Klassifikation der femoralen knöchernen Defekte nach Mattingly

Anwendung

Revisionsendoprothetik

 Modifizierte AAOS Klassifikation mit Behandlungsoptionen.

 Klassifikation
Behandlungsempfehlungen
I
Cavitary deficiencies: expansion ⎯ slight, moderate, severe (loss of cancellous and/or
cortical bone from within)

 


IA
Metaphyseal

Metaphyseal Expansion

Slight: standard stem, B, D or F cone with small or large triangle

Moderate: standard or long stem, D or F cone with large triangle 

Severe: standard or long stem, F cone or upsize cone by use of mm diameter
increasing sleeve; possible inlay graft with cemented sleeve and press-fit
cementless stem; possible onlay graft for cortical reinforcement

IB
Diaphyseal
Diaphyseal Expansion

Slight: large diameter stem; standard or long depending on segmental loss

Moderate: larger diameter stem; standard, long or extra-long depending on
segmental loss

Severe: largest possible diameter stem; long, extra-long or extra,extra-long
depending on segmental loss; possible onlay cortical graft for reinforcement;
possible intramedullary graft
II
Segmental deficiencies: combination with cavitary
Segmental

IIA
Slight (bone loss above the top of the lesser trochanter)
Slight:: standard stem, B, D or F cone with small or long triangle 
IIB
Moderate (bone loss through the base of the lesser trochanter)
Moderate: Calcar long stem; possible 42 neck, long stem, possible + 12 mm head
IIC
Severe (bone loss below lesser trochanter to the isthmus)
Severe: extra-long or extra, extra-long stem with segmental sleeve or allograft
IID
Extreme (bone loss below the isthmus)
Extreme: extra, extra-long stem modified with locking screws segmental sleeve or
allograft
III
Cortical deficiency (any fracture, perforation or loss of cortical substance)
Windows less 113 canal diameter: stem bypass by 21/2 canal diameters with or
without graft

Windows greater than 113 canal diameter: stem bypass by 21/2 canal diameters
with onlay bone graft

Crack: cerclage and possible onlay grafts 

Fracture: stem bypass at least 21/2 canal diameters with cerclage and possible
cortical onlay grafts 
IV
Malalignment
 
IVA
Version abnormalities (too much anteversion or retroversion) Version abnormalities: index sleeve into position of structural support; index
stem into position of function

IVB
Angular deformity (diaphyseal angle or bow restricts the insertion of the femoral
stem)
Angular deformities: Osteotomize through deformity stem bypass by greater than 21/2 canal diameters