hip and knee arthoplasty *lower limb reconstruction · wael abdel rahman egypt 20 02:15 constraint...
TRANSCRIPT
1
The 4th Spring Meeting of
The Egyptian Orthopaedic Association in
Collaboration with
Mansoura University Orthopaedic
Department
* Hip and Knee Arthoplasty
*Lower Limb Reconstruction
5-6, March, 2015
Movenpick Resort
Hurghada - Egypt,
PROGRAM
2
Dear colleagues:
On behalf of the Egyptian orthopaedic association, its my
great pleasure to welcome you all to Hurghada and to the 4th
EOA Spring Congress, our congress for 2015 is held in this
remarkable setting in collaboration with the Orthopedic
Department of the Mansoura university.
The congress this year has been designed to provide an
innovative and comprehensive overview of the latest research
developments on " Arthoplasty Hip, Knee and Lower & Limb
Reconstruction", many distinguished Professors are taking part
in all symposia that will include superb scientific material that
was carefully selected to highlight the featured topics of our
congress agenda this year.
We would like to express our thanks to the pharmaceutical
and manufacturing industry for their generous support, to the
EOA organizing committee and to the Orthopedic department of
the Mansoura University for their outstanding contributions in
all aspects of this profound event, also a well deserved thanks to
all service suppliers and to all my colleagues for their dedicated
work and support on planning this event.
We hope that you will enjoy this assembly and I hope it will
stimulate creative exchange of ideas and will be personally
rewarding.
Prof. Adel Adawy
President of EOA
3
Dear colleagues:
It’s my pleasure to welcome you all in the 4th annual Spring
congress of the Egyptian orthopaedic association. This
association was established in 1948 by the efforts of our great
professors. It is my honor to be the general secretary of EOA
I wish you all a successful congress that helps us in
expanding the knowledge and practice of orthopaedic surgery.
Let’s have a great stay here in Hurghada. I know that Egypt
is going through a critical phase and now facing great
challenges, but nations like Egypt with all its history, culture
and glory will certainly come out of it stronger and prosperous
Finally I wish you all an enjoyable stay & safe return home.
Prof. Alaa ElZoheiry
General Secretary of the EOA
4
Dear colleagues:
On the behalf of the orthopaedic department Mansoura
university, it is my great pleasure to welcome all members of the
Egyptian Orthopaedic Association who participates in this
prestigious Congress . I would like to express my gratitude to all
the Board members of the Egyptian Orthopaedic Association as
well as the orthopaedic department Mansoura university.
This Congress will discuss two important topics:
* Arthoplasty Hip, Knee and Lower & Limb Reconstruction.
I hope this Congress will add fruitful flow of information
to my friends and colleagues.
Thank you
Prof. Hani El-Mowafi
Head of orthopedic Department of
Mansours University
5
Congress Board
Head of orthopedic Department Mansoura University & EOA Treasurer
Prof. Hani El-Mowafi
EOA General Secretary Prof. Alaa El Zoheiry
President of EOA Prof. Adel Adawy
6
Scientific Committee
Prof. Hani El-Mowafi
Prof. Roshdy El- Sallab
Prof. Mostafa Abdel-Khalek
Prof. Akram Hammad
Dr. Wael Abdel-Rahman
7
EGYPTIAN ORTHOPAEDIC ASSOCIATION BOARD
Prof. Adel Adawy President
Prof. Gamal A Hosny Vice President
Prof. Alaa ElZoheiry Secretary General
Prof. Hani El Mowafi Treasurer
Prof. Abdel-Mohsen Arafa Member
Prof. Anis Shiha Member
Prof. Abdel Salam Eid Member
Prof. Bahaa Kornah Member
Prof. Mohamed Fadel Member
Prof. Hassan El-Zaher Member
Prof. Hazem Abd El-Azeem Member
Prof. Khamis El Deeb Member
Prof. Mohamed Osama Hegazy Member
Prof. Mahmoud El Rosasy Member
Prof. Talaat Ezz El-Din Member
8
01:00 – 01:30 Opening Ceremony
Head of orthopedic Department Mansoura University & EOA Treasurer
Prof. Hani El-Mowafi
General Secretary of the EOA Prof. Alaa El Zoheiry
President of EOA Prof. Adel Adawy
01:30 – 02:00 Coffee Break
9
SCIENTIFIC
PROGRAM
10
Thursday 05 March 2015
Session 1 02:00-03:45
Chairmen
Prof. Ahmed Hassaan Prof. Alaa ElZoheiry Prof. Roshdy El Sallab
Primary Arthroplasty
1 02:00 Difficult primary TKA.
