Particularités des reprises acétabulaires avec couple ...imk-forum.com/Confs/2003/apres...

Hopital Lariboisiere Paris

Particularités des reprises acétabulaires avec couple

alumine alumine

Didier Hannouche , Remi Nizard , Jacques Witvoet , Laurent Sedel

Hopital Lariboisiere parisForum de l’institut Marcel Kerboull Jan/03

Hopital Lariboisiere Paris

De 1977 à 1997

• Nous avons implantés environ 3000 prothèses de hanche à couple Al2O3/ Al2O3

• Avec 4 types de fixations cotyloïdiennes– Massif cimenté– Massif sans ciment (Cerapress*)– Metal back anneau vissé lisse– Métal back grillage de titane

Hopital Lariboisiere Paris

Questions

• Particularités des reprises du couple Al/Al• Conduites à tenir• Résultats

Hopital Lariboisiere Paris

Problem

• Cone– Damaged– Another alumina

head is risky

Hopital Lariboisiere Paris

Few but hard debris

• If ceramic head replaced by metallic head• Possibility of severe metallic head damage

-Kempf I, Semlith M. Massive wear of a steel ball head by ceramic fragmentin the polyethylene acetabular cup after revision of atotal hip prosthesis with fractured ceramic ball .

Arch Orthop Trauma Surg 1990,109(5):284-287.-Allain et al J;Bone and Joint Surg. B, 99

Hopital Lariboisiere Paris

12 ans8 ans

Hopital Lariboisiere Paris

6/90 6/92

98

9/99

Mrs F. 19 years AVN

Slight pain protrusio

Cementless bulky

1/03

Hopital Lariboisiere Paris

Mr He.. 52 yearsOperated 1979

1984 Fully activeL: Class AR:Class B

1999 : slight painAnd limp

2000After socket

revision

Hopital Lariboisiere Paris

Osteolysis : One case/401

Mrs B.. 57 years remained 9 years with Socket tilt. Massive wear and osteolysis

Hopital Lariboisiere Paris

- To identify the specific issues related to the use of the material alumina

- To evaluate the importance of osteolysis around failed ceramic implants

- To evaluate the clinical and radiological resultsof Al/Al revision surgery (survival analysis)

Alumina/Alumina Revision Hip Surgery

RETROSPECTIVE STUDY

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Results

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Discussion

• Conduite à tenir– En cas de fracture alumine– En cas de descellement acétabulaire

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Hopital Lariboisiere Paris

Take home message

• Revision of Al2O3/ Al2O3– Frequently limited to the acetabulum– Limited osteolysis– Majority of grade 0, 1 or 2 acetabular bone defect

• Thus retain the stem– Put another Alumina head– Socket reconstruction is dependant on the age and

activity : older : cemented with or whithout Kerboull plate

– Young active : cementless reconstruction with all alumina bearings

Hopital Lariboisiere Paris

Mr D.. 35 years ( 16 years follow up)

It is usually more difficult to revise a metal on polyethylene couple

Hopital Lariboisiere Paris

Thank you