From OT Europe

State-of-the-art hip revisions: An expert summary of what to know

EFORT

Total hip arthroplasty is a successful and cost-effective procedure, hence the number of THAs is increasing worldwide and now reaches more than 1 million hip replacements per year. Long-term results have been recently reported with up to 50% of successful hip replacements showing a 25-year survival of the implants. However, the counterpart to such demand is that hip surgeons also expect there will be a greater number of revisions for failed hip prostheses.

Hip surgeons are faced with great challenges around hip revision, in particular regarding postoperative complications. Infection, adverse response to the implant material, corrosion-related diseases, bone-stock deficiencies and periprosthetic fractures remain difficult situations to solve. Moreover, stability is not always immediate. Thus, after diagnosing the indication for a hip revision, there is an essential work-up that is necessary. However, what are the crucial steps to consider?

One of the imperatives is obviously to exclude the presence of septic loosening. Several questions are linked to the achievement of this goal: Is preoperative aspiration necessary? Which pharmaceutical treatments should be ceased before the surgery?

Another important aspect is to anticipate the expected bone loss. But how should surgeons define the real extent of the acetabular and femoral bone stock defect around the failed implant? To help attendees to find an adequate approach, the most suitable bone stock loss classifications will be reviewed and discussed in this course.

Once these initial questions have been answered for each specific case, it is important to establish a preoperative plan for how to address the bone stock loss. Is there still a role for allogenic bone grafts in revision THA or what options should options should be considered, such as the use of more metal or of more cement? Regarding available implants, trends in hip revision surgery include trabecular metal, cup cage reconstruction and modularity. Moreover, larger heads and dual mobility solutions are also gaining popularity. The panel of experts of this Interactive Expert Exchange (IEE) session will share their clinical experience with regard to these new developments.

To cover these questions in the best possible way during this IEE session, the latest data will be provided along with an analysis of the registries that focus on revision and re-revision outcomes.

Lisbon Banner

Friday 7 June 2019 | 10:00 to 12:15Hip Revisions

Introduction & Conclusions

Willem Schreurs (The Netherlands)

Presentations & Questions

The work-up for hip revision surgery | Willem Schreurs (The Netherlands)

Planning of revision procedures | Eleftherios Tsiridis (Greece)

Type of fixation in revisions | Carsten Perka (Germany)

Type of articulation in revisions | A. John Timperley (United Kingdom)

Emerging data from registries on the outcome of hip revisions | Maziar Mohaddes (Sweden)

Clinical Cases - Discussion

Provocateurs: Stephan Vehmeijer (The Netherlands) & Jenaro A. Fernández-Valencia (Spain)

Speakers of this IEE panel will be discussing the indications and outcomes of techniques they use on a regular basis to perform hip revisions, as well as giving their personal hints on how to select the right type of implant for each individual case. For this, the programme of the session will highlight the most common implants available and their related medical procedures. Finally, together with the audience, each possibility presented will be analyzed to underline the benefits for the patient.

IEE banner

The format of this exchange, including lectures, open debates and case presentations, will lead to an in-depth evaluation of all the possibilities for arthroplasty surgeons when faced with the need for hip revision. The highly experienced surgeons in the specialty of hip replacement will discuss pros and cons of each technique to help the attendees’ decision-making.

As of this year, the IEE sessions can be attended by any participant fully registered for the EFORT Congress without any extra fee to be paid. All details to sign-up for the Lisbon meeting are available on the EFORT Congress registration platform. Join the session and challenge the experts.

EFORT

Total hip arthroplasty is a successful and cost-effective procedure, hence the number of THAs is increasing worldwide and now reaches more than 1 million hip replacements per year. Long-term results have been recently reported with up to 50% of successful hip replacements showing a 25-year survival of the implants. However, the counterpart to such demand is that hip surgeons also expect there will be a greater number of revisions for failed hip prostheses.

Hip surgeons are faced with great challenges around hip revision, in particular regarding postoperative complications. Infection, adverse response to the implant material, corrosion-related diseases, bone-stock deficiencies and periprosthetic fractures remain difficult situations to solve. Moreover, stability is not always immediate. Thus, after diagnosing the indication for a hip revision, there is an essential work-up that is necessary. However, what are the crucial steps to consider?

One of the imperatives is obviously to exclude the presence of septic loosening. Several questions are linked to the achievement of this goal: Is preoperative aspiration necessary? Which pharmaceutical treatments should be ceased before the surgery?

Another important aspect is to anticipate the expected bone loss. But how should surgeons define the real extent of the acetabular and femoral bone stock defect around the failed implant? To help attendees to find an adequate approach, the most suitable bone stock loss classifications will be reviewed and discussed in this course.

Once these initial questions have been answered for each specific case, it is important to establish a preoperative plan for how to address the bone stock loss. Is there still a role for allogenic bone grafts in revision THA or what options should options should be considered, such as the use of more metal or of more cement? Regarding available implants, trends in hip revision surgery include trabecular metal, cup cage reconstruction and modularity. Moreover, larger heads and dual mobility solutions are also gaining popularity. The panel of experts of this Interactive Expert Exchange (IEE) session will share their clinical experience with regard to these new developments.

To cover these questions in the best possible way during this IEE session, the latest data will be provided along with an analysis of the registries that focus on revision and re-revision outcomes.

Lisbon Banner

Friday 7 June 2019 | 10:00 to 12:15Hip Revisions

Introduction & Conclusions

Willem Schreurs (The Netherlands)

Presentations & Questions

The work-up for hip revision surgery | Willem Schreurs (The Netherlands)

Planning of revision procedures | Eleftherios Tsiridis (Greece)

Type of fixation in revisions | Carsten Perka (Germany)

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Type of articulation in revisions | A. John Timperley (United Kingdom)

Emerging data from registries on the outcome of hip revisions | Maziar Mohaddes (Sweden)

Clinical Cases - Discussion

Provocateurs: Stephan Vehmeijer (The Netherlands) & Jenaro A. Fernández-Valencia (Spain)

Speakers of this IEE panel will be discussing the indications and outcomes of techniques they use on a regular basis to perform hip revisions, as well as giving their personal hints on how to select the right type of implant for each individual case. For this, the programme of the session will highlight the most common implants available and their related medical procedures. Finally, together with the audience, each possibility presented will be analyzed to underline the benefits for the patient.

IEE banner

The format of this exchange, including lectures, open debates and case presentations, will lead to an in-depth evaluation of all the possibilities for arthroplasty surgeons when faced with the need for hip revision. The highly experienced surgeons in the specialty of hip replacement will discuss pros and cons of each technique to help the attendees’ decision-making.

As of this year, the IEE sessions can be attended by any participant fully registered for the EFORT Congress without any extra fee to be paid. All details to sign-up for the Lisbon meeting are available on the EFORT Congress registration platform. Join the session and challenge the experts.