Do you have experience in total hip replacement in osteopetrosis. Cemented or cementless?
Dear Agarwal, thank you for yuor answer and advises. Anyway, I'm not familiar with ResearchGate and I don'n Know how to do a facus group. From the clinical point of wiew osteopetrosis is a clinical entity which defines by itself the clinical picture. I just would like to know if someone have some experience in hip arthroplasty in osteopetrosis and can make some comments.
Dr Pignatti, osteopetrosis is a difficult condition to treat with any implant! In our center, we have used non-cemented implants but copious irrigation during femoral canal preparation is capital. Furthermore, you need to get prepared for a long surgery and will require many copies of sharp instruments. My last case took 4 hours to get to a 7 mm femoral canal! The key is to respect bone biology, keep stems short, use screws for cup fixation and avoid mal positioned implant that may lead to stress fractures. Any subsequent complications with fracture can become a nightmare. I hope it may help!
I agree entirely with Dr. Belzile. The bone in osteopetrosis is so hard and thick that you may have to use special instruments, i.e. metal-cutting drills for widening of the femoral canal. There is a nice article by Sen et al. from India on the osteosynthesis in osteopetrotic fractures which is published in Musculoskeletal Surgery, August, 2013
(formerly La Chirurgia degli Organi di Movimento). It is very instructive and may also be useful in THR.
Yes I did a case recently, actually 1 years ago, Cementless implant. No particulary problem for the pressfit cup. The stem: I used a conical stem, I had to use a burr to find the femoral canal. I usually use a powered reamer, but in this case but was more difficoult. After 1 year the patients is fine, wide ROM normal gait. Usually complications described are intraop. fracture and infection.
I agree that it is a difficult problem. One requires lot of patience with these cases and a meticulous preoperative planning.
We have published our experience of osteosynthesis in this disease as:
http://www.sciencedirect.com/science/article/pii/S1572346104000285/pdfft?md5=f22b9941fb8f5930c44dcc6a6c97813c&pid=1-s2.0-S1572346104000285-main.pdf
In our country we face with poor bone quality and high score osteoporotic patients especially females. In terms of femoral implantation with gentle work no problem. but in acetabular implantation and medialisation a press fit socket is difficult to obtain because most of time you feel ineveitable medial wall penetration with implantation
I´ve done some hip replacements not only in osteopetrosis, but also in other hip bone disorders such as Paget´s disease or post irradiation pelvic bone disease.
In all those cases I used cemented acetabular cups and drilled a lot of roles trough sclerotic bone to improve the fixation. 100 % of good results till now (10 years mfu).
Maybe, trabecular metal can be an option in same cases...
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