Total Hip Replacement in Patients with Severe Bone DefectsTotal hip replacements (THRs) aren't always successful. Sometimes infection, fracture, or loosening of the implant means the patient needs another operation. In this study 16 patients who had previous hip operations now had major bone loss in the femur (thigh bone).
Treatment of a failed THR with a large piece of bone missing is a challenge. Surgeons at the Allegheny Hospital in Pittsburgh, Pennsylvania used a custom-made femoral replacements. Each implant had to be special ordered. The first three implants used were customized further in the hospital's machine shop by the senior surgeon.
The old implants were taken out. The femoral implant (a long rod-shaped device) was put in the canal of what was left of the patient's femur. Cross-locking screws were used to hold the rods in place wherever there wasn't enough bone.
All but one patient had a good result. No one had an infection or hip dislocation. X-rays showed the bone was starting to thicken and fill in around the rod and screws. The authors conclude this method of reconstruction for severe femoral bone deficiency works well. There is a wait of six to eight weeks for the custom-made rod. There's also a risk of bone fracture when holes are drilled into the bone.
Patients in this study will be followed long-term to see what the final outcome is for deficient bones treated this way.
Nicholas Sotereanos, MD, et al. Revision Total Hip Arthroplasty with a Custom Cementless Stem with Distal Cross-Locking Screws. In The Journal of Bone and Joint Surgery. May 2006. Vol. 88-A. No. 5. Pp. 1079-1084.
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