[An evaluation of the methods used for removal of components and cement in revision hip arthroplasty].
OBJECTIVE
This study was designed to evaluate the methods that we used for removal of components and cement in revision hip arthroplasty (RHA).


METHODS
Thirty-seven patients (mean age 65.6 years; range 18 to 78 years) who underwent RHA were retrospectively evaluated. Arthroplasty had been cementless, hybrid, cemented, and partial in 13, 16, 5, and 3 hips, respectively. Revision included only acetabular cup in four patients, femoral component in three, and all components in the remaining patients. Of the acetabular cups revised, five were cemented, 28 were cementless (10 expanded, 18 porous-coated); of the femoral components, 22 were cemented and 11 were cementless. The mean time to revision was 7.3 years (range 1.5 to 13 years). Extended proximal femoral osteotomy (EPFO) was performed in 28 hips (84.9%), of which 10 hips (35.7%) required the use of high speed cutting heads. All the patients were evaluated before and after revision according to the criteria of Merle d'Aubigne and Postel which were modified by Charnley. The mean follow-up period was 36.3 months (range 2 to 48 months).


RESULTS
There were no difficulties in the removal of cemented acetabular cups. Expanded cementless cups were readily removed by bending their expanded leaves. However, high speed cutting heads were used to resolve the bone-cup integration in eight porous-coated cups (44.4%); of these, two cups (25%) even required the use of high speed metal cutting heads to split several parts apart. In one patient, a spiral fracture occurred extending to the distal end of EPFO. On final follow-ups, the results were evaluated as perfect or good in 92% of the hips.


CONCLUSIONS
The removal of components and cement during RHA may require the use of more complex methods and device in addition to standard ones.
Erdemli
Bülent
B
Department of Orthopedics and Traumatology, Medicine Faculty of Ankara University, Turkey. erdemli@dialup.ankara.edu.tr
D000077:Acetabulum / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001843:Bone Cements; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011183:Postoperative Complications; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology
D001843:Bone Cements