Roshdy El Sallab
Egypt
2 02:15 Metal-on-Metal Articulation. Where are we now?
Ahmed Hassaan
Egypt
3 02:30
1ry prosthesis in complex primary TKA.
Mostafa Abdel khalek
Egypt
4 02:45
Non arthroplasty management of adolescent hip arthritis. Gamal Hosny
Egypt
5 03:00
Results of THA in DDH.
Fouad Zamel
Egypt
6 03:15
Uni-compartmental TKA: A forgotten art.
Tarek El khadrawy
Egypt
03:30 Discussion
11
Thursday 05 March 2015
Session 2 03:45-04:15
Chairmen Prof. Gamal Hosny Prof. Hani El Mowafi
SYMPOSIUM
03:45 ABBOTT
12
Thursday 05 March 2015
Session 3 04:15-06:00
Chairmen
Prof. Gamal El Adl Prof. Magdy Nabil Prof. Mohamed Saleh
Lower Limb Reconstruction
7 04:15
Salvage procedure in charcot ankle.
Hani EL-Mowafi
Egypt
8 04:30
Plat late rich plasma shorten consolidation phase in distraction osteogenesis. Barakat Al-Alfy
Egypt
9 04:40
Unhappy triad in lower limb reconstruction.
Barakat Al-Alfy
Egypt
10 04:50
Role of Ilizarov in management of open floating knee.
Nabil El-Moghazy
Egypt
11 05:00
Recurrent equinovarus deformity in arthrogryposis treatment by talectomy and modified Ilizarov external fixation. Mahmoud Rosasy
Egypt
12 05:10
Management of non-traumatic osteonecrosis femoral head using impaction bone grafting through light bulb window using safe surgical dislocation. Nabil El-Moghazy
Egypt
13
Thursday 05 March 2015
Session 3 04:15-06:00
13 05:20
Safe surgical dislocation for anatomical reduction of slipped capital femoral ephyphysis. Yasser Roshdy
Egypt
14 05:30
To be vascularized or non vascularized. Yasser Youssef
Egypt
15 05:40 Reconstruction of leg and foot defects by using free tissue
transfer. Magdy Nabil
Egypt
16 05:50 Unusual complication in pediatric femoral shaft fracture. Yasser Youssef
Egypt
END OF THE DAY
14
Friday06 March 2015
Session 4 01:30-03:00
Chairmen Prof. El Sayed Morsy Prof. Mostafa Abdel Khalek Prof. Raouf El Abbasi
Revision Arthroplasty
17 01:30 Impaction grafting in acetabular defect.
Fouad Zamel
Egypt
18 01:45 Update on periprosthetic joint infection.
Mahmoud Abdel Karim
Egypt
19 02:00 Acetabular bone deficiency: Indication of cages and cup cages. Wael Abdel Rahman
Egypt
20 02:15 Constraint level in revision TKA.
Mahmoud Abdel Karim
Egypt
21 02:30 Metal augmentation for bone deficiency in revision TKA. Wael Samir
Egypt
02:45 Discussion
03:00 – 03:30 Coffee Break
15
Friday06 March 2015
Session 5 03:30-05:00
Chairmen Prof. Adel Anwer Prof. Ahmed Anan Prof. Yasien El Ghoul
Revision Arthroplasty
22 03:30 Conversion of knee arthrodesis to TKA: Surgical Technique and complications. Wael Samir
Egypt
23 03:45 Results of revision THA after failed MOM THA.
Wael Abdel Rahman
Egypt
24 04:00 Two stage revision infected knee replacement.
Wael Samir
Egypt
25 04:15 Revision of infected THA using antibiotic loaded Spacer. Mahmoud Abdel Karim
Egypt
26 04:30 Mid-term results of one stage single component exchange in management of infected THA. Wael Abdel Rahman
Egypt
04:45 Discussion
16
Friday06 March 2015
Session 6 05:00-06:00
Chairmen Prof. Akram Hammad Prof. Hesham Abdel Sadek Prof. Mohamed Shabana
Primary Arthroplasty
27 05:00 THA IN Protrusio.
