By Pierre Le Béguec
The writer of this multimedia paintings units himself an bold aim: to permit a healthcare professional to accomplish the revision of a prosthesis with out too many problems (or an excessive amount of apprehension!) with assured effects if he follows the proposed procedure step-by-step, and this, whether he isn't very skilled during this discipline.To fulfil this function, the writer offers a transparent definition of the press-fit suggestion (principles and sensible purposes) and from there, he deals a logical and rigorous process for, to start with, making plans the surgical procedure, after which, acting it.The written textual content can be to be had as a automated slide exhibit, coming with a shopping approach with a view to make a pre-operative making plans, which supplies actual pedagogic worth to the full of this work.
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Extra resources for Revision of loose femoral prostheses with a stem system based on the "press-fit" principle: A concept and its system of implants, a method and its results
Example text
2 groups of patients can be observed: 1 – Absence of any difficulties 2 – Presence of difficulties No cement plug OR plug < 4 cm and stable cortices Plug > 4 cm, even if stable cortices Plug < 4 cm, eccentric tip position with weak cortices OR thick intermediate cement mantle and thin cortices 50 Second part – Preoperative planning The radiological analysis of the cement bed should not be limited to the eventual presence of a plug; it should also evaluate the quality of the surrounding bone. The predictable difficulties to remove the cement should be taken into account when opting for the femoral approach.
The fixation mode will depend on the site of the defects and the presence or not of any osteoporosis. The goal is always to use a short stem and to aim for a proximal fixation. Intermediate cases are better treated with a trochanteric osteotomy if there are problems with an endo-femoral approach and one does not want to create a femoral flap for other reasons. 8) If the femur is straight in the frontal view, axially only slightly curved and the bone defects are only situated in zones 1 and/or 7, and there is no osteoporosis.
In those cases the corticals are most time of good quality and the medullary canal can be conical. Nevertheless the choice of a longer stem will be mandatory in order to reconstruct the correct leg length. Chapter 2 – Determining a surgical strategy 59 2. INDICATIONS FOR AN ENDOFEMORAL APPROACH OR TROCHANTERIC OSTEOTOMY When a femur is straight in the frontal view and only slightly curved in the axial view an endofemoral approach should be considered, except when the defects are classified stage 4.