Revisión acetabular con conservación del componente metálico osteointegrado y cementado de un componente de poliestireno. Reporte de una serie de 40 casos. [Acetabular revision cementing a liner into a stable acetabular shell]
Barra lateral del artículo
Publicado:
dic 28, 2013
Palabras clave:
copa osteointegrada, cementación, componente de polietileno, fixed cup, cementing, polyethylene component
Contenido principal del artículo
Resumen
Introducción: Un escenario cada vez más frecuente en la cirugía de revisión protésica de la cadera es hallar un cotilo no cementado fijo con una falla del componente modular de polietileno. Una completa revisión acetabular se presenta como demasiado agresiva cuando el componente metálico es salvable. Cementar un nuevo inserto de polietileno dentro del componente acetabular metálico os-teointegrado es una alternativa. Comunicamos los resultados con esta técnica, y sus indicaciones, el modo de realización y las posibles limitaciones. MaterialesyMétodos: Entre 2001 y 2011, se cementaron 40 componentes de polietileno dentro de copas no cementadas. Se evaluó radiológicamente y clínicamente a todos los pacientes. El motivo por el que se cementó un inserto fue falla o rotura de mecanismo de captura (11 casos; 27,5%), ganar estabilidad (18 casos; 45%) y falta de disponibilidad del inserto correspondiente (11 casos, 27,5%).Resultados: La tasa de duración del implante sin reoperación a 46 meses de seguimiento fue del 92%. Un paciente (2,4%) sufrió una infección, y dos presentaron inestabilidad (4,8%). No se presentaron aflojamientos hasta el último seguimiento. El puntaje preoperatorio y posoperatorio en la escala de Harris fue de 59 y 80, respectivamente.Conclusiones: Los datos técnicos por considerar para tener éxito son: utilizar un inserto de menor tamaño que el de la copa, cementar insertos texturizados y dejar siempre como mínimo un manto de cemento uniforme de 2 mm. Nuestros resultados preliminares cementando un inserto de polietileno dentro de una copa acetabular osteointegrada parecerían justificar esta técnica de revisión en pos de prevenir la pérdida de capital óseo asociada a la necesidad de recambio de copas osteointegradas.
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Cómo citar
Bidolegui, F. M., Pereira, S., Lugones, A., Pereira, H., & Vindver, G. (2013). Revisión acetabular con conservación del componente metálico osteointegrado y cementado de un componente de poliestireno. Reporte de una serie de 40 casos. [Acetabular revision cementing a liner into a stable acetabular shell]. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 78(4), 190-198. https://doi.org/10.15417/171
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Investigación Clínica
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Citas
1. Springer BD, Hanssen AD, Lewallen DG. Cementation of an acetabular liner into a well fixed acetabular shell during revision hip arthroplasty. J Arthroplasty 2003;18(Suppl 1):126-30.
2. Haft DA, Heiner AD, Dorr LD, Brown TD, Callaghan JJ. A biomechanical analysis of polyethylene liner cementation into a fixed metal acetabular shell. J Bone Joint Surg Am 2003;85:1100-10.
3. Callaghan JJ, Parvizi J, Novak CC, Bremner B, Shrader W, Lewallen DG, et al. A constrained liner cemented into a secure cementless acetabular shell. J Bone Joint Surg Am 2004;86(10):2206-11.
4. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fracture. Treatment by mold arthroplasty. An end result study using a new method of result evaluation. J Bone Joint Surg Am 969;51:737-54.
5. Claus AM, TottermanSM, Sychterz CJ, Tamez-pena JG, Looney RJ, Engh CA Sr. Computed tomography to assess pelvic lysis after total hip replacement. Clin Orthop 2004;422:167-74.
6. Jiranek WA. Acetabular liner fixation by cement. Clin Orthop Relat Res 2003;417:217-23.
7. Heiner AD, Haft GF, Dorr LD, Brown TD, Callaghan JJ. A biomechanical analysis of polyethylene liner cementation into a fixed metal acetabular shell. Trans Orthop Res Soc 2003;49:1367.
8. Beaule PE, Ebramzadeh E, LeDuff MA, Prasad R, Amstutz HC. Cementing a liner into a stable cementless acetabular shell: The double-socket technique. J Bone Joint Surg Am 2004;86(5):929-34.
9. Bonner KF, Delanois RE, Harbach G, Bushelow M, Mont MA. Cementation of a polyethylene liner into a metal shell: factors related to mechanical stability. J Bone Joint Surg Am 2002;84:1587-93.
10. Louwerse RT, Heyligers IC. Late failure of the polyethylene liner fixation in an uncemented total hip arthroplasty. J Arthroplasty 1999;14:391-6.
11. Meldrum RD, Hollis JM. The strenght of a cement acetabular locking mechanism. J Arthroplasty 2001;16:748-52.
12. Bensen CV, Del Schutte H Jr, Weaver KD. Mechanical stability of polyethylene liners cemented into acetabular shells. Crit Rev Biomed Eng 2000;28(1-2):7-10.
13. Ebramzadeh E, Beaule PE, Culwell JL, Amstutz H. Fixation strength of an all metal acetabular component cemented into an acetabular shell. A biomechanical analysis. J Arthroplasty 2004;19:45-9.
14. Dunlop D, Oxland T, Gordon J, Garbuz D, Masri B, Duncan C. The biomechanics of cementing a new liner into a well-fixed metal acetabular shell. Trans Orthop Res Soc 2002;27:973.
15. Oh I. A comprehensive analysis of the factors affecting acetabular cup fixation and design in total hip replacement arthroplasty: a series of experimental and clinical studies. The Hip Proceedings of the Eleventh Open Scientific Meeting of the Hip Society, St Louis: CV Mosby; 983:129-77.
16. Laporte DM, Mont MA, Pierre-Jacques H, Peyton RS, Hungerford DS. Technique for acetabular liner revision in nonmodular metal-backed component. J Arthroplasty 1998;13:348-50.
17. Bohm P, Bosche R. Survival analysis of the Harris Galante I acetabular cup. J Bone Joint Surg Br 1998;80:396-403.
18. Gonzalez della Valle A, Ruzo PS, Li S, Pellicci P, Sculco TP, Salvati EA. Dislodgment of polyethylene liners in first and second-generation Harris Galante acetabular components. A report of eightheen cases. J Bone Joint Surg Am 1997;83:553-9.
19. Peters CL, Dunn HK. The cementless acetabular component. En: Callaghan JJ, Rosenberg AG, Rubash HE (eds.). The Hip. Philadelphia: Lippincott-Raven; 1998:993-1016.
20. Silverton CD, Rosenberg AG, Sheinkop MB, Galante JO. Revision of the acetabular component without cement after total hip arthroplasty. A follow-up note regarding results at seven to eleven years. J Bone Joint Surg Am 1996;78:1336-70.
21. Maloney WJ, Herzwurm P, Paprosky W, Rubash HE, Engh CA. Treatment of pelvic osteolysis associated with a stable acetabular component inserted without cement as a part of a total hip replacement. J Bone Joint Surg Am 1997;79:1628-34.
22. Schmalzried TP, Fowble VA, Amstutz HC. The fate of pelvis osteolysis after reoperation. No recurrence with lesional treatment. Clin Orthop 1998;350:128-37.
23. Niggemeyer O, Fink B, Ruther W. Dislocation of the polyethylene liner in hip arthroplasty: 6 patients with dislocation within 3 years. Acta Orthop Scand 2002;73:403-6.
24. Scott DL, Campbell PA, McClung CD, Schmalzried TP. Factors contributing to rapid wear and osteolysis in hips with modular acetabular bearings made of hylamer. J Arthroplasty 2000;15:35-46.
25. Weber KL, Callaghan JJ, Goetz DD, Johnston RC. Revision of a failed cemented total hip prosthesis with insertion of an acetabular component without cement and a femoral component with cement. A five to eight year follow-up study. J Bone Joint Surg Am 1996;78:982-94.
26. Heck DA, Murray DG. In vivo construction of a metal-backed, high molecular weight polyethylene cup during McFee-Farrar revision total joint arthroplasty. A case report. J Arthroplasty 1986;1:203-6.
27. Khanuja HS, Aggarwal A, Hungerford MC, Hungerford DS, Jones LC, Mont MA. Cementing polyethylene liners into nonmodular acetabular components in revision total hip arthroplasty. J Orthop Surg 2010;18(2):184-8.
28. Kummer FJ, Adams MC, Dicesare PE. Revision of polyethylene acetabular liners with a cemented polyethylene cup. A laboratory
study. J Arthroplasty 2002;17:1055-7.
29. Yoon TR, Seon JK, Song EK, Chung JY, Seo HY, Park YB. Cementation of a metal inlay polyethylene liner into a stable metal
shell in revision total hip arthroplasty. J Arthroplasty 2005;20:652-7.
30. Goetz DD, Capello WN, Callaghan JJ, Brown TD, Johnston RC. Salvage of total hip instability with a constrained acetabular component. J Bone Joint Surg 1998;80(4):502-9.
31. Desantis M, Dorr LD, Longjjohn DB, Wan Z. Can inserts be cemented into fixed shells at revision THR? Presented as a poster at the Annual Meeting of the American Academy of Orthopaedic Surgeons; 2000, Mar 15-19, Orlando, Florida.
32. Ranawat AS, DiGiovanni CW, Pellici PM. Treatment of recurrent instability after total hip arthroplasty by cementing constrained liners into well fixed, metal backed shells: Two years results. 67th Annual Meeting Proceedings. Rosemont IL, American Academy of Orthopeadic Surgeons, 2000:312.
33. Haft DA, Heiner AD, Callaghan JJ, Dorr LD, Wan Z, Long W, et al. Polyethylene liner cementation into fixed acetabular shells. J Arthroplasty 2002;17:167-70.
34. Callaghan JJ, Liu SS, Schularick NM. Shell retention with cemented acetabular liner. Orthopaedics 2009;32(9):673-75.
35. Hofmann AA, Prince EJ, Drake FT, Hunt KJ. Cementation of a polyethylene liner into a metal acetabular shell: a biomechanical study. J Arthroplasty 2009;24(5):775-82.
36. Mahuerman DR, Peindl RD, Coley ER, Marshall A. Cementation of polyethylene liners into well-fixed metal shells at the time of revisión total hip arthroplasty. J Arthroplasty 2008;23(6):873-8.
2. Haft DA, Heiner AD, Dorr LD, Brown TD, Callaghan JJ. A biomechanical analysis of polyethylene liner cementation into a fixed metal acetabular shell. J Bone Joint Surg Am 2003;85:1100-10.
3. Callaghan JJ, Parvizi J, Novak CC, Bremner B, Shrader W, Lewallen DG, et al. A constrained liner cemented into a secure cementless acetabular shell. J Bone Joint Surg Am 2004;86(10):2206-11.
4. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fracture. Treatment by mold arthroplasty. An end result study using a new method of result evaluation. J Bone Joint Surg Am 969;51:737-54.
5. Claus AM, TottermanSM, Sychterz CJ, Tamez-pena JG, Looney RJ, Engh CA Sr. Computed tomography to assess pelvic lysis after total hip replacement. Clin Orthop 2004;422:167-74.
6. Jiranek WA. Acetabular liner fixation by cement. Clin Orthop Relat Res 2003;417:217-23.
7. Heiner AD, Haft GF, Dorr LD, Brown TD, Callaghan JJ. A biomechanical analysis of polyethylene liner cementation into a fixed metal acetabular shell. Trans Orthop Res Soc 2003;49:1367.
8. Beaule PE, Ebramzadeh E, LeDuff MA, Prasad R, Amstutz HC. Cementing a liner into a stable cementless acetabular shell: The double-socket technique. J Bone Joint Surg Am 2004;86(5):929-34.
9. Bonner KF, Delanois RE, Harbach G, Bushelow M, Mont MA. Cementation of a polyethylene liner into a metal shell: factors related to mechanical stability. J Bone Joint Surg Am 2002;84:1587-93.
10. Louwerse RT, Heyligers IC. Late failure of the polyethylene liner fixation in an uncemented total hip arthroplasty. J Arthroplasty 1999;14:391-6.
11. Meldrum RD, Hollis JM. The strenght of a cement acetabular locking mechanism. J Arthroplasty 2001;16:748-52.
12. Bensen CV, Del Schutte H Jr, Weaver KD. Mechanical stability of polyethylene liners cemented into acetabular shells. Crit Rev Biomed Eng 2000;28(1-2):7-10.
13. Ebramzadeh E, Beaule PE, Culwell JL, Amstutz H. Fixation strength of an all metal acetabular component cemented into an acetabular shell. A biomechanical analysis. J Arthroplasty 2004;19:45-9.
14. Dunlop D, Oxland T, Gordon J, Garbuz D, Masri B, Duncan C. The biomechanics of cementing a new liner into a well-fixed metal acetabular shell. Trans Orthop Res Soc 2002;27:973.
15. Oh I. A comprehensive analysis of the factors affecting acetabular cup fixation and design in total hip replacement arthroplasty: a series of experimental and clinical studies. The Hip Proceedings of the Eleventh Open Scientific Meeting of the Hip Society, St Louis: CV Mosby; 983:129-77.
16. Laporte DM, Mont MA, Pierre-Jacques H, Peyton RS, Hungerford DS. Technique for acetabular liner revision in nonmodular metal-backed component. J Arthroplasty 1998;13:348-50.
17. Bohm P, Bosche R. Survival analysis of the Harris Galante I acetabular cup. J Bone Joint Surg Br 1998;80:396-403.
18. Gonzalez della Valle A, Ruzo PS, Li S, Pellicci P, Sculco TP, Salvati EA. Dislodgment of polyethylene liners in first and second-generation Harris Galante acetabular components. A report of eightheen cases. J Bone Joint Surg Am 1997;83:553-9.
19. Peters CL, Dunn HK. The cementless acetabular component. En: Callaghan JJ, Rosenberg AG, Rubash HE (eds.). The Hip. Philadelphia: Lippincott-Raven; 1998:993-1016.
20. Silverton CD, Rosenberg AG, Sheinkop MB, Galante JO. Revision of the acetabular component without cement after total hip arthroplasty. A follow-up note regarding results at seven to eleven years. J Bone Joint Surg Am 1996;78:1336-70.
21. Maloney WJ, Herzwurm P, Paprosky W, Rubash HE, Engh CA. Treatment of pelvic osteolysis associated with a stable acetabular component inserted without cement as a part of a total hip replacement. J Bone Joint Surg Am 1997;79:1628-34.
22. Schmalzried TP, Fowble VA, Amstutz HC. The fate of pelvis osteolysis after reoperation. No recurrence with lesional treatment. Clin Orthop 1998;350:128-37.
23. Niggemeyer O, Fink B, Ruther W. Dislocation of the polyethylene liner in hip arthroplasty: 6 patients with dislocation within 3 years. Acta Orthop Scand 2002;73:403-6.
24. Scott DL, Campbell PA, McClung CD, Schmalzried TP. Factors contributing to rapid wear and osteolysis in hips with modular acetabular bearings made of hylamer. J Arthroplasty 2000;15:35-46.
25. Weber KL, Callaghan JJ, Goetz DD, Johnston RC. Revision of a failed cemented total hip prosthesis with insertion of an acetabular component without cement and a femoral component with cement. A five to eight year follow-up study. J Bone Joint Surg Am 1996;78:982-94.
26. Heck DA, Murray DG. In vivo construction of a metal-backed, high molecular weight polyethylene cup during McFee-Farrar revision total joint arthroplasty. A case report. J Arthroplasty 1986;1:203-6.
27. Khanuja HS, Aggarwal A, Hungerford MC, Hungerford DS, Jones LC, Mont MA. Cementing polyethylene liners into nonmodular acetabular components in revision total hip arthroplasty. J Orthop Surg 2010;18(2):184-8.
28. Kummer FJ, Adams MC, Dicesare PE. Revision of polyethylene acetabular liners with a cemented polyethylene cup. A laboratory
study. J Arthroplasty 2002;17:1055-7.
29. Yoon TR, Seon JK, Song EK, Chung JY, Seo HY, Park YB. Cementation of a metal inlay polyethylene liner into a stable metal
shell in revision total hip arthroplasty. J Arthroplasty 2005;20:652-7.
30. Goetz DD, Capello WN, Callaghan JJ, Brown TD, Johnston RC. Salvage of total hip instability with a constrained acetabular component. J Bone Joint Surg 1998;80(4):502-9.
31. Desantis M, Dorr LD, Longjjohn DB, Wan Z. Can inserts be cemented into fixed shells at revision THR? Presented as a poster at the Annual Meeting of the American Academy of Orthopaedic Surgeons; 2000, Mar 15-19, Orlando, Florida.
32. Ranawat AS, DiGiovanni CW, Pellici PM. Treatment of recurrent instability after total hip arthroplasty by cementing constrained liners into well fixed, metal backed shells: Two years results. 67th Annual Meeting Proceedings. Rosemont IL, American Academy of Orthopeadic Surgeons, 2000:312.
33. Haft DA, Heiner AD, Callaghan JJ, Dorr LD, Wan Z, Long W, et al. Polyethylene liner cementation into fixed acetabular shells. J Arthroplasty 2002;17:167-70.
34. Callaghan JJ, Liu SS, Schularick NM. Shell retention with cemented acetabular liner. Orthopaedics 2009;32(9):673-75.
35. Hofmann AA, Prince EJ, Drake FT, Hunt KJ. Cementation of a polyethylene liner into a metal acetabular shell: a biomechanical study. J Arthroplasty 2009;24(5):775-82.
36. Mahuerman DR, Peindl RD, Coley ER, Marshall A. Cementation of polyethylene liners into well-fixed metal shells at the time of revisión total hip arthroplasty. J Arthroplasty 2008;23(6):873-8.