Massive acetabular defects remain an unresolved challenge in revision arthroplasty surgery of the hip. We report on 7 patients treated with custom made acetabular components to manage these massive boney defects. After high resolution CT scans were done, custom made implants were designed in collaboration between the surgeons and the manufacturer. All implants matched the bony defects as designed.Background:
Methods:
Shockwave treatment in our unit is provided in conjunction with our Urological colleagues. Shock Wave Therapy has been used as a last option in patients with difficult and chronic Orthopaedic conditions with an informed consent for all patients.
Patients were consented by the Orthopaedic surgeon and the treatment was administered by urologist The cases included:
4 Humeral fractures: 1 Case in HIV +ve 19 years old 5 Femoral non-union: 1 case bilateral in Osteogenesis imperfecta 4 Tibial non-union: 1 Recurent Fracture in 65 years old man 2 Osteochondritis of the Talus 2 Osteochondritis of the knee 4 Scaphoid fractures: 1 case had been fixed and grafted. Medial Epicondyle fracture non union 5th Metacarpal Fracture Trochanteric Bursitis Tennis Elbow 4 Planter fasciitis – The Shock wave Machine used is Storz SLX – F2 Electromagnetic shock wave generator which focus the shock wave low energy high frequency in focal zone with no harm to other tissues. Frequency 4 htz = 4 shockwave/sec – Energy level 1–3 generate pressure value in the focal area of 5–30 megapascal – Size of focal zone 9X 50 mm or 6X 28 mm – Total shock wave applied per session 2000 to 3000 shock – large focus and small focus were used in fracture of large bones and small bones respectively. Most of cases required 2–3 session with 4–6 weeks interval. – in Soft tissue Treatment Less energy was used and patients required 1 to 2 sessions.
– Clinical and radiological union in 3 of the 4 Humeral Fracture including HIV+ve and in 2 of 3 tibial fracture and 1 of 2 scaphoid. – 50% pain relief in Psedo arthrosis – Union is promoted by Cellular stimulation and pain relief is by unknown mechanism but explained by increase vascularity and neuro-modulation. – None of the patient’s have so far required subsequent operative interventions, several had residual symptoms.
In this review of a limited series of 24 hip replacements done over a six-year period is reviewed, the rationale and theoretical motivation are discussed and the results reported. The mean follow-up is 30 months (10 to 66). There were twice as many male as female patients. Their mean age was 46.8 years. Results were scored on a Charnley/D’Aubigne system. There were technical difficulties but they were not insurmountable. Disciplined preoperative planning is required. The results are promising but some questions remain about long-term effects of metal debris and long-term prosthetic survival.
