Total Hip replacement (revision): Direct exchange to Rimfit socket (Stryker) with X-change Rim-Mesh (Stryker) and impaction bone grafting
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Impaction Bone grafting of the acetabulum is a skill that all revision surgeons should possess and is used for smaller acetabular defects. Rim mesh is not used for constrained defects but when there has been loss of the acetabular wall (usually posterosuperior), and is combined with impaction grafting in these situations. Rim mesh does have limits, in particular it only comes in three sizes and any bone loss gap that cannot be spanned by the mesh is not reconstructable using this method.
The ultimate goal of using impaction bone grafting is to leave the revision acetabular bed looking like a primary case. Bone loss is replaced with bone which remodels and incorporates which is essential for the younger patient requiring revision, who may go on to need subsequent revision arthroplasty.
Trabecular metal acetabular implants, acetabular augments and custom implants have all superseded the massive strut and bulk allografts that were performed historically for the larger defects, and where outcomes from these massive procedures using avascular structural allografts were often relatively poor. The amount of long term data for some of these technologies is not yet available.
Author: Mr Andrew Gordon PhD, FRCS (Tr & Orth)
Institution: The Northern General Hospital, Sheffield, UK.
Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.
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