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Total hip arthroplasty using porouscoated femoral components in patients with rheumatoid arthritis

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Used an Anatomic Medullary Locking (AML) porous-coated femoral component, in ... (THAS) using the anatomic medullary locking (AML) femoral component. ... – PowerPoint PPT presentation

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Title: Total hip arthroplasty using porouscoated femoral components in patients with rheumatoid arthritis


1
Total hip arthroplasty using porous-coated
femoral components in patients with rheumatoid
arthritis
  • Jana, A. K., C.A. Jr. Engh, P.J.
    Lewandowski, R.H. Hopper, C.A. Engh. 2001.
    Total hip arthroplasty using porous-coated
    femoral components in patients with rheumatoid
    arthritis. Journal of Bone Joint Surgery.
    July 83-B (5)686-690.

  • Presented by Wislaine Coby

2
Total Hip Anthroplasty (THA)
  • A surgery to relieve pain and restore range of
    motion by realigning or reconstructing a joint.
  • Used an Anatomic Medullary Locking (AML)
    porous-coated femoral component, in combination
    with different acetabular design

3
Experiment Conducted
  • From 1977-1986, performed 82 total hip
    arthroplasties (THAS) using the anatomic
    medullary locking (AML) femoral component.
  • Total of 64 patients 7 men (8 hips), 57 women
    (74 hips).

4
AML Component
  • To obtain bony ingrowth
  • The extent of the porous coating 65 extensive
    and 17 proximal porous coating.
  • Extensively 50 of the stem were coated for
    diaphyseal bony ingrowth
  • Proximally 1/3 of the proximal end was coated
    for metaphyseal bony ingrowth

5
Acetabular Components
  • Cup-shaped socket of the hipbone
  • 3 particular types were used
  • 1977-1983 implanted 23 cemented polyethylene
    cups
  • 1983-1985 implanted 20 threaded cups without
    porous coating
  • 1982-1986 implanted 39 porous coated cups

6
Experiment Condt
  • Test the stability of the implant before
    operation and during each follow-up using the
    Merle DAubigne and Postel
  • Other signs of instability include
  • Tilting greater than 5
  • Migration more than 2mm
  • Circumferential radiolucent line

7
Re-operation among patients
  • With a minimum follow-up of 2 years, 14 patients
    had 15 re-operations
  • One complete revision
  • 14 acetabular revisions

8
Re-operation in hips
9
Life Table Of AML Revision
10
Survivorship of the acetabular components
  • Survivorship for revision due to aseptic
    loosening at ten years
  • Porous coated- 93.8 survivorship, CI 85.5-100
  • Cemented- 84.3 survivorship, CI68.0-100.0
  • Threaded- 54.1 survivorship, CI27.9-100.0

11
Results of revision
  • Majority of the patients with loose or dislocated
    cemented or polyethylene acetabular components
    were replaced with the porous coated.

12
Unrevised cases (56 hips)
  • This is based on pain and walking ability.
  • Pain component improved from a mean of 2.6
    (preoperatively) to 5.3 (at follow-up).
  • 51 hips had less pain, 2 hips moderate pain, and
    3 hips had more pain.
  • Walking component improved from a mean of 2.8
    (preoperatively) to 4.3 (at follow-up).
  • 34 hips had great improvement, 11 hips were
    moderate, and 11 hips were poor.

13
Unrevised Cases Condt
  • Radiological follow-up (stability of the femoral
    stems and acetabular components)
  • 4 femoral stems were loose and 52 had bony
    ingrowth
  • 49 acetabular components were stable and 7 were
    loose

14
Conclusion
  • THA did provide relief from pain.
  • The use of the porous coated stem had good
  • long term results and was more reliable and
  • durable.
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