Particularités des reprises acétabulaires avec couple ...imk-forum.com/Confs/2003/apres midi/L_Sedel.pdf · acétabulaires avec couple alumine alumine. Didier Hannouche , Remi Nizard

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


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


Questions

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


Problem

• Cone– Damaged– Another alumina

head is risky


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


12 ans8 ans


6/90 6/92

98

9/99

Mrs F. 19 years AVN

Slight pain protrusio

Cementless bulky

1/03


Mr He.. 52 yearsOperated 1979

1984 Fully activeL: Class AR:Class B

1999 : slight painAnd limp

2000After socket

revision


Osteolysis : One case/401

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


- 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















Results














Discussion

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










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


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

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


Thank you

Documents

Particularités des reprises acétabulaires avec couple ...imk-forum.com/Confs/2003/apres midi/L_Sedel.pdf · acétabulaires avec couple alumine alumine. Didier Hannouche , Remi Nizard