Observations on the replacement of loose prostheses

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Regenerative Medicine

Background:

• Revision total hip replacement for aseptic loosening remains a significant clinical challenge.
• Cemented revisions can cause biological damage to bone grafts, especially in Schneider grades 2 and 3 aseptic loosening.
• Stability of uncemented reimplantations relies on endosteal osteogenesis for biological anchorage.

Purpose of the Study:

• To outline a technique for revision total hip replacement in cases of aseptic loosening.
• To emphasize the contraindication of cement in specific aseptic loosening grades and propose an alternative approach.
• To detail methods ensuring biological fixation and stability in revision hip arthroplasty.

Main Methods:

• Complete removal of cement, necrotic bone, and fibrous membranes.
• Utilizing autoplastic bone chips to reconstruct bone stock.
• Employing prostheses with features for optimal load distribution (e.g., long stems, large acetabula).
• Performing diaphyseal osteotomy for cement and prosthesis removal in cases of stem rupture, with stabilization using a long-stem prosthesis.

Main Results:

• The described technique facilitates stable biological anchorage through endosteal osteogenesis in revision hip arthroplasty.
• Successful management of aseptic loosening in Schneider grades 2 and 3 without cement.
• Effective bone stock reconstruction using autoplastic bone chips.
• Stable revision outcomes achieved with specifically designed prostheses and surgical techniques.

Conclusions:

• Uncemented revision hip arthroplasty, utilizing autoplastic bone grafting and appropriate prosthesis design, is a viable alternative to cemented procedures.
• Careful technique, including complete removal of foreign material and bone reconstruction, is crucial for successful biological fixation.
• The described approach addresses the challenges of aseptic loosening, promoting long-term stability and implant survival.