[Revision hip arthroplasty management tactics--own experience].
BACKGROUND
Aseptic loosening of hip prosthesis is one of the most serious complications after primary joint arthroplasty. Due to the aging of societies, lengthening of the average life span and increasing number of primary arthroplasty procedures, it can be assumed that the number of revision procedures will be continuously increasing by the year.


OBJECTIVE
presentation of own experience in operative management tactics and early results of treatment after the revision hip arthroplasty. MATERIALS AND THE METHOD: The analysis included 182 patients at the average age of 68, who underwent the revision hip arthroplasty procedure. The procedures of this type were performed most often after cement arthroplasty performed using the Weller's method (45%). The average observation period was 2.3 years. A clinical evaluation of the patients was performed using the Harris scale. A preoperative radiological evaluation was performed using Paprosky classification (for an acetabulum) and Mallory classification (for a femoral bone shaft). Bone defects were evaluated using AAOS classification. A postoperative radiological evaluation was performed on the basis of: radiolucent lines of the acetabulum area in DeLee-Charnley zones and in the area of the endoprosthesis stem in Gruen zones, acetabulum migration and settling of the endoprosthesis stem.


RESULTS
During the 2-year observation there were 88.5% of good results reported. According to the Harris scale an improvement was achieved from the average of 46 points before the operation to 85 points after the procedure. 11.5% of bad radiological and functional results were reported including: 11 cases (6.0%) with bad radiological results, and 10 cases (5.5%) with bad clinical results.


CONCLUSIONS
Revision hip arthroplasty procedures require individual planning, selection of implants and additional implants. Intraoperative evaluation is required due to lack of an objective image analysis of prosthesis element loosening and a level of bone stock damage determining the scope of the procedure, selection of implants and number of allogenic grafts. Our management tactics is an effective method of aseptic loosening of acetabulum and stem treatment after primary hip arthroplasty.
Kaleta
Marek
M
Katedra i Oddział Kliniczny Ortopedii, Slaska Akademia Medyczna w Katowicach.
Gaździk
Tadeusz Szymon
TS
Wroński
Sławomir
S
Gajda
Tomasz
T
Bozek
Marek
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D016896:Treatment Outcome