Here the responses that we have received:

5/31/99 -  Dr.H. Kiefer ( Germany )
 

Dr. Dr Olavo,

Your photoes came out very fine. Unfortunately, we have this problem
very often, since we have to revise hundreds of hips implanted from 1975 up
to now.
I would do this hip in my common procedure with a cementless technique:
For the acetabulum, i would use a reinforcement ring (Schneider-Burch,
from Aesculap or Sulzer Companies), with bone grafting and cancellous screws.
For the stem, Iwould use a long Bicontact revision stem (300, 340 or 380mm
long, Aesculap) via a transfemoral or dorsal approach, gone grafting and
distal interlocking. I copied you some pages from the 1998 edition of the
Bicontact-book, whre I wrote a chapter dealing with preop. planning. I
hope, you can open and read it for transmission quality.
Maybe, you can get a copy of this booklet from Cid.
I'm sorry, that  the videoconference via netmeeting will not work, as,
up to now, I do not fave a camera and a microfone for my computer. I think I
will have to get these things within the next weeks.
So we would have to telephone at 5 h Brasil time.

Hartmuth Kiefer
 

Dear Dr Olavo,

I'm sorry that it did't work. I sent you 3 e-mails with additional scans
with examples how to operate on your special case.
May be you try again to call me.
Yours
Hartmuth

5/31/99   Dr Pedro Tucci - Brazil
 
 

JOlavo,
Parece que na radiografia de 1192 já havia sinal de soltura do acetábulo
e mal posicionamento do componente femoral.
Em 0299 houve fratura da diáfise com soltura do acetábulo.
Que tipo de papo foi usado para convencer o paciente que poderia esperar
até 0599 para fazer algo?
Enfim, estamos diante de uma caca total, para a qual só resta rezar e,
se o paciente for suficientemente saudável, tentar refazer o acetábulo
com enxerto e reforço de metal, com enxertia e colocação de um
componente femoral de tipo longo e não convencional, torcendo para
integração do enxerto e não-infeção.
Em caso muita dor e impossibilidade de reoperação segura, a resseção
será a via final, indesejável.
Um abraço.
PTucci

5/31/99 Dr. H. Kiefer ( Germany )
 
 

To your case:

For the cup I would use an acetabular reinforcement ring type Schneider-Burch
from Aesculap or Sulzer Companies.This enables you to upgrade the acetabulum
with bone grafts and allows partial weight bearing from the beginning. Only
the interface between reinforcement ring and PE-cup is cemented, so, in total
it is a socalled cementless anchorage. If you would use a primary cemented
cup, you will get the next loosening within very few years.
This is also true for the cemented stem. Because of the large shaft defect and
the very thin remnants of cortical bone you should try to recover the bone
stock using bone grafts in combination with a cementless "ingrowing" long
revision stem and distal interlocking (Bicontact revision stem, Aesculap).
Again this allows partial weight bearing from the beginning for 10-12 weeks. I
have done many of these procedures with very good success. My favorite approch
in these cases with a horizontal semicircular osteotomy of the shaft at the
level of the fracture (about 3 cm above the tip of the stem).
Cid shall give you the Bicontact booklet from 1998, were examples of this
technique are shown.

Sorry again for our bad communication. If you like, you may call me again on
tuesday, 1.June at home between 5 and 6 h p.m. Brasil time.

Best regards

Hartmuth Kiefer

6/01/99  Dr. Bartha Lajos  ( Hungria - Budapeste )
 

Bonjour Cher Ami,
I faut faire une reprise de prothese et changer pour une prothese de l anche tumeur avec une tige fémorale long, n importe quel production il y a plusieur. J ai montré pour notre spécialiste et on a dit ceci. Jéspaire tu vas bien. Je vais bien installé encore une fois mon programme NetMeeting. J éspaire nous pouvouns parler  cette été. Ton fiston vas bien ? Tudo bem? Obrigado, je t´embrasse
Lajos