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[The cement-free modular revision prosthesis MRP-hip revision stem prosthesis in clinical follow-up].

INTRODUCTION: We present prospective medium-term results of the modular revision prostheses "MRP-TITANIUM". MATERIAL AND METHODS: 45 patients (n = 48 prostheses) were evaluated. The mean follow-up was 4.7 years (min.-max.: 1.0-9.0 years). Pre- and postoperatively the Harris hip score (differentiated to Paprosky I-III) was examined. 66.67 % of the cases had extensive bony defects (> or = Paprosky II b). By means of X-ray examinations, the stability of the prostheses, periprosthetic bone remodelling, the presence of radiolucent lines as well as bone defect regeneration were assessed postoperatively. RESULTS: The mean Harris hip score improved from 25.6 preoperative to 71.4 postoperative (p < or = 0.05). In 44 cases the X-ray showed stable fixation without secondary migration. In one case the stem (stand time 2.36 years) was revised due to secondary migration (> or = 5 mm). The survival rate (Kaplan-Meier) was 97 %. Bone transplantation with consecutive defect regeneration was (n = 30) complete in all cases. In six cases (12.5 %) a postoperative dislocation occurred with subsequent successful closed reposition four times (8.3 %). In two cases (4.2 %) an open reposition was done with correction of the antetorsion angle of the prostheses. CONCLUSION: The "MRP-TITANIUM modular revision prostheses" has proved to be reliable in cases of revision surgery with extensive bony defects. The failure rate was 2.1 % for 48 prospectively examined prostheses.

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PubMed1993

Movement of the tibial end in a PTB prosthesis socket: a sagittal X-ray study of the PTB prosthesis.

To investigate the movement of the tibial end in the sagittal plane in the PTB prosthetic socket during a gait cycle, 7 patients with a median age of 72 years were examined using X-ray technique. The gait cycle was reduced to four different static positions: heel contact, midstance, push-off and swing phase. The mean value of tibial movement in the socket in the anteroposterior direction was 2.2 cm, in proximodistal direction 2.8 cm, and the total sagittal movement during the whole gait cycle was 7.5 cm. The results indicate that one factor affecting the magnitude of the movement was the prestretching of soft tissues. All the patients who experienced a good prosthetic fitting had their soft tissues prestretched. The extreme dorsal and proximal positions of the tibial end during the gait cycle was in the swing phase position. The extreme distal position occurred somewhere between mid-stance and push-off. The extreme anterior position of the tibial end was seen during heel contact. This study has shown the magnitude of the movements in a PTB socket during a simulated gait cycle. The study has given hints on factors affecting prosthetic fitting, and further research within this field might provide indications of how to optimise socket shape to give maximal patient comfort.

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