Revision

Total hip
Total knee
Outline
• Revision Total hip
• Classification
• Revision Total knee
• Investigation - rationale
• Classification
• Acetabular component
• Femoral component
• Femoral component
• Tibial component
• Dislocation after total hip
• Early (<3 months)
• Late (>3 months)
Revision Total hip
Revision Total hip
Investigation
CT scan
• Sagittal
• Pelvic discontinuity
• Axial
• Wall, column, protusio
• Coronal
• Superior bone loss
• Superior migration
Revision Total hip
Type Migration Ischial Tear drop Breakthrough
Kohler’s line
Treatment option
osteolysis osteolysis
I No No No No Hemisperical cup
IIA Superomedial < 3cm No No or No Hemispherical cup +/- morsellized allograft
(mild) Partial
IIB Superolateral < 3cm No or Mild No No - Hemispherical cup +/- Structural bone graft
(moderate) - Metal augment
- Jumbo cup
- Oblong cup
IIC Superomedial < 3cm No or Mild Moderate Yes - Hemispherical cup +/- bone graft
(Mainly medial) Lysis But not protusio
IIIA Superolateral >3cm Moderate Moderate No - Hemispherical cup +/- Structural bone graft, Metal
Up and Out Lysis augment
- Oblong cup
- Jumbo cup
- High hip center technique
- Custom made cup
IIIB Superomedial>3cm Severe Severe YES - Hemispherical cup +/- Structural bone graft, Metal
Up and In Lysis Protusio augment
- Jumbo cup with structural bone graft or Metal augment
- Oblong cup
- Custom made cup
- Reconstruction ring or cage with cemented cup
- Cup cage technique

Posterior column medial wall medial wall

+ Anterior column
Dislocation after total hip
• Early (< 3 months) • Late (> 3 months)
• Component malposition • Extreme motion
• Inadequate healing • Impingement: component
• Rehabilitation malposition, retained
osteophyte
• Post-trauma
• Severe PE wear

Recurrent 33-40% Recurrent 55%

61% recurrent  surgery
Dislocation after total hip
Acetabular component malposition Abductor complex deficiency
• Revise acetabular component
• Elevated rim liner if < 10º malposition ◦Restore LL & offset; modular implant
◦ GT advancement/Fix GT non-union
Femoral component malposition
• Revise Femoral component
◦ GM repair/muscle transfer
◦ Constrained liner

Impingement ◦ BHR/Dual mobility

◦ Remove impinged tissue

◦ Larger head/dual mobility Other causes/unknown

GT advancement
Eccentric PE wear
Constrained liner/BHR/Dual mobility
◦ Change PE
◦ Larger head