Zimmer Implant Spinning 2 Months Post-Op: What Should I Do?

Alas take it out leave for 3 months or more and re-place , no room for praying in Implantology . Regards Peter

Dear P. maybe you did't pay attention to the following: how many N/cm2 did you obtain on the initial stability of the implant? And how many N/cm2 did you use to unscrew the cover screw? I guess you didn't wait enough time for osseointegration (4 to 6 months). I have meassured the force to unscrew the cover screw and some times I get 20 N/cm2, maybe at the time of surgery even if you rinse and clean the implant there is a little imperceptible amount of blood between the implant and the cover screw. So if the osseointegration is not completed and your initial stability was lower than the force you used to unscrew, then you commited a mistake. But if you had a higher initial stability and you used less force to unscrew then the osseointegration would fail anyway. You have two options go straight to the predictable way and change the implant as Dr. Fairbairn wrote, or wait the osseointegration period of 4 or 6 months starting since you rotate the implant and a little pray. Good luck.

Remove the spinner, degranulate and place a wider implant if possible, or remove the spinner and degranulate and graft, comeback later to a nice site.

Taking into account the patient's wishes...and assuming the patient wants to continue down the implant path...I would do what Hughes is suggesting (assuming - again - that you can go to a wider diameter implant). If not, then simply remove, wait 3 months...or 4 if grafting and replace. I have prayed about spinners before. Needless to say I stopped praying and started removing them. Fortunately that is only about 3 fixtures in the last 6 years. Now, crossing fingers....that works!

Two months is too soon. I had this happen once and since there were no other symptoms rotated back in and left it for 3-4 months. And the implant was fine. I did have to cut the healing cuff off. Beyond that I only put the cuffs on finger tight.

The implant failed..take it out and start over again.

If you have the room, remove teh implant and redrill one size bigger and longer and place another implant.

If no adverse force is present, leave the implant 4 more months to the day. I've seen many that weren't ready at 60 days, but well- integrated at 180 days. If you didn't move it much, it can still integrate. This way is a waiting game, redrilling is more predictable, but less attractive to the patient I'd think. Without data, my contribution is still,... only my opinion, but I've had them go both ways. Be confidant!

You should have waited at least 3 months regardless of what implant reps tell you on "active" surfaces. If it was spinning with very little pressure (i.e. hand) take it out, degranulate, and replace same day with larger diameter and lenth or degranulate and graft. If it was stable at 20+ Ncm and then moved wait 2-3 months and then check again. Most predictable, however, is remove and try to replace same day if possible but DEGRANULATE well. Good luck.

It happens. Just screw it back in and wait for 3 ms. Then test with osstell. Patient will be happy and so will you. If not, do the right thing. good luck!

Not quite clear on your original premise. Was this an extraction site where you placed a bone graft and implant simultaneously or did you graft first and then place the implant? The Zimmer tapered screwvent has a notoriously high compression value when seated (placing a tapered body into a parallel walled osteotomy). What was the torque value on placement? Sounds like classic compression remodeling. In these cases, this is NOT an infective lesion. Simply currette the fibrous capsule and either place the implant slightly deeper or place an implant of larger diameter. RJM

Is there a shortage interesting scenarios??? Haven't we seen this nebbish before? How do you post a case? Bv

I'm sure the answer is somewhere in the ancillary literature, but I am posting via I-phone with 2.0 magnifiers . Only time I use a computer now, is when I'm editing or reading a scan. Bv

If there is no signs of infection, as someone previously stated, unscrew, degranulate and replace with a slightly wider diameter (and slightly longer if possible) implant and start your 3-4 month clock all over again! You're very likely just wasting time with waiting to test the same implant later. DRTLAU

I think the implant fail. Remove implant, wait for healing period and start again. Good luck

Dr.p, you revisited the site to soon. Do not over-tighten the healing screw. Just use finger pressure only, till all the threads are down. If there was no infection, no ST btw the implant and osteotomy, then just screw back to place and give it time or replace the implant.

Hi everybody! The fate of that implant was FAIL!!!!!! I'm managing a time to remove it and implant a larger diameter one. It will be an unpleasant conversation with patient to persuade him Anyway,thank you everybody

I had one case did spin ( minor) on force more than 20 plus Ncm, I left it for 4 months was fine after. Second option take it out irrigate the site and osteotomy and place a wider size implant

if the implant just ritate in its site >> its ok >>> leave it as it is >> wait longer period >>> for 4 monthes at least >>> then start to unscrew the cover screw normally >>> IF IT IS COLD WELDED >>> dont scared >>> just bring your ultra sound scaler and put it over the cover screw and press the foot switch >>>>> it will take with you about 30 min>> after thet evry thing will be ok ( god willing )and remember >>> (we as a muslem) always there is a time for pray > good luck my friend

take it off..you are wasting time... in mand. implant u can load after 2 to 3 month if u got good primary stability.. what you are talking about is fibro-integration.. unscrew cover screw need much less torque than use to unscrew implant... try to unscrew on 20 Nm.. if the implant it out...so it a failure ;) graft and wait better ,, then install implant later GOOD luck