Revista Brasileira de Ortopedia (Jul 2007)
Revisões femorais de artroplastias totais do quadril com afrouxamentos assépticos e fraturas periprotéticas: análise de 49 casos tratados com haste de Wagner Femoral revision total hip arthroplasties with aseptic loosening and periprosthetic fractures: analysis of 49 cases treated with Wagner stem
Abstract
OBJETIVO: Avaliar 49 quadris em 48 pacientes submetidos a revisão de artroplastia total do quadril usando a haste de Wagner. MÉTODOS: De abril de 1999 a janeiro de 2005, foram tratados 49 quadris em pacientes portadores de afrouxamento femoral (39 quadris) ou fratura periprotética do fêmur (10 quadris) com revisão da artroplastia com a prótese de Wagner. O seguimento médio foi de 35 meses e a média de idade, de 63,4 anos. As revisões do componente femoral foram realizadas em 49 quadris e, simultaneamente, no componente acetabular em 36 quadris. RESULTADOS: A avaliação dos resultados pelo índice de D'Aubignè-Postel-Charnley apresentou melhora estatisticamente significante no pós-operatório em relação ao pré-operatório (p OBJECTIVE: To evaluate 49 hips in 48 patients submitted to revision total hip arthroplasty using Wagner stem. METHODS: From April 1999 to January 2005, 49 hips were treated in patients with femoral loosening (39 hips) or periprosthetic fracture of the femur (10 hips) with revision arthroplasty using the Wagner prosthesis. Mean follow-up lasted 35 months and mean age was 63.4 years. Revisions of the femoral component were performed in 49 hips, with concomitant acetabular component revision in 36 hips. RESULTS: Results evaluation according to the D'Aubignè-Postel-Charnley index presented a statistically significant improvement in the post-operative period in comparison to the pre-operative period (p < 0.001). The most important problems seen were the high rate of dislocations (three hips) and dislocations associated to the deepening of the stem (two hips). The four unsatisfactory results were due to loosening (two hips), infection (one hip), and acetabular loosening (one hip). All of the unsatisfactory results occurred in the group of aseptic loosening, but this finding was not statistically significant (p = 0.569). Restoration of bone stock (radiographic evaluation) was seen consistently in most cases, without correlation with patient age (p = 0.852). Likewise, clinical results were not related to patient ages (p = 0.636). CONCLUSION: The procedure of femoral revision with Wagner prosthesis yields clinical and radiographic satisfactory results and consistently restores femoral bone stock.
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