Revisionsalloarthroplastik des Hüftgelenks

Abstract

Cementless revision hip arthroplasty is described as state of the art, especially in cases of advanced bone loss of the femur. A requirement for a good result from cement-free revision hip arthroplasty is classification of the bone defect and the presence of a mechanically stable anchorage in the area of the original implant or, in cases of bone defects, distal to the original area in stable diaphyseal bone. The possibility of the accumulation of autografts or allogeneic osseous grafts and the entire removal of the cement and debris has been postulated. The advantages of cementless revision hip arthroplasty include regeneration of the bone stock and the often available modularity of the revision hip system, which allows adaptation to different bone configurations and also allows a partial change of the prosthesis in rerevision cases, such as in cases of sintering or derotation. Cemented revision arthroplasty should be done only in special cases, such as with marginal bone defects or for older patients with a short life expectancy.

Towards Clinical Application of Mesenchymal Stromal Cells: Perspectives and Requirements for Orthopaedic Applications

“…Bone cement is stiff and strong with a gradual increasing resorption area at its limits. Where bone cement is placed, immediate primary stability is provided, however, at the expense of bone regeneration that does not take place anymore (Izquierdo and Northmore-Ball 1994;Gruner and Heller 2009). Depending on the localization of the bone cement and the mechanical stress, this can gradually lead to a decreased stability.…”

“…Bone cement on the other hand can be stored as powder, provides immediate stability and is easily prepared and applied during an operation. Within a few minutes, the cement becomes firm (Gruner and Heller 2009). Although acellular scaffolds prove stability immediately following implantation, a better option would be to seed them with cells.…”

“…These scaffolds have osteoconductive potential, however regular radiological controls often demonstrate gradually increasing resorption at sites of the implanted acellular bone. In the consequence, stability may be compromised (Gruner and Heller 2009).…”

“…Depending on the localization of the bone cement and the mechanical stress, this can gradually lead to a decreased stability. In case another revision operation is needed but great bone defects and osteolysis can impede or even inhibit surgical possibilities (Kavanagh, Ilstrup et al 1985;Izquierdo and Northmore-Ball 1994;Stromberg and Herberts 1996;Gruner and Heller 2009). Fresh autologous bone or allogenous acellular bone from a bone bank can support bone growth.…”

“…Bone defects appear in increasing numbers in orthopaedic clinics due to aseptic loosening of hip endoprosthesis after 10 to 20 years. These defects are then covered primarily with either bone cement or acellular bone from a bone bank prior to insertion of a new endoprosthesis in order to provide primary stability -that is immediate mechanical support of a new implant (Gruner and Heller 2009). …”