Mostafa Abdel Khalek
Egypt
28 05:10 Results of THA in Dysplastic Hip.
Akram Hammad
Egypt
29 05:20 Results of Hyper-flex TKA.
Kamel Youssef
Egypt
30 05:30 Long-term results of MOM THA.
Tamer Abdel Mawlla
Egypt
31 05:40 Radiological assessment of TKA. Ehab Ramadan
Egypt
05:50 Discussion
End of the Day
17
ABSTRACTS
18
1 DIFFICULT PRIMARY TKA.
Roshdy El Sallab
Professor of orthopedic surgery Mansoura University, Egypt
2 METAL-ON-METAL ARTICULATION. WHERE ARE WE NOW?
Ahmed Hassaan
Professor Orthopaedic surgery Alexandria University, Alexandria, Egypt
Metal-on-metal articulation was extensively used during the last 25 years. Over time the benefits and risks have been identified, revised, weighed and compared to alternative bearings. The major risk is the increased exposure to metal particles and ions, leading to metal reactivity and sensitivity. The long-term results and risks of hip resurfacing should be differentiated from those of metal-on-metal total hip replacement.
3 1RY PROSTHESIS IN COMPLEX PRIMARY TKA.
Mostafa Abdel khalek
4 NON ARTHROPLASTY MANAGEMENT OF
ADOLESCENT HIP ARTHRITIS.
Gamal Hosny Professor of orthopedic surgery Benha University, Egypt
5 RESULTS OF THA IN DDH.
Fouad Zamel
6 UNI-COMPARTMENTAL TKA: A FORGOTTEN ART.
Tarek El khadrawy
7 SALVAGE PROCEDURE IN CHARCOT ANKLE.
Hani EL-Mowafi
8 PLATELET RICH PLASMA TO ENHANCE BONE HEALING DURING DISTRACTION OSTEOGENESIS . AN
EXPERIMENTAL STUDY
Barakat El-Alfy, Ayman M Ali Assistant Professor of orthopedic surgery Mansoura University, Egypt
19
Background: The purpose of this study is to evaluate the effects of platelet-rich plasma (PRP) on bone healing during distraction ontogenesis. Materials and methods: Tibias of 36 New Zealand white rabbits were distracted at a rate of 0.25 mm /8 h for 20 days with a circular external fixator. The animals were randomly divided into a control group that did not receive PRP therapy and an experimental group, with PRP injection into the distracted area. Radiographic examinations were performed at the 10th, 20th, 30th, 40th and 50th days after end of distraction. By the 50th day after distraction, all animals were sacrificed. After that, each group was subdivided into two subgroups: one for pathological study and another one for mechanical study. Results: The experimental group demonstrated higher radiologic scores at the 40th and 50th days. Histopathological examination revealed a statistically significant higher score in the experimental group. Conclusion: The results of this study show that PRP has beneficial effects on new bone formation during distraction osteogenesis.
9 THE UNHAPPY TRIAD IN LIMB RECONSTRUCTION.
Barakat El-Alfy, Ayman M Ali
Assistant Professor of orthopedic surgery Mansoura University, Egypt Bone loss, soft tissue loss and bone infection are considered to be the unhappy triad in the field of limb reconstruction. In presence of this triad the scope of reconstruction becomes very narrow and amputation may be the eventual outcome. During distraction osteogenesis, not only the bone but also the soft tissues are lengthened, and this may help in spontaneous closure of the soft tissue defects without the need for major plastic surgery. 18 cases with bone loss, soft tissue loss and infection were managed by distraction osteogenesis in our institution. Acute shortening of the limb was done in three cases to help in rapid closure of both the bone and soft tissue defects, then re-lengthening was done from a distant corticotomy to restore the limb lengths. The infection was eradicated in all of the cases. All the soft tissue defects healed during the process of bone transport without the need for plastic surgery, except in one case. We found that restoration of the soft tissue envelope is not necessary before the distraction process. With distraction histogenesis is a good method that can treat the three problems of this triad simultaneously.
