Vasfi KARATOSUN, İzge GÜNAL, Bayram ÜNVER

Plaklı kalça protezi: Total kalça protezinde femoral bölgede yeni bir yaklaşımın erken sonuçları

Amaç: Femoral bölgede farklı ve yeni bir yaklaşım olan ekstramedüller plaklı kalça protezi (PKP) uygulanan ve prospektif olarak değerlendirilen olguların sonuçlarını sunmak. Çalışma planı: Yirmi dokuz olgunun 35 kalçasına (6 olgu bilateral) PKP uygulandı. Olguların yaş ortalaması 54.4 (dağılım 26-79) olup, 18’i kadın, 10’u erkekti. Etyolojik nedenler koksartroz (n=14), avasküler nekroz (n=7), doğuştan kalça çıkığı (n=5), trokanter kırığına bağlı koksartroz (n=4), femur boyun kırığı (n=3) ve femur boynu kaynamamas› (n=1) şeklindeydi. Olguların tümünde femura PKP uygulanırken, asetabuler bölgede çimentolu CCB cup uygulanan dört olgu dışında tümüne çimentosuz Protek expansion cup uygulandı. Olgular Harris kalça de- ğeriyle irdelendi. Ortalama izlem süresi 17.6 aydı (dağı- lım 6-36 ay). Sonuçlar: Plak distalinde fissür gelişmesi üzerine revizyonla Leinbach protez konulan bir olgu değerlendirme dı- şı bırakıldı. Bir olguda da derin ven trombozu gelişti. Harris kalça değerlendirmesi ortalaması preoperatif dönemde 47.2, postoperatif 6. ayda 88.7, 12. ayda 93.2 (23 kalça), 18. ayda 96.9 (17 kalça) ve 24. ayda 97.7 (14 kalça) bulundu. Olgulardan hiçbirinde gevşeme veya enfeksiyon görülmedi. Çıkarımlar: Plaklı kalça protezinin, femoral medulla oyulmadan metafize yerlefltirilmesi, kemik kaybına yol açmaması, biyomekaniğe uyumu, dar ve açılı femoral medulla varlığından etkilenmemesi ve erken harekete olanak sağlaması nedeniyle önerilebilir ve çağdaş bir yöntem oldu ğu sonucuna varıldı.

Anahtar Kelimeler:

Ameliyat sonrası komplikasyonlar, Biyomekanik, Femur başı, Kalça eklemi, Kalça protezi, Stres, mekanik

Thrust plate hip prosthesis: Early results of a new concept in the femoral component of total hip arthroplasty

Objectives: To assess the results of a new and different concept of extramedullary total hip arthroplasty, namely the thrust plate prosthesis (TPP). Methods: Thirty-five hips (6 bilateral) of 29 patients (18 females, 10 males) were treated by TPP. The mean age was 54.4 years (range 26 to 79 years). Etiologic factors included primary coxarthrosis (n=14), avascular necrosis (n=7), developmental dysplasia of the hip (n=5), coxarthrosis due to a trochanteric fracture (n=4), and fracture (n=3) and nonunion (n=1) of the femoral neck. Uncemented Protek expansion cup was used in all but four patients who received cemented CCB cup. Patients were evaluated preoperatively and postoperatively by the Harris hip score. The mean follow-up period was 17.6 months (range 6 to 36 months). Results: One patient was excluded as TPP was replaced by a Leinbach type prosthesis because of a femoral shaft fracture detected during the rehabilitation period. Deep vein thrombosis was observed in one patient. The mean preoperative Harris score was 47.2, being 88.7 at 6 months, 93.2 (23 hips) at 12 months, 96.9 (17 hips) at 18 months, and 97.7 (14 hips) at 24 months. Neither loosening nor infection was encountered during the follow-up period. Conclusion: Thrust plate prosthesis seems to have many advantages, including its applicability both to the metaphyseal region without reaming the medullary canal and to narrow and angulated femora, prevention of bone loss, allowing early motion, and biomechanical compatibility, making it a reliable method for total hip replacement.

Keywords:

Postoperative Complications, Biomechanics, Femur Head, Hip Joint, Hip Prosthesis, Stress, Mechanical,

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