Re-Implantation of Total Hip Replacement (THR) with Burch-Schneider (BS) plate in 2003-2007 - Midterm Results at Our Institution
Abstrakt
Here, we report the midterm results of re-implantation using Burch-Schneider (BS) plate for Paprosky bone defects IIIa and IIIb. The optimal treatment of pelvis discontinuity remains controversial.
Materials and Methods: Five hundred and forty-nine total hip re-replacement surgeries were performed at our institution, the Orthopaedic Clinic of the Bulovka Hospital, between 2003 - 2007. Follow-up ranged from 5 to 10 years. 243 of the surgeries involved acetabular cup re-implantations, with 77 (31.6%) of those having used the BS cage.
In all cases, the acetabular bone loss was assessed according to Paprosky classification. Preoperative procedures included anteroposterior pelvis x-ray pelvis, with determination of the proximalization of the center of rotation, osteolysis of the os ischii and teardrop, and position of the implant in relation to Köhler's line.
During the operations, the remaining bone stock and pelvis discontinuity was defined. Results: Early aseptic loosening as a sequel of insufficient proximal screw fixation due to bone loss occurred in 7% (defined as asymptomatic loosening); among these cases, 4.2 % had complete loosening necessitating revision surgery and 2.8 % had an infection complication necessitating extraction of the BS cage.
The affected patients were 72 % females, with median age of 75 years. Kaplan-Meier analysis showed 50 % survival > 9 years, with survival out to 16 years (maximal monitoring time of the study) being 36 %.
Conclusion: For good long-term results of BS plate implantation it is mandatory to use bone allografts with optimal implant stability so as to achieve good bone osteointegration.