10 ILIZAROV METHOD IN TREATMENT OF OPEN
FLOATING KNEE
Nabil A Elmoghazy, MD Orthopedic department, Mansoura University Mansoura, Egypt
20
Background: Floating knee injuries are complex injuries. The type of fracture, soft tissue and associated injuries make this a challenging to manage. Methods: 25 patients with open floating knee injuries presented between (2007- 2013), they treated by combined Ilizarov method for the tibia and intramedullary nailing for the femur. Associated injuries were managed appropriately. The fracture types were classified according to Fraser classification, type I (8), type IIa (6), type IIb (7), type IIc (4). The mean follow up was 3.4 years (range 1.4- 7 years). Assessment was done by the Karlstrom criteria. Results: The union time for the Femur ranged from (15-21 weeks) and for the Tibia ranged from (18-27 weeks). According to the Karlstrom criteria, the end results were excellent 12, good 8, acceptable 2, poor 3. Complications were Knee stiffness, deep infection, delayed union and nonunion. Conclusion: Combined ilizarov method and IM nail is a good and reliable method for treatment of open floating knee, but associated with multiple procedures and complications which needs to be treated appropriately.
11 RECURRENT EQUINOVARUS DEFORMITY IN ARTHROGRYPOSIS TREATMENT BY TALECTOMY AND
MODIFIED ILIZAROV EXTERNAL FIXATION.
Mahmoud Rosasy Tanta University, Faculty of Medicine
Introduction: Talectomy has been described in the management of the rigid talipes equinovarus that is seen in some cases of arthrogryposis multiplex congenita. causes of failure of soft-tissue release operations when used in the management of the gross equinovarus deformity sometimes encountered in this condition. Methods: Ten feet with recurrent sever equinovarus deformity were treated in five patient with arthrogryposis multiplex congenital. The procedure included complete excision of the talus through Olier approach on the antero-lateral aspect of the foot. Then the foot and ankle were held in the plantigrade position using a simplified Ilizarov external fixator for eight weeks followed by a below knee walking cast for four weeks then prolonged use of plastic splint to maintain the foot position. No neurovascular injury occurred due to deformity correction. Results: The plantigrade position of the foot was maintained with no recurrence of deformity. Discussion & Conclusion: Talectomy provides acute and relatively safe correction of sever recurrent equinovarus deformity in arthrogryposis.
21
12 MANAGEMENT OF NON-TRAUMATIC OSTEONECROSIS
BY IMPACTION BONE GRAFT THROUGH A LIGHT BULB WINDOW
Nabil A Elmoghazy, MD
Orthopedic department, Mansoura University Mansoura, Egypt Introduction: Osteonecrosis of the femoral head (ONFH) is a disorder than can lead to femoral head collapse. Various head preserving surgeries including various vascularized and non-vascularized bone grafting procedure have been used to avert the need for total hip replacement. Objective: We evaluate the clinical results of impacted bone graft via bone window on the head neck junction for treatment of non traumatic a vascular necrosis of femoral head through a safe surgical dislocation approach. Methods: We treated 18 hips in 12 patients with femoral head necrosis by impaction of autogenous iliac bone graft via bone window on the head neck junction (light bulb) through a safe surgical dislocation approach. There were 7 females and 5 males with an average age of 33 years (ranging from 14 years to 46 years) with stage II and III avascular necrosis of the femoral head according to ARCO (Association research circulation osseous). The outcome was determined by changes in the Harris hip score and progression in radiographic stages. Results: These 12 patients were followed up for from 1 to 3 years (mean 1.8 months). The Harris hip score was 86.7 + 8.3 after 1 year follow up when compared with the preoperative one (62.4 + 13). Pain relief with preservation of the spherical shape of the femoral head was obtained in 8 patients (66%) while 3 patients (25%) had significant limitation of the range of motion that is better than preoperative value with no significant pain during walking & no significant loss of spherical femoral head shape. One case had poor results with marked limitation of range of motion & significant head collapse with a big area of head involvement (> 30%). Conclusion: Impaction of autogenous bone graft through a safe surgical dislocation via a bone window creates a mechanical and biological condition for graft incorporation and therefore it may be the treatment of choice in non traumatic osteonecrosis of the femoral head at the pre-collapse stage ( stage II and early III ).
