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Total Hip Revision Arthroplasty

During the last decades, a lot of Hip prosthesis were implanted which is why the number of revision arthrosplasties caused by prosthetic loosening is constantly increasing. Prosthetic loosening is generated by long service lives and other reasons. In most of the cases there is no reason to be found for a loosening after 15-20 years of service life. These are therefore known as aseptic loosenings and can be caused by abrasion particles from the polyethylene hip sockets. The particles can lead to a bone reduction in the shaft or socket area.

Aseptic loosening caused by an bacterial infection is much rarer and is already clear directly after the implantation. If these infections show up years later and are insidious infections also known as low-grade-infections.
Generally both, the hip shaft and hip socket can loosen. Depending on the bone defect size either conventional endoprosthesis or special implants are neccesary in order to pull the revision arthrosplasties through.

Hip Socket
There are classical hip socket components: Pressfit sockets which are pressed into the pelvic bone, threated cups which are screwed into the pelic bone or prosthesis which are cemented. In case of larger bone defects they are filled up with bone replacement substances or bone allografts and get revisioned with threated cups (Figure 1, 2).

Figure 1: Aseptic socket loosening, socket reconstruction with bone allografts and revision

Figure 2: Complex Revision: multiply pre-operated acetabular fracture with a loosened and tilted revision cup. Reversal into a modular pelvis partial substitute (Lumic, Fa. Implantcast)

Femoral Head
In the shaft area mostly standart degree shafts are used. Oblong prosthesis shafts with the possibility of screw anchoring are only needed with larger proximal femur defects (Figure 3, 4)

Figure 3: Premature aseptic short shaft loosening (service life: 4,5 years) which could be revisioned into a standart degree shaft prosthesis.

Figure 4: Artificial hip shaft exchange because of an occuring periprosthetic fracture caused by loosening

For all cases where aseptic loosening appears it is valid to treat this with a two-time change. Therefor a bone cement containing antibiotics gets insered until the defect is healed. After 6-8 weeks of antibiotic therapy the hip endoprosthesis reinstallation usally succeeds effectively.

For a more precise examination we use the conventional medical imaging ( x-ray) but also bone scan. If there is any suspicion of septic loosening, further diagnostic measures such as inflammation scintigraphy ( Leukocytes-Scintigraphy) in combination with joint puncture should be discussed. Additionally, nowadays the so called SPECT-CT can be used for a highly specialized prosthesis pain analysis.

Depending on the defect size and on the exchanged components early functional mobilization at full load follows. With larger defects or reduced bone quality 6 weeks of partial weight loading should take precedence.