Revision Total Hip Arthroplasty
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Part I. Generalized Principles in Revision THA.- Revision burden-projections in US and world-wide.- Soft tissue balancing/biomechanics.- Reconstruction of femoral defects- ETO, tapered modular stem, mega prosthesis.- Reconstruction of Acetabular defects- augments, bone graft, cup, cages.- Consideration of biomaterials (ceramics, corrosion, cement).- Basic science of THA failure.- Part II. Evaluation of the Painful Total Hip Arthroplasty (PTHA).- History and Physical, laboratory, injections.- Radiographic evaluation of the PTHA.- Hip-spine evaluation.- Special medical considerations (RSD, MS, cervical stenosis, Neurological).- Part III. Preoperative Planning.- Acetabular evaluation and classification of failure.- Femoral evaluation and classification of failure.- The patient evaluation and optimization of modifiable risk factors before revision THA.- Blood/fluid and Anesthesia.- Bone graft and bone substitutes.- Implant inventory-general (stem choices, acetabular choices) and Specialized Equipment -long chapter.- Part IV. Surgical Approaches/exposure.- Posterolateral.- Extended Trochanteric Osteotomy.- Direct anterior.- Direct anterior (Naylor).- Anterior based osteotomies.- Direct lateral.- Trochanteric slide osteotomy.- Anterolateral.- Tap out-tap in technique.- Removal of Well-fixed acetabular components.- Removal of well-fixed femoral components.- Part V. Acetabular reconstruction techniques.- Landmarks to determine anatomic hip center of rotation.- Hemispherical cup.- Augments.- Buttress.- Cup/cage.- Cage.- Custom triflange.- Pelvic discontinuity techniques.- Structural allografts.- Part VI. Femoral Reconstruction techniques.- Tapered modular stems.- Proximal porous modular stems.- Non-modular stems (Wedge or HA coated).- Fully porous stems.- Calcar replacement stems.- Articulated Antibiotic cement spacer.- Non-articulated antibiotic cement spacer/resection arthroplasty.- Proximal femoral replacement.- Total femoral replacement.- Cemented stems.- Impaction grafting.- APC.- Part VII. Trochanteric reconstruction techniques.- Short Plate, Long plate, Wires/sutures.- Part VIII. Surgical Techniques in Revision Total Hip Arthroplasty: Authors preferred techniques.- Instability.- Aseptic Loosening.- Infection.- Periprosthetic fracture.- Corrosion.- Implant Failure/Implant Fracture.- Osteolysis.- Use of Mega-prosthesis/total femur.- Use of Cages and custom triflanges.- Part IX. Minimizing complications after Revision THA.- Neurological Injury.- Thigh pain.- Vascular injury.- Postoperative Infection.- Instability.- VTE.- Wound Complications.- Part X. Revision THA: Unique surgical considerations.- Complex THA after previous surgeries.- Complex THA after Acetabular fracture.- Abductor tears, soft-tissue impingement, iliopsoas, rectus.- HO.- Combined abdominal and pelvic approaches.- Revision THA for LLD.- Conversion of Girdlestone arthroplasty to THA.- Conversion of hip arthrodesis to THA.- Metastatic Disease of the Hip.- Part XI. Special considerations with Revision THA.- Performing revision THA in ASC's.- Using current data and research to drive decision-making.- Evaluating Outcomes in Revision THA.- Considering malpractice in revision THA.- The role of physical therapy in revision THA.- Maximizing efficiency in revision THA (hospital and personnel).- Financial implications of revision THA (surgeon and hospital).
Eric L. Smith MD, FAAOS, FAAHKS, FAOA
Benjamin E. Bierbaum Chairman
Department of Orthopaedics
New England Baptist Hospital
Professor of Orthopaedics
Tufts University School of Medicine
125 Parker Hill Ave
Boston, MA 02120
617-754-5413
James V. Bono, MD Clinical Professor of Orthopaedic Surgery
Tufts University School of Medicine
Boston, MA
Vice Chair, Orthopaedics
Roderick H. Turner Distinguished Professor of Hip & Knee ArthroplastyNew England Baptist Hospital
Boston, MA
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