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Loosening of the hip joint prostheses.
Revision hip replacement refers to the procedure to repair or replace a failed first hip replacement. Over the past three decades total hip replacement has become one of the most important surgical procedures to return patients to active, contributing members of society. The surgical procedure to replace a worn out, painful hip with prosthetic components () has been performed on millions of patients with great results and overall few complications. Once reserved for the senior citizen with a sedentary lifestyle, total hip replacement is rapidly becoming an operation in demand by a mid-life, still working patient population who demand high function and long lasting mechanical properties to coincide with a highly active lifestyle.
For many years, the use of fluid-controlled knee mechanisms for high-level amputees was considered unwarranted since these individuals obviously walked at only one (slow) cadence. The development of hip flexion bias mechanisms and more propulsive foot designs have challenged this assumption. Furthermore, a more sophisticated understanding of the details of prosthetic locomotion has revealed an additional advantage of fluid control for the hip-level amputee.
How Much Does A Hip Replacement Prosthesis Weigh …
Patel et al. investigated factors associated with prolonged wound drainage after primary total hip arthroplasty . The authors found that increased drain output, prophylaxis with low-molecular-weight heparin, and morbid obesity (body mass index > 40) were independent risk factors for prolonged wound drainage, and this in return was a significant predictor of wound infection. Each day of prolonged drainage was associated with a 42% increase in the risk of wound infection. Similar findings have been also reported by Saleh et al. and Knobben et al. [, ]. In our collective, we have had 10 cases with a draining sinus, of which 8 had surgical treatment. None of these patients had a reinfection or infection persistence. Hereby, we believe that the early surgical revision of the haematoma is an indispensable premise in the prevention of a wound infection.
Despite the assumption of Fehring and colleagues, we could observe in our collective a prosthesis dislocation in 23 % of the cases. We believe that this high dislocation rate after prosthesis reimplantation can be explained by following thesis: every surgical procedure causes trauma to the local tissues, leading to muscle and bone loss. Proper debridement of the infected hip requires often debridement of bone. Bone loss makes proper component position difficult, leading to potential malposition and increasing the risk of instability. Multiple surgical revisions also increase the risk of developing abductor dysfunction. As the abductors become less functional, their important role in hip stability is lost. We believe this is a very important topic, and patients undergoing a two-stage protocol in the treatment of hip joint infection should be preoperatively informed about it, especially those having already undergone surgical revisions for infection management. Perhaps, it would be advisable to use constrained acetabular components in these cases.
How Much Does A Hip Replacement Prosthesis Weigh 2018
Antibiotic-loaded cement spacers are an efficient method in the treatment of hip joint infections. However, during treatment several complications might occur that might endanger the infection eradication as well as the functional outcome after prosthesis reimplantation. Our data demonstrate that > 50 % of patients suffering from hip joint infections and treated with a two-stage protocol will have some kind of complications besides reinfection or infection persistence, mostly consisting of mechanical ones (spacer fracture, -dislocation, femoral fracture, prosthesis dislocations), systemic side effects (acute renal failure, allergic reactions), and general complications (draining sinus, pneumonia, etc.). Despite the retrospective design of our study and the limited possibility of interpreting these findings and their causes, this rate indicates that these patients are prone to have some kind of complication. Orthopedic surgeons should be aware of these complications and their treatment options and concentrate on the early diagnosis for prevention of further complications. Between stages, an interdisciplinary cooperation with other facilities (internal medicine, microbiologists) should be aimed for patients with several comorbidities for optimizing their general medical condition.
Although wearing a transpelvic or hip disarticulation prosthesis may be cumbersome, when fitted within a few weeks of amputation, the initial acceptance rate appears to be similar to that for transfemoral amputation. Immediate postoperative fitting is technically feasible but rarely performed today. Long-term wearing rates increase significantly when sockets are comfortable, flexible, and carefully aligned. In view of the magnitude of loss at this level, application of newer, sophisticated joint and foot mechanisms is often helpful. Every case requires review on its own merits; careful attention to socket design, components, and alignment ultimately determines the effectiveness of the prosthesis.
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This is related to the type of cementless hip prosthesis and the ..
In conjunction with the reconstruction of any bone defects, the surgeon will need to determine which of the many revision prostheses available is right for the current situation. In most systems used today for this type of surgery, manufacturers of these implants have multiple and variable attachments to the implants which allow the surgeon to create the tightest and most stable construct possible while maximizing the normal motion of the hip.
When any type of hip prosthesis begins to exhibit signs of wear or ..
We prefer to have the amputee simulate weight bearing during the plaster impression technique to create as precise a mold as possible. However, in contrast to the technique advocated by Otto Bock, we believe that careful attention to shaping the medial wall in the ischial region is important to improve control of the prosthesis for both walking and sitting.
CT of the Hip Prosthesis: Appearance of Components, Fixation, ..
The most important part of any prosthesis is the socket, which provides the man-machine interface. During the initial assessment of the amputee, examination of postoperative radiographs and careful palpation of the pelvis are recommended. Some amputees present as "hip disarticulation" when they have a short femoral segment remaining or as "transpelvic" when part of the ilium, sacrum, or ischium remains. Unanticipated bony remnants can become a puzzling source of discomfort. On the other hand, they may sometimes be utilized to assist suspension or rotary control or to provide partial weight-bearing surfaces. Due to the success of ischial containment transfemoral sockets, the importance of precise contours at the ischium and ascending ramus is now more widely recognized. The same principles can readily be applied to hip disarticulation sockets to increase both comfort and control (Fig 21B-11.).
The components of a total hip prosthesis ..
One patient denied a prosthesis reimplantation. In this case, the patient started to increase weight-bearing on the leg 3 months after spacer implantation. 13 months later, X-rays revealed an asymptomatic acetabular fracture without any spacer dislocation. At a follow-up of 52 months the patient is still free of any infection signs and has no complaints at an almost free range of motion.
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