13 SURGICAL HIP DISLOCATION FOR ANATOMICAL
REDUCTION OF SLIPPED CAPITAL FEMORAL EPIPHYSIS
Yasser Roshdy Kandil, MD
Lecturer of Orthopaedic Surgery Mansoura University
22
The aim of treatment of slipped capital femoral epiphysis is an anatomically aligned epiphysis with normal blood supply. This result can be achieved by open sub capital reorientation of the epiphysis or by a wedge osteotomy of the femoral neck. Other procedures have, so far, not gained optimal control over the risk of avascular necrosis. The blood supply to the epiphysis from the medial femoral circumflex artery can be preserved by surgical hip dislocation and a soft-tissue flap derived subperiosteally from the retinaculum and external rotators. This soft-tissue flap permits not only the detachment of the epiphysis, but also complete callus resection from the femoral neck without causing tension in the retinaculum. Dislocation of the femoral head ensures its manual protection during curettage of the epiphyseal plate and, ultimately, allows anatomic reduction under visual control of the retinaculum. With the head dislocated there is less risk to the integrity of the retinaculum due to unintentional manipulation of the leg than there would be, if the head remained in the socket. By using this technique it was found that safe dislocation of the hip is a very useful surgical approach in cases of severe SCFE. The hips became stable, deformity corrected and achieved full union without compromising the vascularity. Strict attention must be taken not to penetrate the head with the internal fixation implant.
14 TO BE VASCULARIZED OR NON VASCULARIZED.
Yasser Youssef
15 RECONSTRUCTION OF LEG AND FOOT DEFECTS BY
USING FREE TISSUE TRANSFER.
PROF. MAGDY NABIL MORSY, M.D. Rhôn Fellowship of Hand Surgery, GERMANY
Vice President of Military Medical Academy Formal Head Burn Reconstructive Surgery Department,
Helmia Military Hospital Introduction
Cutaneous injuries of the lower third of the leg and foot represent a great challenge for plastic surgeons. Microsurgical repair of the lower extremity has begun when Danial and Taylor, 1973 performed the first free vascularized groin flap to reconstruct a traumatic soft tissue defects in the lower extremity. Our aim was to evaluate the role of free tissue transfer in reconstruction of the lower leg and foot. The authors describe latissimus dorsi and anterolateral thigh flaps in reconstruction of leg and foot defects. Also the role of sensate flaps in reconstruction of the foot as a protection from ulceration in the weight bearing area of it.
16 UNUSUAL COMPLICATION IN PEDIATRIC FEMORAL
SHAFT FRACTURE.
23
Yasser Youssef
17 IMPACTION GRAFTING IN ACETABULAR DEFECT.
Fouad Zamel
18 GUIDELINES FOR DIAGNOSIS OF PERIPROSTHETIC
JOINT INFECTIONS
Mahmoud Abdel Karim Lecturer Tr & Orth surgery Department, Cairo University Hospitals.
This presentation will cover current different guidelines for diagnosis of Periprosthetic joint infections (PJI) ; including the AAOS, IDSA and International consensus on PJI. In addition to other recent modalities for diagnosis of PJI.
19 ACETABULAR BONE DEFICIENCY : INDICATION OF CAGES AND CUP CAGE CONSTRUCT FOR
RECONSTRUCTION OF LARGE ACETABULAR DEFECTS AND PELVIC DISCONTINUITY.
Wael Abdel Rahman, MBBCh, MSc, MD (Ortho)
Lecturer Orthopaedic surgery Mansoura University Egypt
The failed acetabular component is a common and often challenging scenario encountered by the arthroplasty surgeon. Because it is often accompanied by varying degrees of osteolysis and bone loss, the challenge in reconstruction lies in clearly identifying the location and quality of remaining viable host bone. Once the bone defect pattern is identified by radiographic and intraoperative analysis, its classification facilitates choice of an appropriate reconstruction method to achieve an optimal outcome . Long-term success in acetabular reconstruction is obtained by maximizing contact of the implant with an adequate amount of viable host bone and creating sufficient mechanical stability to allow successful implant osseointegration. The goal of this presentation is to outline the methods of management of acetabular bone deficiency in revision Total hip arthroplasty.
20 THE ROLE OF CONSTRAINT IN TOTAL KNEE
ARTHROPLASTY.
Dr. Mahmoud Abdel Karim Lecturer Tr & Orth surgery Department, Cairo University Hospitals.
This presentation will discuss different levels of constraints in Total Knee Arthroplasty (TKA) including the constrained condylar and hinge designs as well as indications and results of each type both in primary
24
and revision TKA surgery.
