, 87% of the primary cases with various etiologies were satisfied with the outcome. The majority of patients had pain-free range of motion and returned to improved daily function. One technical intra-operative complication (false route) was resolved with immediate revision. Two patients required cerclage wiring due to a femoral crack. Immediate post-operative complications included 2 cases of persistent distal peroneal nerve palsy. Three cases of anterior dislocations were reduced and did not recur. A case of positive intra-operative culture was treated successfully with 6 weeks of intravenous antibiotic therapy. Late complications included one case of cup loosening and one of a painful hip with suspected infection that required revision with a cemented prosthesis. Radiographic examination included measuring of radiolucent lines around the femoral stem according to the zones described by Gruen et al. and acetabulum as described by DeLee and Charnley. No femoral radiolucent lines were found. Seven cases revealed partial ace-tabular radiolucent lines.
The purpose of this study is to evaluate the results of revision surgery in the treatment failed TKR with the TCP III like prosthesis.
In 81 of them the implanted prosthesis was TCP III or CCK and were evaluated in this study. 33 were males and 58 females. The average age at revision was 72 years. Most of the cases were performed by the senior author. All cases were osteoarthritic except one which was rheumatoid. The distribution of TCP III like prosthesis was as follows: 47 were TCP III, 33 were CCK and 2 dual. The infected cases were treated whether by one stage or two stage surgery. Patella was not resurfaced but reshaped if patella bone stock was not adequate.