RU115652U1 - DOUBLE HIP JOINT SPACER - Google Patents

Abstract

The bipolar spacer of the hip joint is made of bone cement containing an antibiotic and contains three parts: the first part in the form of a "hemisphere" for anchoring in the bottom of the acetabulum, the second part in the form of a ball and the third part in the form of a "saddle" leg of the femoral component ...

Description

The utility model relates to orthopedics. It is used as a treatment stage, after complications of total hip replacement, with purulent-inflammatory diseases, which led to the removal of the prosthesis and the establishment of the device. This utility model is used to restore the support ability of the lower limb, in cases of defects in the bottom of the acetabulum, preventing its shortening, scarring and contractures in the hip joint, which as a result reduces pain, restores movement in the joint, and as a result, significantly improves quality patient's life.

The essential features of the utility model are that after removal of the endoprosthesis, a device modeled from bone cement is installed, but having certain advantages over the prototype. After purulent lesions in the area of the hip joint, it becomes difficult to remove the pelvic component (cup), especially heavier, fixed with bone cement, which often leads to chips of bone substance, leaving defects in the structure of the bottom. Also, because of the pain syndrome, patients do not load the affected lower limb, as a result of which local osteoporosis develops, which increases the risk of protrusion. The proposed device closes the defect, having a large area of contact with the bottom of the acetabulum, prevents protrusion of the spacer during physical exertion. Another advantage is the spherical central part, which allows to increase the range of movements in the hip joint, due to the multi-plane movements that make up the parts of the device itself. The risk of spacer dislocation from the acetabulum is reduced.

Benefits of the utility model:

- An affordable and widely used bone cement with antibiotics is used.

- The device prevents its protrusion into the bottom of the acetabulum.

- Increased range of motion in the hip joint, greater compared with those when installing a standard spacer.

- The risk of spacer dislocation is reduced.

- By loading the affected limb, the phenomena of local osteoporosis are reduced.

The proposed method for creating a utility model is as follows.

The posterolateral incision reveals the trochanteric region of the femur and the posterior wall of the capsule of the hip joint. Hip joint prosthesis is removed. Three parts are made intraoperatively from bone cement with an antibiotic. The first part, in the form of a “hemisphere”, which is fixed in the bottom of the acetabulum. The second part, made in the form of a ball, the shape of which allows you to increase the multi-plane movements in the joint. And the third part, has the shape of a “saddle-shaped” leg of the femoral component of the spacer, with a notch corresponding to the size of the ball for a closer contact.

Next, the integrity of the joint capsule is restored and the wound is sutured in layers with the installation of a drainage system. Physiomechanotherapy is subsequently prescribed. Walking is allowed after 2-3 days with a partial load (crutches are used).

Clinical example

Patient B. 47 years old, operated on in December 2006 for left-sided coxarthrosis of the 3rd degree, loosened the cup of the endoprosthesis due to a sluggish chronic infection. 3 years after the operation, periodic pains appeared in the operated joint, and a fistula opened. Taking antibiotics and non-steroidal anti-inflammatory drugs stopped the pain only for a while.

In November 2009, a revision intervention was performed: a thick hyperemic scar capsule of the joint was discovered, at the opening of which pus with white flakes was released, a thorough toilet of the wound with antiseptic solutions. The endoprosthesis is completely removed along with the cement. A bipolar spacer of the hip joint with the gentamicin antibiotic is installed. A drainage flushing system with the introduction of chlorhexidine into the joint cavity was established. An analysis of bacteriological studies showed the presence of hemolytic staphylococcus sensitive to ceftriaxone. The patient received this antibiotic in the postoperative period for 14 days. The drainage system is removed after 7 days. In the postoperative period, there was no increase in temperature. The patient was discharged for outpatient treatment.

The patient was re-operated after 6 months and the spacer was removed and total hip replacement was performed. Examined 12 months after the last operation, the postoperative scar is consistent, with no signs of inflammation. There was no temperature for the entire post-hospital period.

