Faut il disposer d’un col modulaire de reprise lorsque l’on veut laisser la tige fémorale en place dans les reprises ?
Do
we need a modular neck system in revision hip surgery ?
John Van Overschelde
MD, Martijn Raaijmaakers MD , Jaques Van Overschelde MD
Department of Orthopedic Surgery, Algemeen
Stedelijk Ziekenhuis, Aalst, Belgique
Currently the main reason for revision of a total hip arthroplasty (THA) is aseptic loosening of the components. Instability is the most frequent reason for early revision. Osteolysis around a well fixed implant is a common reason for late revisions.
In revision of a THA we are often challanged with solitairy loosening of the acetabular cup with a well retained femoral stem. Recent review of the literature report as many as twenty seven percent of revisions only needing replacement of the acetabular cup. Aseptic loosening and osteolysis account for seventy-one percent of single acetabulalar revisions. Sixteen percent of single acetabulalar revisions are performed for instability.
Leaving the fixed femoral implant in place, reduces the intra operative possibilities to correct instability and leg length discrepancies after revision of the acetabular cup. Sometimes revision of the femoral stem becomes necessary only to become a stable implant. Revision of a well fixed femoral stem has a high peri operative morbidity and extends the total operation time and blood loss considerably and is to be avoided if possible.
A system that allows us to modulate the femoral neck of a well fixed stem is therefore very useful. The Merete BioBall® system gives us the opportunity to correct the femoral neck length, anteversion and offset of a femoral stem. A second advantage is the availability of different cone adaptors that allows placement of current heads on older and uncommon cones. When the reason for revision is instability of well fixed components, stability can be obtained with adjusting the femoral neck with the adaptor only and leaving the components in place.
The Merete BioBall® system can reduce operative time, blood loss and perioperative complications and thus reduce the morbidity of revision hip surgery.
