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Hopital Lariboisiere Paris
Particularités des reprises acétabulaires avec couple
alumine alumine
Didier Hannouche , Remi Nizard , Jacques Witvoet , Laurent Sedel
Hopital Lariboisiere parisForum de l’institut Marcel Kerboull Jan/03
Hopital Lariboisiere Paris
De 1977 à 1997
• Nous avons implantés environ 3000 prothèses de hanche à couple Al2O3/ Al2O3
• Avec 4 types de fixations cotyloïdiennes– Massif cimenté– Massif sans ciment (Cerapress*)– Metal back anneau vissé lisse– Métal back grillage de titane
Hopital Lariboisiere Paris
Questions
• Particularités des reprises du couple Al/Al• Conduites à tenir• Résultats
Hopital Lariboisiere Paris
Problem
• Cone– Damaged– Another alumina
head is risky
Hopital Lariboisiere Paris
Few but hard debris
• If ceramic head replaced by metallic head• Possibility of severe metallic head damage
-Kempf I, Semlith M. Massive wear of a steel ball head by ceramic fragmentin the polyethylene acetabular cup after revision of atotal hip prosthesis with fractured ceramic ball .
Arch Orthop Trauma Surg 1990,109(5):284-287.-Allain et al J;Bone and Joint Surg. B, 99
Hopital Lariboisiere Paris
12 ans8 ans
Hopital Lariboisiere Paris
6/90 6/92
98
9/99
Mrs F. 19 years AVN
Slight pain protrusio
Cementless bulky
1/03
Hopital Lariboisiere Paris
Mr He.. 52 yearsOperated 1979
1984 Fully activeL: Class AR:Class B
1999 : slight painAnd limp
2000After socket
revision
Hopital Lariboisiere Paris
Osteolysis : One case/401
Mrs B.. 57 years remained 9 years with Socket tilt. Massive wear and osteolysis
Hopital Lariboisiere Paris
- To identify the specific issues related to the use of the material alumina
- To evaluate the importance of osteolysis around failed ceramic implants
- To evaluate the clinical and radiological resultsof Al/Al revision surgery (survival analysis)
Alumina/Alumina Revision Hip Surgery
RETROSPECTIVE STUDY
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Results
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Discussion
• Conduite à tenir– En cas de fracture alumine– En cas de descellement acétabulaire
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Hopital Lariboisiere Paris
Take home message
• Revision of Al2O3/ Al2O3– Frequently limited to the acetabulum– Limited osteolysis– Majority of grade 0, 1 or 2 acetabular bone defect
• Thus retain the stem– Put another Alumina head– Socket reconstruction is dependant on the age and
activity : older : cemented with or whithout Kerboull plate
– Young active : cementless reconstruction with all alumina bearings
Hopital Lariboisiere Paris
Mr D.. 35 years ( 16 years follow up)
It is usually more difficult to revise a metal on polyethylene couple
Hopital Lariboisiere Paris
Thank you
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