Endoprótese em Revisões de Artroplastias

Endoprosthesis in Arthroplasty Revisions

Summary

The use of unconventional endoprostheses in orthopedic oncosurgery has emerged as an alternative in cases of complications and failures in arthroplasties, offering an approach that deserves special attention. The publication of our lecture, held at the Advanced Hip Surgery Course in November 2022 at Hospital Sírio Libanês in São Paulo/SP, representing the Dr. Arnaldo Vieira de Carvalho Cancer Institute, the first cancer hospital in Brazil, aims to disseminate this distinctive technique as a solution for complex cases of revision in failed arthroplasties.

In the United States, hundreds of thousands of hip arthroplasties are performed annually, with revisions accounting for about 20% of them. A significant portion of the expenses underscores the importance of effective solutions for these cases.

The Paprovisky classification, used by hip surgeons to catalog femoral defects and provide guidance for treatment, mentions the use of endoprostheses as a last resort. The dogma instilled in surgeons to “always preserve bone stock” has resulted in numerous revision surgeries, representing a high social cost and creating significant hardships for patients.

We analyze two cases of hip prostheses that have been revised multiple times to illustrate the complexity of these situations and the need to keep an open mind to innovative approaches.

It is essential to recognize that arthroplasty revisions pose unique challenges, requiring detailed surgical planning, knowledge of described materials and surgical techniques, as well as a deep understanding of our patient’s clinical conditions and expectations.

The alternative use of unconventional endoprostheses and “en bloc resection” of the affected problematic segment should be considered, allowing us to offer all alternatives and opt for the one with the least morbidity and the highest probability of rapid functional recovery for the elderly patient.

As we progress in medical practice, it is essential to continue exploring and refining these techniques to provide the best possible care for our patients.

Check out the video of the lecture

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