21 METAL AUGMENTATION FOR BONE DEFICIENCY IN REVISION KNEE ARTHROPLASTY.
rlma leaW
Lecturer surgery Department, Ain shams University .Cairo,Egypt Bone loss in revision TKA could always be considered as a
consequence of the previous arthroplasty. Bone loss is often underestimated on preoperative radiographs relative to the true bone loss found during revision surgery. The final evaluation of bone loss is made more accurately during surgery, after component removal; so that various classification systems used are mainly based on the size and type of the defect found intraoperatively. Various options exist to manage bone defects, available in both primary and revision surgery. Indication to whether option to use, depends on knee-related and patient-related factors. The use of metal augments for bone deficiencies has become quite popular since mid Eighties, after the work of Brooks et al which indicated that biomechanically the modular augments are equivalent to a custom implant. On the tibial side, multiple sizes of metal wedges and blocks are available, up to full tibial block for defects of entire plateau, thus maintaining balanced flexion and extension spaces. Femoral defects can be reconstructed with metal blocks in increments of 5 mm; because bone loss in femur is most often on the posterior and distal surfaces, augments fixed to the distal and posterior femoral condyles are used.
22 CONVERSION KNEE ARTHRODESIS TO KNEE
ARTHROPLASTY: SURGICAL TECHNIQUE AND COMPLICATIONS
rlma leaW
Lecturer surgery Department, Ain shams University .Cairo,Egypt
Conversion of a fused knee to a total knee arthroplasty (TKA) is a challenging procedure with many possible complications including high incidence of skin, soft tissue complications and infection. Material and methods
Eleven pa t ien ts with a mean age of 56 years underwent conversion of a fused knee to a total knee arthroplasty. The mean duration of fusion had been 2.5 years. Clinical and radiographic evaluation was done preoperatively; at six weeks, six months, and twelve months postoperatively. The mean duration of follow-up was 3.2 years. Results
The mean preoperative KSS score of 55 points improved to 85 points at the final follow-up examination. The mean ROM of active flexion in the entire group was 72°. The extension lag in the entire
25
group averaged 17°. Complications included necrosis of the skin edges in eighteen knees (50%), Ischemic lateral skin necrosis needed grafting in two cases, pyogenic infection in one and knee dislocation in one case. No prosthesis required revision because of clinical or radio- graphic loosening. Conclusion
Conversion knee arthrodesis to knee arthroplasty is a technically demanding procedure and improved the functional status and range of motion of the patient. The high rate of skin and soft complications with the procedure may warrant for two stage conversion though first stage of skin expansion.
23 OUTCOME OF REVISION TOTAL HIP ARTHROPLASTY
IN MANAGEMENT OF FAILED METAL ON METAL HIP ARTHROPLASTY
Wael Abdel Rahman, MBBCh, MSc, MD (Ortho) Lecturer Orthopaedic surgery Mansoura University Egypt
PURPOSE: The purpose of this study is to report: 1) functional outcomes and complications after revision Total Hip Arthroplasty (THA) of failed Metal-on-Metal (MoM) hip arthroplasty; 2) report the causes of failure of MoM THA in our patient population. METHODS: Twenty revision MoM THAs in 19 patients (10 women and 9 men) were retrospectively reviewed. Two cases were failed hip resurfacing and 18 cases were failed large head MoM THA. The mean age of patients at the time of primary hip arthroplasty was 55.7 years (SD 9.97, range 38–74 years). The mean age at the revision surgery was 59.35 (SD 9.83, range 42-77 years). The mean interval between primary hip arthroplasty and the revision procedure was 43.3 months (SD 25, range 12-132 months). RESULTS: The mean follow up was 33 months SD 13.98 (range, 15-58). The reason for revision were aseptic loosening of the acetabular component without adverse local tissue reaction (ALTR) (10 hips), aseptic loosening of the acetabular component with adverse local tissue reaction (ALTR ) (5 hips) , Mal-positioned acetabular or femoral components (3 hips), failed hip resurfacing (2 hips) . The acetabular components were revised in 18 hips. Survivorship free from further revision for any cause was 95% at 28 months. There were 2 complications (one foot drop and one superficial infection). There was one failure (recurrent dislocation) that required revision to a constrained liner. The Harris hip score (HHS) was 48.4 SD 12.98 (range, 32-75) preoperatively and 83.25 SD 10.08 (range, 54-96) postoperatively (p<0.0001). CONCLUSIONS: Revision THA of failed MoM hip arthroplasty is a successful procedure with good early term survival and improvement in pain and functional outcome. Extensive soft tissue and abductor muscles dysfunction are
26
commonly encountered in these cases. We recommend use of a constrained acetabular component with repair of the hip abductors when abductor muscle dysfunction is present.
