A longterm followup article pdf available in clinical orthopaedics and related research 4723. We present a case of failed acetabular revision with extensive bone loss paprosky type 3b in a 50yearold woman with rheumatoid arthritis, which was treated using total acetabular allograft. Revision of a cemented acetabular component to a cementless acetabular compo nent. Revision hip arthroplasty classification and algorithmic. The incidence of tha revision has increased substantially during the last decade and is projected to nearly double by 2026 8, 9. Paprosky femoral defects classification orthopaedicsone. Oct 15, 2014 in general, among patients with paprosky type 3b defects, the indications for use of custom acetabular components were 1 failed prior salvage reconstruction with cage or porous metal construct augments, 2 large contained defects with possible discontinuity, 3 known discontinuity, and 4 complex multiply surgically treated hips with.
The paprosky classification system is based on the severity of bone loss and on the ability to obtain cementless fixation for a given bone loss pattern. All were reoperated with a trabecular metal acetabular component and a cupcage. The treatment options of pelvic discontinuity and major acetabular defects in the setting of a revision total hip arthroplasty are use of a plate with cage and structural allograft, trabecular metal augments, custommade implants, triflange implants, and whole acetabular allograft. This study looked at patients with type iiib and type iv femoral deficiencies revised with 9c10inch solution stems vs. Selectedinstructional courselectures the american academy of. Springfield deputy editor of the journal of bone and joint surgery for instructional course lectures printed. Outcome of porous tantalum acetabular components for paprosky. Baixe no formato pdf, txt ou leia online no scribd. In this work, the design and numerical evaluation of a personalized hip prosthesis for a 31yearold male patient, who suffered of unilateral coxarthrosis, was performed. In general, among patients with paprosky type 3b defects, the indications for use of custom acetabular components were 1 failed prior salvage reconstruction with cage or porous metal construct augments, 2 large contained defects with possible discontinuity, 3 known discontinuity, and 4 complex multiply surgically treated hips with.
Our findings confirm that tantalum porous cups provide a viable reconstruction option when dealing with paprosky type 3 and 4 defects in the short term. Springfield deputy editor of the journal of bone and joint surgery for instructional course lectures printed with. Bloqueo nervio alveolar superior anterior fisonomia. Trabecular metal in acetabular revision surgery for severe. Fractura mandibular by andres ortiz belalcazar on prezi. Types 2 and 3 are further divided into subtypes fig. Classification and an algorithmic approach to the reconstruction of femoral deficiency in revision total hip. Osteointegracion al 100% en 9 pacientes, 75% en 6 y 50% en 3 pacientes. Defectos congenitos del tubo neural especialidades medicas.
Femur is characterized by loss of the anterolateral region of the subtrochanteric bone of the metaphysis type 2c. Comparison of acetabular anterior coverage after salter osteotomy and pemberton acetabuloplasty. Are custom triflange acetabular components effective for. Selectedinstructional courselectures the american academy of orthopaedic surgeons paul tornettaiii editor,vol. Aloinjerto estructurado masivo,cajas y cotilo cementado transplante acetabular, aloinjerto estructurado y diseos a medida. This series demonstrates the excellent clinical and radiographic results of porous tantalum acetabular components in complex revision thas withwithout the use of augments andor cages. The treatment of acetabular revisions with major bone defects and pelvic discontinuity is controversial. Type 1 defects have minimal focal bone loss with maintenance of the hemispheric shape of the acetabulum. Download as pptx, pdf, txt or read online from scribd. Pdf comparison of acetabular anterior coverage after salter. In young people, we are advocates of restoring bone stock and will therefore recommend the use of the impaction grafting technique, taking care to strengthen the assembly of posterolateral defects with tantalum augments hybrid technique. The constituents retain their identities, that is, they do not dissolve or merge. The paprosky classification system was designed to provide guidance on when cementless components are appropriate and when other techniques should be used.
Geometria descriptiva alberto m perez sistema coordinado. Eighteen months ago he began having hip and thigh pain. The femoral stem is cemented and the acetabular cup is uncemented. Numerical and experimental analysis of a personalized. All were reoperated with a trabecular metal acetabular component and a. Selectedinstructional courselectures the american academy. Femur is similar to the femur in a primary total hip arthroplasty type 2a.
Aug 31, 20 the supporting structures of the acetabulum used by the paprosky classification as seen on routine ap radiographs of the pelvis include the teardrop medial wall, red arrow, hip center migration superior walldome, green bracket, the kohler line anterior columnmedial wall, blue line, and the presence or absence of ischial lysis posterior columnposterior wall, yellow square. Defect has calcar bone loss that does not extend to the subtrochanteric level, which is fairly supportive type 2b. Acetabular defect classification and surgical reconstruction in revision arthroplasty. At a followup of 1 year and 3 months, the allograft had united with the host bone. Over the past 6 weeks, the pain has become excruciating and he has been unable to ambulate, even with the aid of a w. The paprosky classification is divided into three types with increasingly severe degrees of bone loss.
Migracion 2 cm, lisis isquiatica presente migracion 2 cm, lisis isquiatica presente. Tipo i columnas continentes, sin osteolisis ni migracion. The paprosky system uses preoperative radiographs to classify defects by the amount of acetabular component migration and the status of the acetabular supporting structures including the anterior and posterior columns, the superior weightbearing dome, and the medial wall table 1. The paprosky classification system was designed to provide guidance on when cementless components.
Lars rapida rehabilitacion con minimo dolor 10 semanas. Pinzamiento femoroacetabular by luis saavedra on prezi. The purpose of this study was to describe the radiological appearance of moulded cancellous bone graft used for acetabular reconstruction in revision arthroplasty of the hip. Reconstruccion osea acetabular con cotilos no cementados y. Andreas ochsner holm altenbach editors structures, materials and. Defectos oseos segmentarios infectados en huesos largos.
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