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BONE DEFECTS CAUSED BY HIP AND KNEE REVISIONS

Artificial hip and knees may need to be replaced over time because of loosening and wear. Removing the loosened hip or knee surgically often leaves large bone defects, demanding repair in order to achieve the necessary long term fixation and stability.

Hip and knee revisions have also consistently been reported to be at higher risk of infection in comparison to the primary operation (when the hip or knee is first implanted), with infection rates of 7.9% - 33% reported, and bone loss becomes an increasing problem with every revision.

Treatment options

Repair of bone defects are managed by the use of special revision implants, and by filling the defects with bone graft normally taken from the patient's own iliac crest (rim of the pelvis), which requires a second invasive surgical procedure. However, iliac crest grafting can result in donor site pain that often overshadows the pain from the hip/knee operation itself, and the amount of graft available is limited, and so may not be enough to fill the defects created.

 

Allograft or bone cement may also be used, but allograft carries the risk of transmission of disease because it contains living cells, and bone cement will never remodel into bone. In addition, if a further revision is required, any cement will need to be removed, and this inevitably removes good bone as well.

 

CERAMENT® provides an attractive alternative treatment option to bone grafting as it can be injected into the bone defect during the procedure, with no need for a second surgical procedure, and will remodel within 6-12 months, allowing for replenishment of bone stock, should a further operation be needed in the future. CERAMENT®|G and CERAMENT® V also provide a high local concentration of antibiotic, ensuring that implants and bone healing is protected.

REFERENCES

Malchau H & Herberts P. Prognosis of total hip replacement. The Swedish National Hip Arthroplasty register 1996. Proceedings American Academy of Orthopedic Surgeons. Atlanta: 1996

Namba, RS et al. Risk Factors for Total Knee Arthroplasty Aseptic Revision. J Arthroplasty (2013), http://dx.doi.org/10.1016/j.arth.2013.04.050

Pulido L et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008;466:1710–1715

Tsukayama DT et al. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg [Am] 1996;78-A:512–523

Jamsen E, Huhtala H, Puolakka T, Moilanen T. Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am. 2009;91:38–47

Kubista B, Hartzler RU, Wood CM, Osmon DR, Hanssen AD, Lewallen DG. Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty. Int Orthop. 2011;36:65–71

Azzam K, McHale K, Austin M, Purtill JJ, Parvizi J. Outcome of a second two-stage reimplantation for periprosthetic knee infection. Clin Orthop Relat Res. 2009;467:1706–14

Hanssen AD, Osmon DR. Evaluation of a staging system for infected hip arthroplasty. Clin Orthop Relat Res. 2002;403:16–22.

Springer, BD & Javad P. Periprosthetic Joint Infection of the Hip and Knee, Springer.