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Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 148 - 148
1 Jul 2014
SHORT-TERM OUTCOME OF THE M2A-38TM METAL ON METAL CEMENTLESS TOTAL HIP ARTHROPLASTY
Smeekes C Ongkiehong B van der Wal B
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Summary

The M2a-38tm metal on metal total hip arthroplasty showed a high incidence of pseudotumors and an unexpected high revision rate in our thoroughly screened cross sectional cohort.

Introduction

After the revival of the metal on metal (MoM) bearing in total hip arthroplasty (THA) at the beginning of this century, there are now serious questions about this type of bearing. The advantage of large head MoM bearing is the increase in range of motion and stability. In our institution the choice was made for 38 mm heads. During the last few years concerns have been raised about the relationship of MoM bearing and elevated serum cobalt and chromium ion levels, their local and systemic toxicological effects and the incidence of local tumorous masses (pseudotumors). Are these findings applicable for all MoM bearings or are there also product specific issues. We present the outcome of a cementless MoM THA using a 38mm head in a unique consecutive series of 377 THA who were performed in our institution.

Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 328 - 328
1 Jul 2011
S07.3 SHORT TERM OUTCOME OF A NEWLY DEVELOPED CUSTOMIZED SPACER CONCEPT FOR TREATMENT OF LARGE SEGMENTAL RESECTIONS AFTER PROSTHETIC INFECTION: AN UPDATE OF THE SPACER PROJECT
Ongkiehong B Ensing G Boerboom L Wagenmakers R Neut D Jutte P
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Introduction: Infection is a challenging problem in orthopaedic surgery. In oncologic and revision surgery large prosthesis are placed during long procedures, even in patients with immunocompromised status. Infection rates here are reported up to 10%. Infections may necessitate large segmental resections thereby creating large defects. This defect can be filled with antibiotics loaded beads that release the substances locally to sterilise the defect. In recent years solid antibiotic loaded bone cement spacers have been applied. These spacers fill the defect, stabilize the extremity, release antibiotics and keep the soft tissues on their original length. Additionally, the patients will be able to preserve mobile function as well. In small defects prefabricated bone cement spacers temporarily replace the infected hip or knee prosthesis. For larger segmental of terminal defects there are no readily available constructs.

Purpose: To report short term outcome of a newly developed customized spacer concept for treatment of large segmental resections after prosthetic infection or osteomyelitis.

Material and Methods: We have treated 13 patients with large segmental defects after infection treatment with customized antibiotic bone cement spacers reinforced with strong intra-medullar implants like the Gammanail, the DFN and the UHN.

Results: These customized spacers are easy to make, fill the defect, stabilize the extremity, release antibiotics, keep the length of the soft tissues and allow patients to practice and preserve joint function as well. In 11 of 13 patients operated with an interim construct like this, a successful reimplantation of a tumor prosthesis was performed.

Conclusion: With customized antibiotic bone cement spacers augmented with a solid implant one can fill the defect, stabilize the extremity, release antibiotics and keep the soft tissues on their original length and keep function as well in infected tumorprosthesis. Successful reimplantation could be performed in 11 of 13 cases.

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