24 TWO STAGE REVISION FOR INFECTED TKA.
rlma leaW
Lecturer surgery Department, Ain shams University .Cairo,Egypt
Peri-prosthetic infection remains one of the most devastating complications after total joint arthroplasty. The numerous treatment options include antibiotic suppression, operative debridement, resection arthroplasty, arthrodesis, and exchange arthroplasty. It is now widely accepted that the most reliable outcome for the treatment of late chronic infection is obtained by a two-stage exchange technique involving implant removal followed by a 6-week course of systemic antibiotics and delayed exchange arthroplasty. Two-stage exchange arthroplasty is the gold standard for treating chronic infection after TKA. This procedure is highly successful in curing or controlling infection and returning patients to a functional status. It is reported to be approximately 90% successful in curing or controlling infection and restoring a functional limb.
25 ANTIBIOTIC LOADED CEMENT SPACERS.
Dr. Mahmoud Abdel Karim
Lecturer Tr & Orth surgery Department, Cairo University Hospitals.
This presentation will cover classification of different antibiotic loaded cement hip spacers, choice of antibiotics and factors affecting its elution. The technique of the custom made spacer will be discussed in addition to the outcomes of spacers utilization.
26 OUTCOME OF SINGLE STAGE ACETABULAR
COMPONENT EXCHANGE ARTHROPLASTY WITH RETENTION OF WELL FIXED CEMENT-LESS FEMORAL COMPONENT IN MANAGEMENT OF INFECTED TOTAL
HIP ARTHROPLASTY
Wael Abdel Rahman, MBBCh, MSc, MD (Ortho) Lecturer Orthopaedic surgery Mansoura University Egypt
Introduction: We postulated that well-fixed femoral component in the setting of infected THA can prevent spread of pathogens and the formation of biofilm around the femoral stem. We assessed the success of single stage acetabular component exchange with preservation of the well-fixed circumferentially ingrown femoral component. Methods: Retrospective study (15) patients. All had acetabular
27
component exchange only in management of infected THA. Results: Mean age at surgery 58.93 years (± 10.67). Mean follow-up 90.5 months (± 56.4). One hip (6.7%) was revised for infection, Kaplan Meier curve shows 93.3% survival rate. Conclusion: good results in selected infected THA. Comparable results to two-stage exchange arthroplasty are achievable with less patient morbidity and less cost to the health care system.
27 THA IN PROTRUSIO.
Mostafa Abdel Khalek
28 RESULTS OF THA IN DYSPLASTIC HIP.
Akram Hammad
29 RESULTS OF HYPER-FLEX TKA.
Kamel Youssef, MBBCh, MSc, MD (Ortho) Lecturer Orthopaedic surgery Mansoura University Egypt
Introduction: The goal of total knee replacement surgery is to provide the best possible outcome for the patient. There are many factors that influence the outcome of total knee replacement. There are also many measures of outcome. Range of motion has been an important measure of outcome and is an important part of most knee scoring systems. The high flex total knee system was introduced to accommodate deep knee flexion after total knee arthroplasty. The high flex prosthesis is specifically designed to aim for 150 degrees of flexion. Methods: 88 primary total knee replacement were performed in 67 patients. 44 knees had conventional total knee prostheses, whereas the remaining 44 knees had high-flexion total knee. The surgical procedure was the same in the two groups. The rehabilitation program also was the same in the two groups. All patients were evaluated according to guidelines of the Clinical Knee Society Rating System. Discussion: In the presented study, we compared the clinical outcome of patients after high-flexion or conventional total knee arthroplasty. At 2 years follow-up, there were no differences between the two groups, especially the range of motion.
30 LONG-TERM RESULTS OF MOM THA.
Tamer Abdel Mawlla
28
31 RADIOLOGICAL ASSESSMENT OF TKA.
Ehab Ramadan