DOI: https://doi.org/10.22141/1608-1706.4.19.2018.142104

Differential approach to the choice of femoral component in arthroplasty of patients with dysplastic coxarthrosis

O.A. Loskutov, A.E. Loskutov, D.A. Siniogubov, K.S. Furmanova

Abstract


Background. There is a high percentage of negative results due to the compex deformation of the proximal femur in patients with dysplastic coxarthrosis (DC). Narrow bone marrow canal and the non­compliance of 25 % of the standard femoral components (FC) of the endoprostheses to this pathology lead to intraoperative fractures of the femur, development of stress­shielding syndrome and implant fractures. The purpose was the development and clinical justification of differentiated choice of the FC in arthroplasty of patients with DC. Materials and methods. We observed 322 patients with dysplasia, who underwent 394 total hip replacements. Patients with high degrees of DC by Crowe: type I — 40 (12.4 %), II — 142 (44.1 %), III — 126 (39.1 %) and IV — 14 (4.4 %). X­ray assessment of the femoral bone was performed according to L. Dorr et al. (1993) and P. Noble (1990), the functioning of the FC of endoprosthesis — according to J. Chanley, De Lec, and by comparative evaluation of X­ray data in dynamics. Results. In 375 cases, cementless fixation technologies have been used: in 342 (86.8 %) cases — ORTEN system, in 24 (6 %) — Versys (Zimmer) and in 9 (2.3 %) — Omnifit system (Stryker), in other 19 cases, techno­logy of cement fixation of the femoral component was applied. According to the results of previous X­ray/morphological and biomechanical studies, the following types of the FC were developed: conical standard for metaphyseal fixation, conical volumetric — for metaphyseal­diaphyseal fixation, and two types of the FC for diaphyseal fixation of shortened and elongated versions. Analysis of the results of using developed FC in the period from 2 to 10 years showed a high level of secondary stability of the FC. Instability of the FC at an early stage (up to 5 years) was observed in three cases and was caused by the errors in the size of the FC during primary arthroplasty. In the period from 5 to 10 years, stress shielding in the form of femoral hypertrophy was detected: in 14 cases — when using type DD stems, and in five cases, revision surgeries were performed due to instability. Conclusions. The degree of adaptation contact of the FC with femoral bed is influenced by the spatial form and dimensions of the bone marrow canal of the femur, which must be carefully evaluated by using markers of the preoperative planning. The developed and certified set of the FC ORTEN allows differentiating the variety of the FC, adapting it to the shape of the bone marrow canal of the femur and providing good primary stability and a positive long­term outcome of the hip replacement in DC. Two­plane evaluation of the proximal femur according to L. Dorr et al. allowed to formulate the following algorithm for differentiated application of the FC ORTEN during the arthroplasty of patients with dysplastic coxarthrosis: type A — to use conical standard stems with metaphyseal fixation; type B — conical volumetric FC with metaphyseal­diaphyseal fixation; type C — FC with square section and elongated stem for diaphyseal fixation or, in cases of osteoporosis, stems with a cement type of fixation.


Keywords


hip joint; dysplastic coxarthrosis; arthroplasty; femoral component; algorithm

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