Revision Total Hip Arthroplasty

using GraftonŽ DBM Putty and Flex

Kenneth B. Mathis, M.D.
Orthopaedic Surgeon

Assistant Professor
Baylor College of Medicine, Houston, TX

Revision Total Hip Arthroplasty


Overview


This procedure will fix a standard revision cup, fill and repair existing defects with allograft bone chips and Grafton DBM, as well as replace the existing long-stem cemented prosthesis with a new long-stem, fluted titanium prosthesis to bypass the defect and maintain a stable purchase above and below. Following are Dr. Mathis' guidelines for use.

Patient Background


The patient is a 47-year-old male who had an uncemented total hip arthroplasty placed 10 years ago for presumed osteonecrosis. Three years ago, he presented to an outside hospital with a perirectal abscess which did not clear up. A sinogram found the sinus tracked all the way to his inferior ischium, which indicated that he had osteomyelitis and a septic hip prosthesis.

Procedure Details

  • In an earlier surgery, the infection was treated by removing the prosthesis, along with the infected portion of the ischium. An interim prosthesis was then placed using heavily impregnated antibiotic cement.
  • The previously infected bone and acetabulum graft site are debrided to remove all fibrous tissue in the defects caused by the infection.
  • A mixture of Grafton DBM Putty and cancellous bone chips is prepared according to product insert guidelines.
  • The Grafton DBM and allograft mixture is placed initially and hand-packed into the acetabulum and surrounding bone defects.
  • The mixture is further impacted into the acetabulum using an appropriately sized reamer set on reverse, resulting in a thoroughly compacted and homogenous graft site that is ready to receive the revision cup.
  • The revision cup is placed and fixed into the acetabulum, using screws for optimal stability.
  • The fluted, long-stem titanium prosthesis is then inserted.
  • The flutes of the prosthesis and existing defects in the femur are coated and filled with Grafton DBM Putty.
  • A non-rehydrated 5cm x 5cm Grafton DBM Flex strip is placed over the Grafton DBM Putty-filled defect in the lateral femoral cortex and secured by Kirschner wires.
  • Grafton DBM Putty is used to fill an anterior metaphyseal defect along the proximal femur prosthesis.