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Fischer M, Nonnenmacher L, Reichert JC, Bohnert JA, Idelevich EA, Doğan E, Becker K, Wassilew GI. Case Report: Hip arthroplasty after fracture-related joint infection caused by extensively drug-resistant Klebsiella pneumoniae. Front Surg 2024; 11:1363298. [PMID: 38476757 PMCID: PMC10927804 DOI: 10.3389/fsurg.2024.1363298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
This case-report focuses on a 23-year-old soldier suffering from a fracture-related hip joint infection (FRI) due to extensively drug-resistant Klebsiella pneumoniae and S. epidermidis. The patient underwent multiple septic revision surgeries including the removal of remaining shrapnel accompanied by last-resort antimicrobial therapy with cefiderocol and colistin. Additionally, the surgeries included repeated tissue sampling for microbiological and histopathological analysis. An antibiotic-loaded cemented filler containing cefiderocol was used to improve local antimicrobial therapy. The biopsies prior to and during hip replacement surgery confirmed successful microbe eradication. Hip arthroplasty restored hip joint function and significantly improved patient's quality of life. The utilization of a trabecular metal shell and a meta-diaphyseally anchored cementless hip stem ensured secure implant fixation and early patient mobilisation. An adjusted biofilm active oral antimicrobial therapy after arthroplasty intervention was continued to prevent early periprosthetic joint infection. This case emphasizes the difficulties of managing FRI and multidrug-resistant pathogens. It contributes valuable insight into navigating complex orthopedic cases while ensuring successful hip arthroplasty outcomes. In conclusion, early interdisciplinary collaboration, appropriate antimicrobial therapy along with tailored surgical interventions are crucial for managing such complex cases successfully.
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Affiliation(s)
- Maximilian Fischer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Lars Nonnenmacher
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Johannes C. Reichert
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jürgen A. Bohnert
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Evgeny A. Idelevich
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Eyüp Doğan
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Karsten Becker
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Georgi I. Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
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2
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Klok JW, Groenewegen J, Temmerman O, Van Straten N, Van Straten B, Dankelman J, Horeman T. Design and In Vitro Validation of an Orthopaedic Drill Guide for Femoral Stem Revision in Total Hip Arthroplasty. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2024; 12:340-347. [PMID: 38606389 PMCID: PMC11008802 DOI: 10.1109/jtehm.2024.3365300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Cemented total hip arthroplasty (THA) demonstrates superior survival rates compared to uncemented procedures. Nevertheless, most younger patients opt for uncemented THA, as removing well-fixed bone cement in the femur during revisions is complex, particularly the distal cement plug. This removal procedure often increases the risk of femoral fracture or perforation, haemorrhage and weakening bone due to poor drill control and positioning. Aim of this study was to design a novel drill guide to improve drill positioning. METHODS AND PROCEDURES A novel orthopaedic drill guide was developed, featuring a compliant centralizer activated by a drill guide actuator. Bone models were prepared to assess centralizing performance. Three conditions were tested: drilling without guidance, guided drilling with centralizer activation held, and guided drilling with centralizer activation released. Deviations from the bone centre were measured at the entry and exit point of the drill. RESULTS In the centralizing performance test, the drill guide significantly reduced drill hole deviations in both entry and exit points compared to the control ([Formula: see text]). The absolute deviation on the exit side of the cement plug was 10.59mm (SD 1.56) for the 'No drill guide' condition, 3.02mm (SD 2.09) for 'Drill guide - hold' and 2.12mm (SD 1.71) for 'Drill guide - release'. The compliant drill guide centralizer significantly lowered the risk of cortical bone perforation during intramedullary canal drilling in the bone models due to better control of the cement drill position. Clinical and Translational Impact Statement: The drill guide potentially reduces perioperative risks in cemented femoral stem revision. Future research should identify optimal scenarios for its application.
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Affiliation(s)
- Jan-Willem Klok
- Department of BioMechanical EngineeringDelft University of Technology2628 CDDelftThe Netherlands
| | | | | | | | | | - Jenny Dankelman
- Department of BioMechanical EngineeringDelft University of Technology2628 CDDelftThe Netherlands
| | - Tim Horeman
- Department of BioMechanical EngineeringDelft University of Technology2628 CDDelftThe Netherlands
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3
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Ali E, Howard LC, Neufeld ME, Masri BA. Treatment of femoral bone loss in revision total hip arthroplasty: a clinical practice review. ANNALS OF JOINT 2024; 9:4. [PMID: 38529292 PMCID: PMC10929365 DOI: 10.21037/aoj-23-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/19/2023] [Indexed: 03/27/2024]
Abstract
Patient and implant selection is essential to optimize outcome. Femoral bone loss classifications such as the American Academy of Orthopaedic Surgeons, Gross, and Paprosky classifications permit surgeons to systematically manage bone stock deficiencies and guide implant selection. Here we provide a comprehensive report on the pitfalls and management of this reconstructive challenge. Preoperative planning remains vital to the treatment of femoral bone loss in revision hip arthroplasty and the authors believe it is essential and should include the entire femur. This commonly includes imaging for bone loss such as Judet views or computed tomography scan and must include the entire femur though additional radiographs such as Judet views apply more for acetabular bone loss as opposed to femoral bone loss. All patients should have pre-operative work up to exclude infection. If any of these results area elevated, an aspirate and sampling is required to guide microbiological management. Classically with regards femoral revision surgery, uncemented fixation has proven to give the best outcomes but surgeons must remain flexible and use cemented fixation when necessary. Adequate proximal bone stock permits the use of implants used in primary joint surgery. Implants with proximal modularity can be used in cases where bone stock allows for superb proximal bone support. The vast majority of femoral revisions have inadequate proximal bone stock, thus distally fixed stems should be used and have been shown to provide both axial and rotational stability provided there is an intact isthmus. Taper fluted stems can provide good outcomes even in cases of major bone loss. However, with severe bony loss, impaction grating or the use of a megaprotsthesis is sometimes necessary and is down to surgeon choice and preference. This article has been written as a guide for management and summarises the best evidence available.
