000			05182nam a22001817a 4500
008			210608b |||||||| |||| 00| 0 eng d
020			_a9783319985954
020			_a9783319985961
100			_aEduardo García-Rey _913245
245			_aAcetabular Revision Surgery in Major Bone Defects
260			_aMadrid Spain _bSpringer Nature Switzerland AG _c2019
300			_a223 Pages
500			_aIncludes References and Index
520			_aTotal hip arthroplasty (THA) has been recognised as one of the most important surgical advances during the last five decades. End-hip arthritis is probably the most disabling condition to affect daily life activities not only in elderly but also in young patients. The older population is increasing in most countries worldwide, and they are more active than ever during the last decades so cartilage aging plus more physical and social demands in the more developed societies are strongly increasing THA indications. Thus, in young patients diagnoses other than primary arthritis, such as avascular necrosis, post-traumatic conditions, rheumatologic diseases and congenital hip diseases or other developmental sequelae, influence THA outcome together with the possibility of loosening and wear at long term. All these issues contribute to a greater number of THA revision procedures. Nowadays, both cemented and cementless bone fixation can provide excellent long-term survival when using most contemporary implants. Most current femoral components have a survivorship higher than 95% more than 10 and 15 years after surgery. In fact, the THA revision procedure that is increasing is acetabular revision, and, as is reflected in most National Registries and clinical studies, the most frequent indication for THA revision surgery is related to the acetabular side. Indications for acetabular revision surgery at short term include dislocation, infection or, more rarely, fractures. To date, recent problems related to newer, not-very well studied, implants have also increased the number of revision procedures due to newer complications. At long term, the most frequent reasons for hip revision surgery are wear and loosening with the appearance of osteolysis. During last years, the appearance of late dislocation in older patients has become of interest. Nevertheless, in an indication for acetabular revision surgery, the most challenging issue is the existence of bone defect. Proper hip reconstruction during surgery to allow the closest distance to the hip rotation centre and the longest duration of the implant is the main purpose of the treatment. First, a hip surgeon must be familiar with the basic science that can affect bone biology and changes associated to implants. A better understanding of all these changes related to bearing surfaces and bone interfaces facilitates clinical management when facing a patient with THA. Biological processes secondary to wear _bparticles and different reactions to all kinds of polyethylenes, metallic particles, ceramics and cement contribute to silent osteolysis until there is significant bone destruction or implant loosening. The hip surgeon must also be familiar with advances in research that may improve clinical management. Second, it is necessary to classify the bone defects in every patient. Different imaging techniques can nowadays improve preoperative diagnosis, while newer surgical tools and tricks can diminish bone loss during explantation of the failed acetabular component. Appropriate surgical planning is critical before starting an acetabular revision procedure. Recommendations in young patients presenting severe polyethylene wear with osteolysis and fixed implants are different than in other patients with loosened cups. The surgical team needs to be familiar with revision implants, techniques and bone graft use. Understanding the biology of the latter, particularly of allografts, improves the clinical and radiological outcome. Despite the surgical choice, the surgeon must keep in mind that bone defect determines surgical technique. From conventional cementless cups to cages, bone impaction grafting or reinforcement rings, adequate hip rotation centre reconstruction in stable construction will affect the clinical and radiological outcome of these patients. Independent industry-unrelated high-quality studies are the most reliable way to review all the different clinical choices. Finally, all issues associated to different complications, such as dislocation or infection, must be addressed for proper management. Acetabular revision surgery in the presence of bone defect continues to be of concern for the patient and the surgeon. In this book all the most critical topics are covered beginning with the basic science, trying to clarify some newer research findings, continuing with established reconstruction techniques with or without the use of bone graft are reviewed. Continuing high-quality clinical studies to evaluate this complex problem and improve our understanding of the concepts will allow us to reliably improve outcomes for our patients.
654			_xSurgery
700			_aEduardo García-Cimbrelo _913246
942			_2ddc _cBK
999			_c14994 _d14994