Révision de Prothèse Totale de Hanche pour Fracture Périprothétique du Fémur : À Propos de Deux cas
Revision of Total Hip Arthroplasty for Periprosthetic Femur Fracture : A Report of Two Cases
DOI :
https://doi.org/10.5281/hra.v2i8.5956Mots-clés :
Prothèse totale de hanche, Révision, Fracture périprothétique, Burkina FasoRésumé
RÉSUMÉ
L’objectif de ce travail était de partager à travers deux observations cliniques les alternatives possibles de révision prothétique pour fracture périprothétique du fémur dans un contexte de ressources limitées. Il s’agissait patients porteurs de prothèses totales de hanche de première intention réalisée 10 ans et 12 ans au paravent. Ils ont présenté des fractures périprothétiques du fémur classées Vancouver C et B3 respectivement. Un patient avait un descellement cotyloïdien associé. Le traitement a consisté au changement des implants fémoraux et à l’ostéosynthèse de la fracture. L’implant fémoral était constitué d’une tige standard encastrée en bilboquet dans un clou AO scié et amputé de sa partie proximale. Cette technique permettait avoir une tige de la longueur d’une tige de révision ou de reconstruction avec une possibilité de verrouillage. La stabilité de l’ensemble était assurée par une cémentation et le verrouillage distal. La cicatrisation cutanée a été effective dans les 2 cas dans un délai de 21 jours. La consolidation osseuse a été obtenue en 4 mois et 5 mois. Au recul de 18 mois et de 25 mois, le score PMA était de 11 et 12.
ABSTRACT
The aim of this study was to share, through two clinical cases, possible prosthetic revision alternatives for periprosthetic femoral fractures in a resource-limited setting. The patients had undergone primary total hip arthroplasty 10 and 12 years earlier, respectively. They presented with periprosthetic fractures classified as Vancouver C and B3, with one patient also experiencing acetabular loosening. Treatment involved replacing the femoral implants and stabilizing the fractures. The femoral implant consisted of a standard stem inserted into a modified AO nail with the proximal portion removed, providing a length comparable to a revision or reconstructive stem, with the option for locking. Stability was achieved through cementation and distal locking. Both cases achieved successful wound healing within 21 days. Bone union was achieved at 4 and 5 months postoperatively. At follow-up of 18 and 25 months, the PMA (Postoperative Morbidity Index) scores were 11 and 12, respectively.
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(c) Tous droits réservés Ouédraogo Souleymane, Soulama Massadiami, Diallo Malick, Zouma Ruffin, Ouermi Ousmane, Dakouré Patrick WH 2024
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