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  • Publicado : 24 de agosto de 2010
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Revision Hip System
The Reach Revision System is part of the Alliance® Family.



Revision Hip System

The unparalleled surgical latitude and clinical results of the Alliance® Family provide the basis from which the Reach™ Revision System was perfected. The Reach Revision System incorporates the proven bi-planar taper with an extensively porous-coated cylindrical distal stem. Thiscombination provides proximal off-loading while obtaining excellent fit and increased potential for initial fixation in the most difficult revision cases. The Reach Revision System presents an integral complement to the highly successful performance of the Alliance Family. Forged Titanium Alloy • Provides high fatigue strength, biocompatibility and a low modulus of elasticity. Bi-Planar Taper to100mm Distally • Promotes proximal off-loading vs. a completely cylindrical stem design. Cylindrical Distal Stem Design • Facilitates a scratch fit distally to increase the potential for initial fixation. Extensively Coated Titanium Porous Plasma Spray • Provides initial stability for potential long-term fixation. Stem Lengths in 200mm Straight & Bowed and 250mm Bowed • Provide fixation solutionsfor deficient femurs. Duckbill Collar • Helps to provide rotational stability and facilitates load transfer to the medial calcar. Extended Neck Length • Provides additional 6mm of length for revision cases where proximal bone stock is deficient.

The Reach Revision System is cleared for press-fit applications for the following indications: non-inflammatory osteoarthritis, avascular necrosis,rheumatoid arthritis, revisions of hip replacement components, treatment of non-union, femoral neck and trochanteric fractures of the proximal femur with head involvement.

Preoperative Planning
Preoperative planning can easily be performed with the Reach templates. It is recommended that a radiographic marker be used to assess X-ray magnification on an individual basis so that the proper templatescan be selected. In preoperative planning for a revision total hip replacement it is necessary to have good quality X-rays demonstrating an AP view of the entire femur, and a lateral X-ray of the entire femur. The femoral component for a revision total hip replacement must be stable and have host bone support for predictable success. It is desirable with the Reach Revision System to obtainaccurate fit and fill with both the proximal and distal portions of the prosthesis. By utilizing the X-rays and Reach templates a plan can be coordinated to ensure this takes place. The appropriate stem length can be made utilizing the X-ray with regard to bone loss and bone quality. A minimum of 5cm of diaphyseal bone is recommended to provide torsional stability when massive proximal bone loss ispresent. Restoration of the patient’s leg length and offset should be addressed prior to the surgical procedure.

Case History
Preoperative
The patient is a 72-year old female who 18 years ago underwent a cemented THA. She had progressive groin and thigh pain and the bone scan confirmed acetabular and femoral component loosening. Preoperative planning called for a large cementless socket and anextended trochanteric osteotomy to facilitate cement removal, followed by an extensively porous-coated Reach femoral component to gain distal fixation.

Postoperative Evaluation
The postoperative radiographs show a cementless hemispherical socket in good position, fixed with screws. A 15mm x 200mm Reach stem has gained good distal fixation 8–10cm below the extended trochanteric osteotomy, whichafter being fixed with cables has gone on to unite uneventfully.

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Exposure of the Femur

Surgical Approach
In general, the femur should be approached via one of the three different methods described below:

• Standard posterolateral approach • Trochanteric slide osteotomy • Extended trochanteric osteotomy

Standard Posterolateral Approach
In most revision situations, the...
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