Master graduation project

Start project: november/december 2016

Background Removal of a well-fixed implant in cemented total hip arthroplasty can be very challenging.                                                Indications for removing a well-fixed implant may include sepsis, recurrent dislocation due to femoral component malposition and/or inadequate offset. Attempting to remove a well-fixed implant from proximal exposure alone can result in extensive bone loss due to the inability to disrupt the bone/prosthesis interface distally

The extended trochanteric osteotomy is the most common osteotomy used in cemented femoral revision and allows improved access to the implant/bone or implant/cement interface.

Indications for the extended proximal femoral osteotomy include revision of well-fixed cemented femoral components or removal of a loose femoral stem with a well-bonded cement mantle.

The use of an extended trochanteric osteotomy in these situations will minimize intraoperative complications and will result in predictable healing. However, comparison of surgeries with and without osteotomy clearly show that trochanteric osteotomy prolongs the surgery, is associated with more blood loss, and causes a slower postoperative rehabilitation course. Besides that, additional fractures (20%), nonunions (1.2%) 1 malunion (0.6%) and reoperations (10.2%) are reported.

Aim: to develop an alternative approach to the extended trochanteric osteotomy by using instrument guided  removal of cement and 3D technology. This will shorten the surgery, decrease blood loss, prevent fractures and reoperations.

See also https://www.youtube.com/watch?v=9dHECqHyLMw

Contact

Dr. B.C.H. van der Wal, orthopedic surgeon, b.c.h.vanderwal@umcutrecht.nl

Prof. Dr. Harrie Weinans
UMC Utrecht, dept. Orthopedics and dept. Rheumatology & TU Delft, dept. Biomechanical Engineering

H.H.Weinans@umcutrecht.nl