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Revision total hip arthroplasty: Cementless stems with bioactive coatings

Published in N°013 - September / October 2021
Article viewed 16 times

Revision total hip arthroplasty: Cementless stems with bioactive coatings

By Jean-Christophe Chatelet (1), Tarik Ait-Si-Selmi (1), Alain Machenaud (1), Sonia Ramos-Pascual (2), Jean-Pierre Vidalain (1), Michel P Bonnin (1), Jean-Charles Rollier (1), Laurent Jacquot (1), Michel-Henri Fessy (1), Institut Artro (1) in category SURGICAL TECHNIQUE
(1) Institut Artro, Lyon, France - (2) ReSurg SA, Rue Saint-Jean 22, 1260 Nyon, Suisse

The goals of revision total hip arthroplasty (THA) are to provide lasting stable fixation, to restore function, and to eliminate pain. Furthermore, adequate primary stability must be attained following revision THA, to allow restoration of metaphyseal and/or diaphyseal bone defects, consolidation of any fractures or femorotomies and to ensure osseointegration of the new device.

Introduction

The goals of revision total hip arthroplasty (THA) are to provide lasting stable fixation, to restore function, and to eliminate pain [1, 2]. Furthermore, adequate primary stability must be attained following revision THA, to allow restoration of metaphyseal and/or diaphyseal bone defects, consolidation of any fractures or femorotomies and to ensure osseointegration of the new device [3]. Primary stability will depend on preoperative femoral conditions (granulomas, osteolysis, fracture, implant breakage…), the revision surgery itself (inadvertent perforation, fracture, cortical window, extensive femoral osteotomy…), and the implant selected (long, modular, distal-locking, cementless/cemented…).

Revision stems are generally longer than primary stems [1, 4-6], to maximise the surface area for bone growth and achieve distal fixation in cases with poor proximal bone stock, thereby reducing the risk of aseptic loosening. Hydroxyapatite (HA)-coated stems have been introduced to promote bone osseointegration [7], while distal-locking stems have been introduced to improve immediate fixation, especially in cases with poor proximal bone stock and/or periprosthetic fracture [8]. Although the choice of cementless versus cemented hip implants is still a topic of controversy,...

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