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102nd CONGRESS OF THE PIEMONTESE-LIGURIAN-LOMBARD SOCIETY OF ORTHOPEDICS AND TRAUMATOLOGY (S.P.L.L.O.T.) - Brescia September 9-10, 2005
NEW TECHNOLOGIES, MODERN INSTRUMENTARIUM IN ARTHROPLASTIC SURGERY
UPDATES ON HIP ARTHROPLASTY
Randelli F., Randelli P., Monteleone M., Visentin O., Randelli G.
Istituto Policlinico di San Donato Milanese San Donato Milanese (MI)
Surface hip prostheses are not a novelty. The use of glass surface prostheses (Smith-Petersen) began in the 1940s; a new generation of surface prostheses was introduced in the 1970s. International experiences all shared a common rationale: to spar the proximal femoral epiphysis. However, the outcomes were less than promising because of failure due to the then employed materials and fabrication techniques. Past lessons, analysis of previous case series and new materials and techniques helped provide the needed improvement in the quality of the devices in the late 1990s. Last generation surface prostheses are hybrid devices (non cemented acetabular cup and cemented femoral lining), with a metal-to-metal coupling and optimal fabrication. Initial results from sufficiently large case series hold promise. Following the reasonable results our team achieved with the Wagner prosthesis during the 1980s, and considering the technical advances in last generation devices, we decided to reintroduce surface prostheses. To minimize impairment of circulation of the femoral head, we modified our standard surgical approach (lateral direct) by adding periacetabular capsulotomy. In this way, we combined the advantages of the Wagner approach (preservation of epiphysial circulation) and those of the lateral direct approach (less invasive technique and better functional recovery). Currently, surface prosthesis advocates are seriously working on such key issues as how to place the femoral component, what type of cement to use, which surgical approach and which indications to follow. A lively debate now surrounds the prospects for surface prostheses.