I. Information about the prototype of a utility model

Bipolar spacer of the hip joint. The prototype of this utility model is a cement spacer of the hip joint described in RF patent No. 220068 (2004). The method of its creation is as follows. During the operation, a soft tissue fistulnecrectomy is performed and the hip joint endoprosthesis is removed. Stage I of the creation of the spacer - the cavity of the acetabulum is densely filled with bone cement with an antibiotic. Using the method of hand sculpting, they create the spacer neck of the same length, but slightly larger diameter (3-4 mm) of the neck of the removed femoral component of the endoprosthesis. Several fragments (2-4) of Kirchner spokes with a diameter of 2 mm and a length of 4-5 cm are introduced into the center of the spacer neck so that one half (2-2.5 cm) is immersed in bone cement and the other half protrudes over the neck end spacer (figa). Stage II of the creation of the spacer - at the time of bone cement hardening, when it ceases to adhere to the gloves, it is introduced to a depth of 5-7 cm into the medullary canal of the proximal femur. They give the lower limb a functionally advantageous position - 15 ° abduction, 170 ° flexion in the hip joint. Connect the two parts of the spacer (acetabular and femoral) using the protruding halves of the fragments of the Kirschner spokes in the acetabulum (Fig.5b). After complete hardening of the second portion of bone cement, a tight connection of the two parts of the spacer takes place (Fig. 5c).

One of the main features of the utility model we have developed is that after removal of the endoprosthesis, a device modeled from bone cement is installed, but having certain advantages over the cement spacer of the hip joint, RF patent No. 220068 (2004):

1. After purulent lesions in the area of the hip joint, it becomes difficult to remove the pelvic component (cup), especially heavier, fixed with bone cement, which often leads to chips of bone substance, leaving defects in the structure of the bottom, also increases the risk of protrusion and local osteoporosis arising from for reducing the load on the affected limb by patients. The device we offer closes the defect, having a large area of contact with the bottom of the acetabulum, prevents protrusion of the spacer during physical activity, compared with the prototype.

2. The second advantage is the spherical central part, which allows to increase the range of movements in the hip joint due to the multiplane movements of the components of the device itself, while the prototype of the utility model is devoid of such advantages. The device is manufactured in such a way that the risk of dislocation of the bipolar spacer from the acetabulum is reduced.

INFORMATION SOURCES

1. Akhtyamov I.F., Kuzmin I.I. Errors and complications of hip replacement - Kazan :. Center for Operational Printing, 2006 .-- 328 p.

2. Danilyak VV, Klyuchevsky VV, Gilfanov SI, Repin S.V. Prevention of infectious complications during hip joint replacement. Materials of the congress of orthopedic traumatologists with international participation. Yaroslavl 1999; 117-118.

3. Zubkov M.N., Urazgildeev Z.I. Antibiotic prophylaxis and antibiotic therapy of purulent complications in traumatology and orthopedics. Manual for doctors. Moscow. 2000.

4. Kuzmin I.I. Pathogenetic features of the infectious process in traumatology and orthopedics. Bulletin of Traumatology and Orthopedics named after N.N. Priorov 2000; 4:67 71.

5. Prokhorenko V. M. Primary and revision hip arthroplasty. - Novosibirsk, 2007 .-- 196 p.

6. Guidance on hip replacement / under. Ed. P.M. Tikhilova, V.M. Shapovalova. - St. Petersburg, 2008 - 141 s.

7. Ahlgren S.A., Gudmundsson G., Bartholdsson E. Function after removal of a septic total hip prosthesis. A survey of 27 Girdlestone hips. Acta Orthop. Scand. 1980; 51: 541-545.

8. Alexander J.W., Fisher J.E., Boyajian M., et al. The influence of hear removal methods on wound infections. Arch. Surg. 1983; 118: 347-352.

9. Elson R.A., Jephcott A.E., McGechie D.B., Verettas D. Antibiotic-loaded acrylic cement. J. Bon Joint Surg. 1977; 59 (2): 2005.

Claims (1)

The bipolar spacer of the hip joint is made of bone cement with an antibiotic and contains three parts: the first part in the form of a “hemisphere” for fastening to the bottom of the acetabulum, the second part in the form of a ball and the third part having the shape of a “saddle” leg of the femoral component .