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Affiliation(s)
- Erden Ali
- Faculty of Medicine, Department of Orthopaedics, The University of British Columbia, Diamond Health Care Centre, Vancouver, UK
| | - Lisa C Howard
- Faculty of Medicine, Department of Orthopaedics, The University of British Columbia, Diamond Health Care Centre, Vancouver, UK
| | - Michael E Neufeld
- Faculty of Medicine, Department of Orthopaedics, The University of British Columbia, Diamond Health Care Centre, Vancouver, UK
| | - Bassam A Masri
- Faculty of Medicine, Department of Orthopaedics, The University of British Columbia, Diamond Health Care Centre, Vancouver, UK
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4
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Kheir MM, Dilley JE, Speybroeck J, Kuyl EV, Ochenjele G, McLawhorn AS, Meneghini RM. The Influence of Dorr Type and Femoral Fixation on Outcomes Following Total Hip Arthroplasty for Acute Femoral Neck Fractures: A Multicenter Study. J Arthroplasty 2023; 38:719-725. [PMID: 36283515 DOI: 10.1016/j.arth.2022.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The American Academy of Orthopaedic Surgeons guidelines report moderate evidence for cementing femoral stems for hip fractures, mainly derived from hemiarthroplasty literature. This is the first large, nonregistry study examining the influence of femoral fixation, implant type, patient characteristics, and radiographic factors on outcomes after total hip arthroplasty (THA) for acute femoral neck fractures. METHODS A multicenter retrospective study was performed of 709 THA cases (199 cemented, 510 cementless) for femoral neck fractures from 2006 to 2020 at three large academic institutions. Demographics, perioperative characteristics, and radiographs were reviewed. Kaplan-Meier survivorship curves were generated for multiple outcomes. Univariate and multivariate analyses were performed with P ≤ .05 denoting significance. RESULTS Cementless stems had a higher all-cause aseptic femoral revision rate (5.1 versus 0.5%, P = .002) and periprosthetic femoral fracture rate (4.3 versus 0%, P = .001). Each successive Dorr type had a higher fracture rate with cementless implants: 2.3%, 3.7%, and 15.9% in Dorr A, B, and C, respectively (P < .001). Logistic regression analyses confirmed that cementless stems (P = .02) and Dorr C bone (P = .001) are associated with periprosthetic fractures; collared implants and prophylactic cables did not protect against fractures. There was no difference in rates of dislocation, septic revision, or mortality between groups. CONCLUSION Cementless stems during THA for femoral neck fractures have a higher aseptic femoral revision rate, specifically for periprosthetic fractures. Dorr C bone was particularly prone with an alarmingly high fracture rate. All fractures occurred in cementless cases, suggesting that cemented stems may minimize this complication. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michael M Kheir
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Julian E Dilley
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jacob Speybroeck
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Emile-Victor Kuyl
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - George Ochenjele
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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5
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Alsheikh KA, Alhandi AA, Almutlaq MS, Alhumaid LA, Shaheen N. The Outcomes and Revision Rate of Total Hip Arthroplasty in a Single Tertiary Center: A Retrospective Study. Cureus 2022; 14:e27981. [PMID: 36120254 PMCID: PMC9468514 DOI: 10.7759/cureus.27981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Total hip arthroplasty (THA) is a commonly performed and successful orthopedic practice procedure. However, failure of arthroplasty may require revision THA and pose substantial clinical challenges for orthopedic surgeons. Therefore, this retrospective study aimed to estimate the revision rate of THA and its risk factors at a tertiary care hospital. Methods A retrospective cohort study was conducted in 2021 of patients who had undergone THA during 2016-2020 in a tertiary care hospital. All patients above 18 years old who had a THA were included in the study. The data was collected from patients' medical charts/electronic databases. Results A total of 148 THAs were included in this study. In total, 77 (52%) were females, and 71 (48%) were males. The average age of our patients was 49±17 years old, and the mean recorded BMI was 29.6. A total of 62% (n=92/148) of our participants were shown to have at least one comorbid disease, with hypertension being the most common comorbidity. Our findings show that half of the patients, 74 (50%), had a THA due to both primary and secondary osteoarthritis, 37 (25%) patients had avascular necrosis of the hip, and 25 (17%) were due to trauma. The most performed surgical approach was Kocher-Langenbeck (posterior) approach on 128 (86%), followed by the Hardinge (lateral) approach on 20 (13.51%). The most observed complication in the patients was postoperative pain in 35 (23.65%), followed by UTIs in 5 (3.38%). Of the 148 patients, nine (6.08%) had revision surgery. Regarding the revision rate, male patients were associated with a significantly higher rate of revision (P=<0.001), and older patients had a significantly increased risk of revision (P=0.026). Patients who developed complications, such as UTI, were associated with a higher revision rate (P=0.035). Also, a posterior approach (Kocher-Langenbeck) of the procedure was significantly linked to an increased risk of revision (P=0.014). Conclusion All in all, there are multiple associated factors with an increased incidence of revision THA. For example, male patients, older patients, complication development during the hospital stay, and posterior surgical approach were all associated with a significantly higher rate of revision.
