Weber P, Steinbrück A, Paulus A C, Woiczinski M, Schmidutz F, Fottner A, Jansson V
Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
Orthopade. 2017 Feb;46(2):142-147. doi: 10.1007/s00132-016-3380-4.
In case of hip revision arthroplasty, one component (cup/stem) is often well fixed and does not need to be exchanged. The newly implanted component needs to be compatible with the well-fixed implant. The combination of implants from different companies leads to "mix and match" or even mismatch between the implants.
The objective of this work was to describe possible combinations including their specifications that need to be considered in partial exchange of hip prostheses. For this purpose the literature, surgical techniques of companies and judgements concerning this topic were analysed and our own results and experiences were included.
Partial revision arthroplasty can be challenging and needs to be planned in detail. In case of isolated cup or inlay revision with exchange of a modular head the cone of the stem needs to be identified. A ceramic head may be used in revision with a titanium sleeve even from a different company as long as they are compatible. Patients however need to give their informed consent for this mix and match procedure. This procedure is done frequently and good study results support this, however from a juristic point of view a definite recommendation cannot be given. If the inlay of a cup is replaced, the original inlay should be used. If this is not available anymore, it can be manufactured as a special product in many cases. If this is also not possible, an inlay can also be cemented into a well-fixed cup. Biomechanical and clinical studies support this off-label technique. In case of an isolated exchange of the stem with a ceramic inlay that is retained in a well-fixed cup, the revision stem and ceramic head need to be from the same company as the cup. In case of ceramic fracture, a ceramic head with a titanium sleeve should be combined with a PE or ceramic inlay, a metal head or inlay should never be used.
在髋关节翻修置换术中，一个组件（髋臼杯/股骨柄）通常固定良好，无需更换。新植入的组件需要与固定良好的植入物兼容。不同公司的植入物组合会导致植入物之间出现“混搭”甚至不匹配的情况。
这项工作的目的是描述在髋关节假体部分置换中需要考虑的可能组合及其规格。为此，分析了相关文献、各公司的手术技术以及关于该主题的判断，并纳入了我们自己的结果和经验。
部分翻修置换术可能具有挑战性，需要进行详细规划。在孤立的髋臼杯翻修或带模块化股骨头置换的镶嵌物翻修中，需要确定股骨柄的锥度。只要兼容，即使来自不同公司的钛合金套筒，陶瓷股骨头也可用于翻修。然而，患者需要对这种混搭程序给予知情同意。这种程序经常进行，良好的研究结果支持这一点，但从法律角度无法给出明确建议。如果更换髋臼杯的镶嵌物，应使用原来的镶嵌物。如果不再有原来的镶嵌物，在许多情况下可以作为特殊产品制造。如果这也不可能，也可以将镶嵌物用骨水泥固定到固定良好的髋臼杯中。生物力学和临床研究支持这种超说明书技术。在孤立地更换股骨柄且保留在固定良好的髋臼杯中的陶瓷镶嵌物的情况下，翻修股骨柄和陶瓷股骨头需要与髋臼杯来自同一公司。在陶瓷骨折的情况下，带钛合金套筒的陶瓷股骨头应与聚乙烯或陶瓷镶嵌物组合，绝不应使用金属股骨头或镶嵌物。
