Total hip arthroplasty revision in elderly patients

Abstract

In the last years, the number of total hip arthroplasty is increased both in young patients and elderly with a poor bone quality due to extension of surgical indications. According to this trend, also revision surgery showed a growth of its number, especially in elderly patients, because of implant loosening, failed osseointegration of prosthetic components, errors in biomechanical restoration and infections. The aim of this study is to analyze life quality improvement through evaluation of articular functionality and postoperative pain, and to examine osseointegration of implant components with periprosthetic bone. During total hip arthroplasty revision, the orthopedic surgeon often has to face complex cases, especially in elderly patients with a preexisting status of poor bone quality and sarcopenia. In these cases, a correct planning and a surgical procedure well-executed are able to ensure a good outcome that led to pain relief and functional recovery. Furthermore anti-osteoporotic therapy surely represents a useful resource both in primary total hip arthroplasty and in revisions, mainly for elderly patients with a poor bone quality.

Çi̇mentosuz Total Kalça Artroplasti̇si̇: Kisa Ve Orta Dönem Sonuçlar

“…10 -year survival rate of THA is 100% in some series (1,4). Despite the high success rates, whether cemented or cementless, prosthesis may potentially result in several complications in early or late postoperative period and demand for revision hip arthroplasty increasing by 137 %.…”

“…As such, it is one of the most important joints in the human body, carrying the maximum load while enabling walk, run, and jump. The destruction of the joint cartilage either by age or by trauma can develop coxarthrosis, leading to chronic progressive pain, which may even cause limited motion, and with time, shortening of the extremity length (1)(2)(3).…”

“…Total hip arthroplasty (THA) is one of the most commonly performed, clinically proven, and successful treatment for the recovery of coxarthrosis since 1960s, where the whole joint is replaced with a prosthesis allowing the restoration of painless movement of the hip joint to regain the patient's quality of life (1)(2)(3). By the improvement in prosthesis technologies and the surgical procedures, the 10-year survival rate of THA was reported to be increased from 88% by 1980s to at least 95% as of today (4,5).…”

Histological evaluation of acetabular bone quality during revision hip arthroplasty

“…Bone stock is one of the major problems when performing revisions, along with bone quality, which is important also for primary fixation of first implant THA. [12][13][14][15][16][17][18][19] A preliminary evaluation can be performed through conventional x-ray and classified according to Paprosky classification; 10 however, a complementary investigation with computed tomography (CT) is also mandatory. These investigations are able to provide information on bone quantity and bone defects.…”

Total Knee Arthroplasty for the Oldest Old

“…Total knee arthroplasty (TKA) relieves or eliminates joint pain caused by osteoarthritis and improves joint function. It presents very satisfactory results, with low complication rates and long implant survival [6,7]. Advanced age can be a determining factor in the assessment of the clinical and functional status of patients, bearing in mind the necessary measures to reduce the surgical risk [6,8].…”