Uncemented Femoral Stems for Revision Surgery: The Press-fit Concept - Planning - Surgical Technique - Evaluation

134 Pages·2015·12.814 MB·English

by  Pierre Le Béguec, François Canovas, Olivier Roche, Mathias Goldschild, Julien Batard (auth.)

Pierre Le Béguec
François Canovas
Olivier Roche
Mathias Goldschild
Uncemented
Julien Batard
Femoral Stems for
Revision Surgery
The Press-fi t Concept
Planning
Surgical Technique
Evaluation
123
Uncemented Femoral Stems for Revision Surgery

Pierre Le Béguec (cid:129) François Canovas
Olivier Roche (cid:129) M athias Goldschild (cid:129) Julien Batard
Uncemented Femoral Stems
for Revision Surgery
The Press-fi t Concept - Planning - Surgical
Technique - Evaluation
Pierre Le Béguec Mathias Goldschild
Rennes Polyclinique Sévigné
France Cesson-Sévigné
France
François Canovas
Hôpital Lapeyronie Julien Batard
Montpellier cedex Hôpital Lapeyronie
France Montpellier cedex
France
Olivier Roche
Centre Chirurgical Emile Gallé
Nancy
France
ISBN 978-3-319-03613-7 ISBN 978-3-319-03614-4 (eBook)
DOI 10.1007/978-3-319-03614-4
Springer Heidelberg New York Dordrecht London
Translation from the French language edition ‘Reprise des prothèses fémorales descellées’ © Sauramps Medical,
Montpellier, 2013; ISBN: 9782840230625
Library of Congress Control Number: 2015934231
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Warni ng
1. This monograph is not an exhaustive survey of the various femoral prostheses and surgical
techniques available for the treatment of loosened femoral stems, namely revisions with
cemented femoral stems will be not addressed in this study.
This monograph discusses the revision of loosened femoral prostheses by means of an
uncemented femoral stem system.
2. Ensuring reliable primary stability for an uncemented implant is achieved in different ways,
depending on the chosen concept and the design of the implant.
This book refers to uncemented, straight femoral stems whose primary stability is achieved
by means of an intimate surface contact between bone and implant.
It is also important to remember that it is not possible to use a straight and a curved stem in
the same manner and the modularity is not a concept in itself to ensure primary stability of
an uncemented femoral implant. The modularity is only a means effi cient for the prepara-
tion of the anchorage zone and for the choice of the right implant.
3. Finally, it should be pointed out that this monograph was written fully independently;
the authors were not biased in their work, especially not when assessing the results.
June 2013
v

Acknowledgments
The authors thank F. Bonnomet and J. Girard for their participation in the development of the
evaluation method of the radiological results and the analysis of the results, as well as
J.C. Murie for the drawings and A. Ingels for the statistical studies.
vii

Contents
Preamble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Part I Press-Fit Concept
1 The Uncemented Concepts: Parameters to Make a Reasoned Choice. . . . . . . . . 3
1.1 What Must Be Avoided. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.2 What Is Preferable to Avoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.3 What Needs to Be Considered with Caution . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.3.1 Modular Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.3.2 The “Mixed” Concepts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.4 What Is Possible But in Limited Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.4.1 Use of a Primary Stem for Revision Surgery . . . . . . . . . . . . . . . . . . . . . 4
1.4.2 Stems with Distal Locking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.4.3 Custom-Made Stems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.5 Frequently Used Uncemented Concepts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.5.1 The “Fit and Fill” Concept . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.5.2 The “Press-Fit” Concept. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2 The Press-Fit Concept: Principles and “Press-Fittable” Zones. . . . . . . . . . . . . . . 7
2.1 Principles of the Press-Fit Concept. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.1.1 Bone/Implant Contact. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.1.2 Wedging of the Implant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.2 “Press-Fittable” Zones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.2.1 Proximal Press-Fit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.2.2 Diaphyseal Press-Fit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
3 The Press-Fit Concept: Practical Application. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
3.1 How to Ensure a Proximal Press-Fit?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
3.1.1 Femoral Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
3.1.2 Preparation of a Proximal Anchorage Zone . . . . . . . . . . . . . . . . . . . . . . 12
3.2 How to Ensure a Diaphyseal Press-Fit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
3.2.1 Femoral Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
3.2.2 Preparation of a Diaphyseal Anchorage Zone . . . . . . . . . . . . . . . . . . . . 13
3.2.3 Selection of the Implant with a Trial Prosthesis. . . . . . . . . . . . . . . . . . . 13
3.2.4 Insertion and Wedging of the Final Stem in Two Steps . . . . . . . . . . . . . 13
3.3 Particular Cases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
3.3.1 Global Press-Fit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
3.3.2 Proximal Press-Fit by Means of a Flap. . . . . . . . . . . . . . . . . . . . . . . . . . 14
ix