Presenting a new evaluation process in cases where revision surgery precedes the fitting of uncemented leg prostheses, the author shows how surgeons can improve their planning and preparation to get optimal results in each individual procedure.
Describes the press-fit concept with planning and surgical technique
Part I: Press-Fit Concept.- Uncemented Concepts: Parameters to Make a Choice.- The Press-Fit Concept: Principles and Press-Fittable Zones.- The Press-Fit Concept: Practical Application.- The Press-Fit Concept: Implants And Instruments.- Part II: Preoperative Planning.- Radiographic Analysis Of The Femur.- Selection of a Strategy.- Making a Preoperative Template.- Part III: Surgical Technique.- Trochantero-Diaphyseal Femoral Flap.- Femoral Flap and Diaphyseal Primary Fixation.- Endofemoral Approach and Proximal Primary Fixation.- Part IV: Evaluation of the Radiographic Results.- General Considerations.- A-Evaluation of the Radiographic Results - How?.- Evaluation of Initial and Secondary Bone Stock.- Evaluation of Osseointegration and Secondary Stability.- Global Radiographic Score.- Comparative Elements with the Engh Score.- Part V: Evaluation of the Radiographic Results - Why?.- The Learning Curve and its Teachings.- Different Types of Primary Stability: Their Impact on the Radiographic Results.- Degree of Osteoporosis: Its Impact on the Radiographic Results.- Affected Initial Bone Stock: Its Impact on the Radiographic Results.- Parameters to Improve Radiographic Results.- Complications and Contraindications.- Numerical Evaluation and Comparative Analysis of Results.- General Conclusions: What You Should and What You Should not Do.
Choosing an uncemented femoral prosthesis means first choosing a concept and to be effective, an operator has to have access to all the information that will allow them to reach the desired goals. This is the first step to be made.
The quality of a surgical procedure does not depend on the manual skills of the surgeon performing it, but on how he has prepared and performed the operation "virtually" before actually performing it. This is the second step.
An operating technique must be adapted to the chosen concept and the purpose of every surgical procedure must be clearly formulated and understood by the operator. This is the third step.
Every surgeon has to have a reliable and rigorous radiological method of analysis for evaluating overall results and which suggests ways of improving results.