ZDJELIČNI DISKONTINUITET U REVIZIJSKOJ ARTROPLASTICI KUKA – PRIKAZ BOLESNIKA

Joško Smilović, Damir Matoković, Dubravko Orlić

Revizijska artroplastika kuka s masivnim gubitkom kosti i zdjeličnim diskontinuitetom do sada nema standardizirani tretman. U radu je prikazan slučaj pacijentice kojoj je dijagnosticiran zdjelični diskontinuitet 4 godine nakon prethodne artroplastike kuka. Pacijentica boluje od reumatoidnog artritisa, a primljena je na bolničko liječenje zbog boli u kuku, skraćenja noge, ograničenja kretnja i nemogućnosti hoda. Učinjena je preoperativna rendgenska slika zdjelice s kukovima koja je pokazala zdjelični diskontinuitet, a intraoperativno je utvrđeno da se radi o tipu IV b, tj. diskontinuitetu udruženom s kavitarnim i segmentalnim defektom acetabuluma. Radi postizanja stabilne konstrukcije, kao bitnog preduvjeta za postizanje koštane konsolidacije, učinjena je osteosinteza stražnjeg nosača rekonstrukcijskom pločicom po A.O.-metodi, a nakon toga defekt je popunjen koštanim presadcima iz koštane banke. Ugrađena je adekvatna revizijska bescementna čašica, a vijcima se nastojala postići dobra fiksacija većih modeliranih koštanih presadaka te fiksacija čašice za preostali dio zdjelice. Time je postignuta dobra inicijalna stabilnost konstrukcije. Radi postizanja urašćivanja kosti i izbjegavanja mehaničkog neuspjeha preporučeno je rasterećenje u razdoblju od 3 do 6 mjeseci nakon operacije. Metodom rekonstrukcije koju smo primijenili dobili smo zadovoljavajući klinički rezultat nakon dvije godine praćenja, a radiološki nema znakova razlabavljenja konstrukcije pa se može govoriti o izlječenju diskontinuiteta.

Revision total hip arthroplasty with massive bone loss and pelivic discontinuity has no standardized treatment up until now. This report presents a case of a female patient with a diagnosed pelvic discontinuity 4 years after the previous hip arthroplasty. The patient is suffering from rheumatoid arthritis, and was admitted to hospital treatment for hip pain, leg shortening, limitated range of motion and the inability to walk. Pelvic discontinuity was identified in preoperative radiographs of the pelvic and hip region, and intraoperatively it was determined that it was a type IV b discontinuity according classifications for acetabular defects defined by AAOS, and subclassification of type IV according Berry et al., that is discontinuity associated with cavitary and segmental acetatabular bone loss. In the goal of achieveing a stable construction, as a vital prerequisite for achieving bone consolidation, an osteosynthesis of the posterior column was done with a reconstructive plate by A.O. method, and afterwards the defect was filed with bone transplants from the bone transplant bank. An adequate revision cementless cup was installed, and screws were used to achieve a good fixation of the bigger modeled bone transplants and the fixation of the cup for the remainder of the pelvis. By that method a good inicial stability of construction was achieved. In the goal of achieving bone ingrowth and avoidance of mechanical failure it was advised an avoidance of weight bearing in the period of 3-6 months after the operation. With the method of reconstruction we applied after 2 years of follow-up the cinical result was satisfactory, and radiologicaly there are no signs of construction loosening so it can be claimed that the discontinuity was cured.