N° 002 - July / August 2019
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The philosophy of total hip replacement revision at Mayo Clinic
By Anthony Viste (1,2), Matthew P. Abdel (1) in category CONFERENCES
(1). Mayo Clinic, Department of Orthopedic Surgery, 200 First Street S.W., Rochester, MN 55905 / (2). Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Chirurgie Orthopédique et Traumatologique, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite Cedex / [email protected]
The number of THR revisions is rising, which is a trend that will likely continue. In 2010, there were 67,534 THR revisions, corresponding to 9.6% of THRs. There are different reasons to perform THR revision, and these need to be considered separately (in the form of the percentage of each cause in the United States between 2005 and 2010 (1)):
- instability (22%),
- aseptic loosening (20%),
- infection (15%),
- periprosthetic fracture (6%).
In 43% of cases, revision involved the cup and stem, and in 28% of cases it involved either the cup or stem in equal in equal proportions.
Before any revision surgery, the risk of infection must be reduced by measuring C-reactive protein level and sedimentation rate and by performing joint aspiration to test joint fluid. Infection is suspected when white blood cells >2500-3000 cells/μl in the test fluid.
Preoperative assessment includes frontal and side x-rays of the pelvis and often includes three-quarter lateral x-rays (Judet views) to examine the acetabular columns. Bone and computed tomography (CT) scans are used only rarely. Preoperative planning must be meticulous, but the plan may be changed by what happens intraoperatively.
1. The acetabular surface
Four major principles govern long-lasting and efficient...
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