Rizični čimbenici za potonuće revizijske modularne bescementne endoproteze kuka ugrađene transfemoralnim pristupom prema Wagneru

doctoral thesis

• Title (english): Risk factors for subsidence of modular revision hip endoprosthesis implanted using the transfemoral approach by Wagner
• Author: Dino Bobovec
• Mentor: Domagoj Delimar (mentor)
• Committee member: Mislav Jelić (predsjednik povjerenstva)
• Committee member: Dražen Matičić (član povjerenstva)
• Committee member: Ivan Bohaček (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2023-02-22, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Orthopedics
• Universal decimal classification (UDC): 617 - Surgery. Orthopaedics. Ophthalmology

Abstract

Uvod
Revizijska modularna bescementna femoralna tijela i transfemoralni pristup prema Wagneru imaju veliku vrijednost u revizijskim artroplastikama nestabilnih cementnih femoralnih komponenti i/ili Vancouver B periprotetičkih prijeloma. Vertikalno potonuće femoralne komponente može dovesti do bolova, skraćenja noge i razlabavljenja implantata te u konačnici zahtijeva novu revizijsku artroplastiku kuka.
Materijali i metode
U retrospektivno kohortno istraživanje uključeni su bolesnici Klinike za ortopediju Medicinskog fakulteta Sveučilišta u Zagrebu i Kliničkog bolničkog centra Zagreb. Identificirani su bolesnici kojima je tijekom revizijske artroplastike kuka, transfemoralnim pristupom prema Wagneru, ugrađeno bescementno modularno konično femoralno tijelo zvjezdolikog poprečnog presjeka (REVISION Hip/Anca-Ti6Al4V, LimaCorporate, Udine, Italija). Analizirani su demografski podatci te klinički i radiološki ishodi bolesnika. Značajno vertikalno potonuće definirano je kao potonuće veće od 5 mm.
Rezultati
Identificirano je 278 revizijskih artroplastika kuka s prosječnim vremenom praćenja od 35 mjeseci. Utvrđena je negativna korelacija između vertikalnog potonuća i duljine dobrog kontakta femoralnog tijela i kortikalne kosti bilateralno te značajna korelacija između duljine modularnog vrata i vertikalnog potonuća femoralne komponente.
Zaključak
Kako bi se spriječilo vertikalno potonuće i osiguralno dugoročno preživljenje revizijske modularne bescementne femoralne komponente, presudno je intraoperacijski osigurati odgovarajući dobar kontakt između femoralnog tijela i kortikalne kosti bilateralno te koristiti kraće modularne vratove.

Abstract (english)

Introduction
Modular fluted tapered stems and the transfemoral Wagner approach have a great value in revision situations like previously implanted unstable cemented femoral stem and/or Vancouver B type periprosthetic fractures. Revision stem subsidence, however, may lead to leg-length discrepancy, prosthesis instability, pain, and ultimately require additional femoral stem revision surgery.
Materials and methods
A retrospective review of a surgical registry of the Department for Orthopaedics, University Hospital Centre Zagreb was performed. Patients who underwent a revision hip arthroplasty, in which the uncemented modular fluted tapered stem (REVISION Hip/Anca-Ti6Al4V, LimaCorporate, Udine, Italy) was implanted using the transfemoral Wagner approach were identified. Patient’s demographic data, clinical and radiographic outcomes were assessed. In this study, the significant subsidence was defined as more than 5 millimeters.
Results
278 revision hip arthroplasties were identified with a mean follow-up of 35 months. A negative correlation was found between the stem subsidence and the length of good contact between the medial and lateral cortical bone and the stem. A neck length was shown to correlate significantly with stem subsidence.
Conclusion
It is crucial to achieve good contact between the bilateral cortical bone and stem intra-operatively and to select implant constructs with shorter femoral necks to reduce subsidence and ensure longer implant survivorship.

• Keywords: Ortopedija; Artroplastika; zamjena; kuk; Periprostetski prijelomi
• Keywords (english): Orthopedics; Arthroplasty; Replacement; Hip; Periprosthetic Fractures
• Language: croatian
• URN:NBN: urn:nbn:hr:105:986359
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
• Type of resource: Text
• Extent: 118 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-03-28 10:36:54