No abstract

Introduction. Rings and cages are indicated for use in revision total hip with severe bone loss. Material and Methods. A retrospective study was performed on 37 acetabular revision cases with an average age at revision of 67.8 years. According to Paprosky classification, 54% grade II and 46% grade III. We used two types of cages, Protrusio and Contour cage. We used 23 standard liners and 14 dual mobility cups. Results. The average follow-up was 5.4 years. The mean Merlé-d’Aubigné score improved from 5.48 to 10.5 points (P<0.05). There were 10 nerve palsies, 6 rings that lost fixation, 10 dislocations, and 4 infections. The need for reoperation for any reason rose to 32% (12/37). Success, defined as a stable reconstruction, was 73%. We found that, using a dual mobility cup cemented into the cage, the dislocation rate and revision rate came down (P<0.05). Conclusions. The treatment of severe acetabular defects using bone graft and reconstruction cages is a viable option. The use of a dual mobility cup cemented into the cage could avoid dislocations and the insertion of the ischial flap inside the ischial portion of the acetabulum for further ring stability and protection of the sciatic nerve.

Introduction: Total femoral replacement (TFR), it is an uncommon surgery in non-oncological patients. Our main objective is to review our total femur replacement surgeries and analyze functional and clinical outcomes. Material and methods: We retrospectively review our series of seven non-oncological patients treated at our center with a TFR from 2011 to 2014. After excluding patients (Oncological patients or non-follow up) we revised four patients. Paprosky bone loos classification and different values were studied: number and time of surgeries, complications, revision surgeries, functional scales, and follow-up. Results: Mean age of 78.5 years. According to Paprosky classification of femur bone loss: 1 IIIA, 2 were IIIB, 1 IV. On the other side acetabular loss: 2 I, 1 IIA, 1 IIB. Surgical time for TFR was 110 minutes on average. Three patients were need revision surgery due to instability. And every single patient suffered from chronic infection. Mean range of motion was 85 flexion, 0 o extension. Comparing preoperative and postoperative Harris Hip Score for hip function was 54.9 points and Enneking score was an average of 14.25 points better in our patients with TFR. Visual analogue pain score was on average less than two points. Mean follow-up is almost seven and a half years. Conclusions: TFP has not a standardized surgical protocol yet. Infection is always present in our series and acetabular constrained components in TFR avoid instability complications. TFP should be implanted only in selected patients.