Revisión acetabular con conservación del componente metálico osteointegrado y cementado de un componente de poliestireno. Reporte de una serie de 40 casos. [Acetabular revision cementing a liner into a stable acetabular shell]

Fernando Manuel Bidolegui, Sebastian Pereira, Alfonso Lugones, Horacio Pereira, Gabriel Vindver

Resumen


In­tro­duc­ción: Un escenario cada vez más frecuente en la cirugía de revisión protésica de la cadera es hallar un cotilo no cementado fijo con una falla del componente modular de polietileno. Una completa revisión acetabular se presenta como demasiado agresiva cuando el componente metálico es salvable. Cementar un nuevo inserto de polietileno dentro del componente acetabular metálico os-teointegrado es una alternativa.
Comunicamos los resultados con esta técnica, y sus indicaciones, el modo de realización y las posibles limitaciones.

Materiales­y­Métodos: Entre 2001 y 2011, se cementaron 40 componentes de polietileno dentro de copas no cementadas. Se evaluó radiológicamente y clínicamente a todos los pacientes. El motivo por el que se cementó un inserto fue falla o rotura de mecanismo de captura (11 casos; 27,5%), ganar estabilidad (18 casos; 45%) y falta de disponibilidad del inserto correspondiente (11 casos, 27,5%).

Resultados:­ La tasa de duración del implante sin reoperación a 46 meses de seguimiento fue del 92%. Un paciente (2,4%) sufrió una infección, y dos presentaron inestabilidad (4,8%). No se presentaron aflojamientos hasta el último seguimiento. El puntaje preoperatorio y posoperatorio en la escala de Harris fue de 59 y 80, respectivamente.

Conclusiones: Los datos técnicos por considerar para tener éxito son: utilizar un inserto de menor tamaño que el de la copa, cementar insertos texturizados y dejar siempre como mínimo un manto de cemento uniforme de 2 mm. Nuestros resultados preliminares cementando un inserto de polietileno dentro de una copa acetabular osteointegrada parecerían justificar esta técnica de revisión en pos de prevenir la pérdida de capital óseo asociada a la necesidad de recambio de copas osteointegradas.


Palabras clave


copa osteointegrada; cementación; componente de polietileno; fixed ­cup; cementing; p­olyethylene­ component

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Referencias


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DOI: http://dx.doi.org/10.15417/171

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