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PATOLOGIA DELL’ARTROSI COXOFEMORALE: IL BONE-LOSS NELLA CHIRURGIA PROTESICA DI REVISIONE

PATOLOGIA DELL’ARTROSI COXOFEMORALE: IL BONE-LOSS NELLA CHIRURGIA PROTESICA DI REVISIONE. Stefano Zanasi. Policlinico di Monza IV Unità Operativa di Ortopedia Responsabile: Dr. Stefano Zanasi e-mail: zanasis.orth@virgilio.it. STEFANO ZANASI. REVISION HIP ARTHROPLASTY NEEDS

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PATOLOGIA DELL’ARTROSI COXOFEMORALE: IL BONE-LOSS NELLA CHIRURGIA PROTESICA DI REVISIONE

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  1. PATOLOGIA DELL’ARTROSI COXOFEMORALE: IL BONE-LOSS NELLA CHIRURGIA PROTESICA DI REVISIONE Stefano Zanasi Policlinico di Monza IV Unità Operativa di Ortopedia Responsabile: Dr. Stefano Zanasi e-mail: zanasis.orth@virgilio.it

  2. STEFANO ZANASI

  3. REVISION HIP ARTHROPLASTY NEEDS TO RECOGNIZE BONE LOSS

  4. REVISION HIP ARTHROPLASTY NEEDS OF BONE-LOSSCLASSIFICATION

  5. BONE-LOSS CLASSIFICATION • PRE-OPERATIVE PLANNING • COMMON LANGUAGE for REPORTING SURGICAL RESULTS ( A.A.O.S. COMMITEE ON THE HIP, 1993 )

  6. BONE LOSS CLASSIFICATIONS • Engelbrecht ( 1987 ) - Oakeshott et Coll. (1987) • Gustilo-Pasternak (1988) - Mallory et Coll. (1988) • Engh et Coll. ( 1988 ) - Schmitt et Coll. (1992) • Tanzer et Coll. ( 1992 ) - Pipino - Molfetta (1992) • Gross et Coll. (1993 - Paprosky et Coll. (1993) ° Chandler et Coll. (1989) - D’Antonio et Coll. (1995)

  7. LIMITS of CLASSIFICATIONS • COMPLEXITY • RELATED to IMAGING • MANY CASES BORDERLINE • INTRAOPERATIVE DEVELOPMENT OF BONE DEFECTS difficulty in application

  8. The BONE-LOSS CLASSIFICATION in hip revision surgery Italian Society of Revision Surgery-GIR

  9. ACETABULAR BONE-LOSS GRADE I GRADE II GRADE III ° Loosening ° Enlargement and deformation of acetabulum GRADE IV • ° Loosening • ° Enlargement and • deformation of • acetabulum • NOwall defect ° Loosening ° Enlargement and deformation of acetabulum MASSIVE and OVERALL Periacetab. Defect Defect inTWO- MOREwalls Defect inONE wall

  10. FEMORAL BONE-LOSS GRADE I GRADE II GRADE III GRADE IV Proximal canal enlargement with cortical thinning NOcortical zonedefect Proximal canal enlargement with cortical thinning Proximal canal enlargement with cortical thinning PROXIMAL CIRCUMFE- RENTIAL & MASSIVE Defect Defect inTWO orMORE zones Defect in ONE cortical zone

  11. ACETABULAR BONE-LOSS (Grade I – cavitary defect) Host bone CAN CONTAIN the cup and ensure its stability. C.O.R. is not (or slightly) translated • Loosening • Enlargement and • deformation of • acetabulum • NO WALL DEFECT

  12. ACETABULAR BONE-LOSS (Grade I) FILLING of the cavity SURGICAL STRATEGY (Larger or elliptical cups, Cement, Bone chips, etc.)

  13. ACETABULAR BONE-LOSS (Grade II ) • Loosening • Enlargement and • deformation of • acetabulum • Defect in • ONE WALL Host bone MAY NOT CONTAIN the Cup C.O.R. always translated

  14. ACETABULAR BONE-LOSS (Grade II) RECONSTRUCTION of the DISRUPTED WALL (Rings, Cages, Conventional or Jambo cup, Bone grafts, etc.) SURGICAL STRATEGY

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  16. ACETABULAR BONE-LOSS (Grade III) - Host bone CAN'T CONTAIN the CUP - DEFECT of SUPPORTING WALL - ARTICULAR BIOMECHANICS ALTERED • Loosening • Enlargement and • deformation of • acetabulum • Defect in TWO or • MORE WALLS

  17. ACETABULAR BONE-LOSS (Grade III) CUP ANCHORAGE in intact bone ( Rings, Cages, Conventional or Jumbo cup, Stemmed cup, Oblong or asymetric cups, Morsellized bone grafts, etc. ) SURGICAL STRATEGY

  18. ACETABULAR BONE-LOSS (Grade IV) Host bone CAN’T CONTAIN the cup MASSIVE and OVERALL PERIACETABULAR Defects (hemipelvis fracture) Biomechanics is deeply altered

  19. ACETABULAR BONE-LOSS (Grade IV) ANCHORAGE in the superior wall SURGICAL STRATEGY (Rings, Cages, Stemmed cups, Allografts, etc. )

  20. FEMORAL BONE-LOSS (Grade I – cavitay defect) Proximal canal enlargement with cortical thinning NO CORTICAL ZONE Defect PROXIMAL FEMUR CAN’T CONTAIN the stem Biomechanics is not altered ( leg length, muscle balance, head/neck offset )

  21. FEMORAL BONE-LOSS (Grade I) FILLING of the femoral canal (larger and longer stem, cement, morsellized grafts, etc. Restoring the appropriate head-neck offset SURGICAL STRATEGY

  22. FEMORAL BONE-LOSS (Grade II – segmental defect) Proximal femurMAY CONTAINthe stem and ensure its stability. Biomechanics is partially compromised Defect in ONE CORTICAL ZONE (Lesser trochanter, reabsorption, osteolysis, perforation, window, etc.)

  23. FEMORAL BONE-LOSS (Grade II) RECONSTRUCTION of cortical defect (bone grafts, proximal anchorage with long stem, ev. cerclages ) Restoring the appropriate head/neck offset SURGICAL STRATEGY

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