A collection of complex joint preservation and replacement case studies and random thoughts of a orthopedic surgeon essentially aimed at knowledge dissemination.
Wednesday 4 August 2010
fracture head in ceramic on ceramic THR
38 year old male 4 years after ceramic on ceramic THR came with head fracture while playing badminton.
What are the options now and cause for the fracture?jacob
1) 38 yr old male, playing badminton...better bearing option would have been MOM?
2)having said that once decided to go ahead with either of the hard on hard bearing the acetabular inclination looks lil too vertical? may be that caused the edge loading of insert.. is the there bone loss / cyst in acetabulum ?
3) having decided on COC , modular uncementned stem option would have been better in view of this possibility?
Yes Bimal. Unfortunately this chap thought its fine. He used to waterslide in blackthunder. I am unsure if the fracture happened during badminton or the fracture propagated through a prior crack not visible. Yes, edge loading could have been an issue but i feel it is the liner which should chip. Now that this has happenend what would be your choice for revision. bearing as well as stem?
when revising,the cup was well fixed with fractured head. Metal debri was there from the taper i believe. The taper was completely scratched and therfore the decision for complete revision to Ceramic bearings was justified. Once a ceramic fractures only a ceramic bearing can be used as the harder ceramic particles from the fractured surface will wear our the metal or poly bearings(3rd body). If the taper was not damaged a metal backed ceramic head with ceramic liner could have been used. We did an ETO and used primary SROM with Pinnacle and COC bearings attached are the final xrays.
1) how much of proximal fixation will be possible in this case as it was cemented earlier?...or in other words how to decide while revising a cemented stem whether to go for a distal fixing stem or not?
2) was the decision to do SROM due to the fact that the bearing is COC ?( and keeping in mind the future black thunder escapades!)
1.A proximal loading stem like srom has its limitations after an eto. In this case we managed it as the femoral bone loss was maximum type 2 where a good shell which could be loaded was available after reconstituting the proximal tube. This guy is 38 and i wanted to load the proximal bone for future revisions.The distal fit is good and its not a scratch fit like in solution. There is a fine line in the fit. This is only the second time, i am using an SROM after ETO. 2.anwser is yes 3. Its about 40 degrees I think. Will measure and answer in time.
38 year old male 4 years after ceramic on ceramic THR came with head fracture while playing badminton.
Damage taper.
sir,
ReplyDeletecauses....
1) 38 yr old male, playing badminton...better bearing option would have been MOM?
2)having said that once decided to go ahead with either of the hard on hard bearing the acetabular inclination looks lil too vertical? may be that caused the edge loading of insert.. is the there bone loss / cyst in acetabulum ?
3) having decided on COC , modular uncementned stem option would have been better in view of this possibility?
Yes Bimal. Unfortunately this chap thought its fine. He used to waterslide in blackthunder. I am unsure if the fracture happened during badminton or the fracture propagated through a prior crack not visible. Yes, edge loading could have been an issue but i feel it is the liner which should chip. Now that this has happenend what would be your choice for revision. bearing as well as stem?
ReplyDeleteis there any cyst or bone defect in acetabulum? cup loose?
ReplyDeleterevision; metal on highly cross linked poly with solution like distal fitting stem?
what was the primary indication? other side had a neck with shaft femur?..this side was it neck with acetabulum?
when revising,the cup was well fixed with fractured head. Metal debri was there from the taper i believe. The taper was completely scratched and therfore the decision for complete revision to Ceramic bearings was justified. Once a ceramic fractures only a ceramic bearing can be used as the harder ceramic particles from the fractured surface will wear our the metal or poly bearings(3rd body). If the taper was not damaged a metal backed ceramic head with ceramic liner could have been used. We did an ETO and used primary SROM with Pinnacle and COC bearings attached are the final xrays.
ReplyDelete1) how much of proximal fixation will be possible in this case as it was cemented earlier?...or in other words how to decide while revising a cemented stem whether to go for a distal fixing stem or not?
ReplyDelete2) was the decision to do SROM due to the fact that the bearing is COC ?( and keeping in mind the future black thunder escapades!)
3) whats the post op inclination of cup?
1.A proximal loading stem like srom has its limitations after an eto. In this case we managed it as the femoral bone loss was maximum type 2 where a good shell which could be loaded was available after reconstituting the proximal tube. This guy is 38 and i wanted to load the proximal bone for future revisions.The distal fit is good and its not a scratch fit like in solution. There is a fine line in the fit. This is only the second time, i am using an SROM after ETO.
ReplyDelete2.anwser is yes
3. Its about 40 degrees I think. Will measure and answer in time.
its a jumbo cup for him i think 58mm( 4mm more than his previous cup and it has its added problems of ilipsaos tendinitis which one has to watch for.
ReplyDeleteI could have gone for a longer stem if needed but got 5 cm of distal fit and good stabilty at the sleeve.
ReplyDeletei would do metal on poly..
ReplyDeletehttp://orthopaedicprinciples.com/2010/08/revision-tha-after-ceramic-head-fracture/