title: Observations on the replacement of loose prostheses.
abstract: Revision surgery for loosening of the components in total hip prostheses is still a problem and not only from the purely technical aspects. According to our experience, the use of cement is contraindicated, at least in Schneider grades 2 and 3 of aseptic loosening, because of the biological damage it can cause to the bone grafts used in such cases. The stability of non-cemented reimplants is dependant on good biological anchorage through endosteal osteogenesis. The cardinal points of technique are: complete removal of all cement, necrotic bone, and interposed fibrous membrane; the use of autoplastic bone grafts in the form of chips to replace the lost "bone stock"; the use of prostheses designed for optimum load distribution (long stem, large acetabulum). In the case of ruptured stems, diaphyseal osteotomy is necessary for complete removal of the cement and prosthesis; this can be stabilised by using a Lord prosthesis with a long stem.
mesh_terms: D000368:Aged; D004868:Equipment Failure; D006615:Hip / Q000000981:diagnostic imaging; D006622:Hip Prosthesis; D006801:Humans; D008875:Middle Aged; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation