Ce diaporama a bien été signalé.
Le téléchargement de votre SlideShare est en cours. ×

femoral bone assessment.pptx

Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Prochain SlideShare
Resective osseous surgery
Resective osseous surgery
Chargement dans…3
×

Consultez-les par la suite

1 sur 25 Publicité

Plus De Contenu Connexe

Similaire à femoral bone assessment.pptx (20)

Plus récents (20)

Publicité

femoral bone assessment.pptx

  1. 1. BONE QUALITY AND FEMUR DEFECT ASSESSMENT IN REVISION THA Dr KANTHI KIRAN G RAKSHA HEALTH CARE
  2. 2. CAUSES OF FAILURE • Wear of articular bearing surface • Aseptic/mechanical loosening • Osteolysis • Infection • Instability • Peri-prosthetic fracture • Implant Failure • Subsidence
  3. 3. Complications after THR • Early (<10%) • Dislocation • Infection • Late (> 3-5 yrs post op) • Wear of articular bearing surface • Osteolysis • Mechanical loosening • Peri-prosthetic fracture • Implant failure
  4. 4. FEMUR ANATOMY • Bowing • Anteversion • Retroversion • Coxa valga • Coxa vara
  5. 5. ASSESSMENT MODALITIES • X RAY • CT • DXA • MRI • BONE SCANS
  6. 6. X RAY • 4 VIEWS • PELVIS AP • AP OF THE AFFECTED HIP • LATERAL VIEW • SHOOT THROUGH LATERAL
  7. 7. CT, SPECT and MRI • CT scans have also been useful in planning for revision surgery and is an excellent tool for evaluating component positioning • MRI is useful in the evaluation of failed metal on metal total hip arthroplasty, where with special metal artifact subtraction sequences it can be used to demonstrate adverse local tissue reactions • Other uses of MRI are to evaluate the soft tissue status in osteolysis with cortical breaches • SPECT in addition to CT will give better understanding of loosening and heterotrophic ossification
  8. 8. Bone scans • Suspicion Of Infection Is An Indication For Bone Scans • The Combination Of Technetium- Or Indium Labeled White Cells And Technetium-labeled Sulfur Colloid Has Excellent Results, With Accuracy Of Over 90% In Assessing The Focus • Fluorodeoxyglucose–positron Emission Tomography (FDG-PET) Scanning Has Variable Performance • Aseptic Loosening Related To Particle Disease Can Cause Increased FDG Uptake FDG- PET
  9. 9. REVISION THA CONSIDERATIONS
  10. 10. REVISION THA CONSIDERATIONS
  11. 11. CLASSIFICATION: Paprosky Classification of Femoral Bone Deficiencies • Type I: Minimal loss of metaphyseal cancellous bone with intact diaphysis • Type II: Extensive loss of metaphyseal cancellous bone with intact diaphysis • Type IIIA: Severely damaged, nonsupportive metaphysis, with >4 cm of intact diaphyseal bone available for distal fixation • Type IIIB: Severely damaged, nonsupportive metaphysis, with <4 cm of intact diaphyseal bone available for distal fixation • Type IV: Extensive damage to metaphysis and diaphysis, with widened femoral canal, nonsupportive isthmus
  12. 12. Type I Minimal loss of metaphyseal cancellous bone with intact diaphysis
  13. 13. Type II Extensive loss of metaphyseal cancellous bone with intact diaphysis
  14. 14. Type IIIA Severely damaged, nonsupportive metaphysis, with >4 cm of intact diaphyseal bone available for distal fixation
  15. 15. Type III B Severely damaged, nonsupportive metaphysis, with <4 cm of intact diaphyseal bone available for distal fixation
  16. 16. Type IV Extensive damage to metaphysis and diaphysis, with widened femoral canal, non-supportive isthmus
  17. 17. Other classifications – American Academy of Orthopaedic Surgeons Femoral Bone Loss Classification Type Description • I Segmental defect • II Cavitary defect • III Combined segmental and • cavitary defect • IV Femoral malalignment • (rotational or angular) • V Femoral stenosis • VI Femoral discontinuity
  18. 18. HOW? METAPHYSIS SUPPORT ISTHMUS SUPPORT PRIMARY STEM TAPERED STEM 13 CM BONE FROM INTERCONDYLAR NOTCH CEMENTED PROSTHESIS LONG STEM/ DISTAL LOADING STEM UNCEMENTED AT LEAST 2.5 MM THICKNESS OF CORTICAL BONE OVER A DISTANCE OF AT LEAST 6 CM? IN DISTAL DIAPHYSIS MEGAPROSTHESIS/ OSSEOINTEGRATION DEVICES TOTAL FEMUR NO YES YES NO NO NO
  19. 19. LITERATURE • John Callaghan, THE ADULT HIP, HIP ARTHROPLASTY SURGERY, 3rd edition, wolters kluwer • Neil P. Sheth, MD, et al, Femoral Bone Loss in Revision Total Hip Arthroplasty: Evaluation and Management; J Am Acad Orthop Surg 2013;21: 601-612 • Cavalli L and Brandi ML. Periprosthetic bone loss: diagnostic and therapeutic approaches F1000Research 2014, 2:266 • Lombard, C et al; Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging strategy. J. Clin. Med. 2022, 11, 4416. https://doi.org/ 10.3390/jcm11154416 • Dobrindt et al. Hybrid SPECT/CT for the assessment of a painful hip after uncemented total hip arthroplasty; BMC Medical Imaging (2015) 15:18 • James V Bono; REVISION HIP ARTHROPLASTY, 1999 Springer-Verlag
  20. 20. • Stable fixation is to be achieved on table with available bone • Care should be taken to avoid intraoperative fractures • Extensive pre operative planning
  21. 21. THANK YOU

×