Goals
- Removal of loose components with out destroying bone and soft tissue
- Reconstruct bone defect
- Stable fixation of implants
- Restore normal hip centre of rotation
Indications
- Instability
- Periprosthetic Fracture
- Infection
- Aseptic loosening
- ARMD
C/I
- Referred pain
- Cause not known
- Medically unfit
- Painless LOM
- Painless LLD
Acetabular reconstruction
- AAOS Classification
- Segmental: loss of perepheral/medial wall
- Cavitatory: Volumetric loss of bone from cavity
- Combined
- Pelvic discontinuity
- Arthrodesis
Paprosky
I: no cup migration/minimal bone loss
IIA: Superior/superomedial migration <3cm
IIB: superior/superolateral migration <3cm
IIC: Medial wall defect
- Cup medial to kohler line
IIIA Superolateral migration
- moderate ischial lysis
- Partial tear drop destruction
- Kohler line intact
IIIB: Superomedial migration
- Severe ischial lysis
- No tear drop
- Migration medial to kohler line
Migration of component
Ischeal lysis
Lysis of tear drop
Kohler line
I: completely supportive
- No migration, rim intact
II: Partly supportive
- Ac/PC intact
- Migration present
- Some destruction of dome/medial wall
- IIA: Lateral Rim is intact (cavitatory)
- IIB: Lateral Rim absent (segmental)
- IIC: Localised medial wall destruction
III: Un supportive
- Ischeal lysis
- Tear drop lysis
- Kohler line breached
Reconstruction options
- Liner exchange
- Cavitatory
- Uncemented hemispherical tantalum/ titanium cup +/- BG
- Segmental loss
- Bulk allograft
- Metal augments
- Massive bone loss/discontinuity
- Cage
- triflange cup
Femoral bone loss
- AAOS
- Segmental
- Cavitatory
- Combined
- Stenosis
- Discontinuity
Paprosky
- Based on metaphyseal and diaphyseal bone loss
- I:Minimal M/Normal D
- II:Extensive M bone loss/Normal D
- IIIA:Metaphysis severely damaged/>4cm D present
- IIIC: M severely damaged/<4cm D present (isthmus supportive)
- IV: Isthmus non supportive
Implant options
- Proximally loaded porous coated
- Extensive porous coated
- Distal locking stem
- Mega prosthesis
- Allograft-prosthesis composite
Impaction bone grafting
- Crouton size particle BG