RESUMEN
The treatment of osteonecrosis in renal-transplant patients with hip arthroplasty was reviewed. From 1972 to 1988, the surgical treatment evolved from the use of cemented total hip arthroplasty (THA) to uncemented bipolar hemiarthroplasty to, most recently, porous-ingrowth THA. During this period, 46 patients had 77 hip arthroplasties. Cemented replacement was used in 32 hips, uncemented bipolar replacement in 32, and porous-ingrowth arthroplasty in 13. At the two- to 18-year follow-up evaluations, the average Harris hip rating was 89 points. Ratings averaged 82 points at 8.7 years in cemented hips, 91 points at six years in bipolar hips, and 90 points at 3.1 years in uncemented hips. Loosening occurred in 46% of hips with cemented total hip prostheses, 9% of hips with bipolar prostheses, and in no hips with porous-ingrowth components. Aseptic revision rates were 31%, 12.5%, and 0% respectively. Infection rates were 0%, 9%, and 10% respectively. Although the follow-up period was shorter for bipolar and uncemented THAs, uncemented bipolar hemiarthroplasty and porous-ingrowth THA may be reasonable alternatives for the renal-transplant patient with osteonecrosis rather than cemented THA, which has a high long-term failure rate. The early results of porous-coated hip arthroplasty are satisfactory in patients with a functioning renal transplant.
Asunto(s)
Necrosis de la Cabeza Femoral/cirugía , Prótesis de Cadera , Trasplante de Riñón , Complicaciones Posoperatorias/cirugía , Adulto , Cementos para Huesos , Femenino , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Necrosis de la Cabeza Femoral/epidemiología , Necrosis de la Cabeza Femoral/etiología , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Prótesis de Cadera/estadística & datos numéricos , Humanos , Trasplante de Riñón/estadística & datos numéricos , Masculino , Persona de Mediana Edad , North Carolina/epidemiología , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Diseño de Prótesis , Radiografía , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Tiempo , Insuficiencia del TratamientoRESUMEN
Forty-seven consecutive revision total hip arthroplasties were performed using porous ingrowth custom-made prostheses designed from plain radiographs and computed tomography scans. At an average follow-up period of 30 months (range, 2-4 years), one revision has been required for loosening. The average Harris pain score was 39 and the average total score was 84 at the last follow-up evaluation. Complications included nine cases (19%) with intraoperatively detected fractures of the proximal femur treated with cerclage wires and seven cases (15%) with subsidence greater than 3 mm. There were no postoperative infections and only two dislocations. At the time of surgery local particulate bone graft was used in all cases. Thirty-four percent required structural graft to restore bone stock; no case required grafting for prosthesis stability. Management of bone loss in total hip arthroplasty using a custom cementless prosthesis appears to provide an attractive alternative to massive bone grafting.