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Mechanical and Fatigue Behavior of Cellular Structure Ti-6Al-4V Alloy Femoral Stems: A Finite Element Analysis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Repetitive loads acting on the hip joint fluctuate according to the type of activities produced by the human body. Repetitive loading is one of the factors that leads to fatigue failure of the implanted stems. The objective of this study is to develop lightweight femoral stems with cubic porous structures that will survive under fatigue loading. Cubic porous structures with different volumetric porosities were designed and subjected to compressive loading using finite element analysis (FEA) to measure the elastic moduli, yield strength, and ultimate tensile strength. These porous structures were employed to design femoral stems containing mechanical properties under compressive loading close to the intact bone. Several arrangements of radial geometrical porous functionally graded (FG) and homogenous Ti-6Al-4V porous femoral stems were designed and grouped under three average porosities of 30%, 50%, and 70% respectively. The designed stems were simulated inside the femoral bone with physiological loads demonstrating three walking speeds of 1, 3, and 5 km/h using ABAQUS. Stresses at the layers of the functionally graded stem were measured and compared with the yield strength of the relevant porous structure to check the possibility of yielding under the subjected load. The Soderberg approach is employed to compute the safety factor (Nf > 1.0) for each design under each loading condition. Several designs were shortlisted as potential candidates for orthopedic implants.
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Di Martino A, Pederiva D, Bordini B, Di Carlo G, Panciera A, Geraci G, Stefanini N, Faldini C. Proximal femoral replacement for non-neoplastic conditions: a systematic review on current outcomes. J Orthop Traumatol 2022; 23:18. [PMID: 35348913 PMCID: PMC8964877 DOI: 10.1186/s10195-022-00632-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/19/2022] [Indexed: 11/10/2022] Open
Abstract
Proximal femoral replacement (PFR) is a well-established treatment for neoplasia of the proximal femur. The use of this surgical technique for non-neoplastic conditions has increased over the years. We carried out a systematic review of the literature to study the indications, complications, and functional results when PFR is used for non-neoplastic conditions. Twenty-seven studies were included in the review with a total of 828 PFRs with a mean follow-up of 50 months (range 1-225 months). The main indications were infection (28%), periprosthetic fracture (27%), aseptic loosening (22%), and fracture (16%). The rate of reoperation was 20.3% overall. The overall revision rate was 15.4%. The main complications were dislocation (10.2%) and infection (7.3%). After 2010, the rates of reoperation (25.5% versus 18.2%), loosening (9.4% versus 3.2%), and dislocation (15.7% versus 7.9%) were lower than before 2010. The 30-day mortality ranged from 0% to 9%. The hip function scores improved post-surgery. In conclusion, the use of PFR in non-neoplastic conditions remains a marginal tool, associated with low direct mortality and high complication rates, but we expect its use to increase in the near future.
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Affiliation(s)
- Alberto Di Martino
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy. .,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy.
| | - Davide Pederiva
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Lab, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Gabriele Di Carlo
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Alessandro Panciera
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Giuseppe Geraci
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Niccolò Stefanini
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Cesare Faldini
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
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8
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Sahemey R, Garala K, Chahal G, Lawrence T. Outcomes of revision total hip arthroplasty using a vascularised anterior femoral window. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1325-1332. [PMID: 34482442 DOI: 10.1007/s00590-021-03106-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Extraction of the distal femoral cement mantle and restrictor during revision total hip arthroplasty (rTHA) is challenging and can compromise host bone stock. The aim of this study is to report outcomes of our femoral windowing technique for cement removal. METHODS We report on a cohort of 36 patients with an average age of 68.7 years who underwent 40 cemented rTHA between 2011 and 2017 using a vascularised anterior femoral window. Clinical and radiological outcomes were retrospectively reviewed with a mean follow-up of 6.6 years (range, 3.8-10). RESULTS Latest mean WOMAC score was 25.4 and all windows achieved radiographic union by a mean of 7.9 weeks. Femoral component survivorship was 100% and 38 out of 40 rTHAs showed no evidence of radiological loosening. CONCLUSION The vascularised anterior window to remove the distal femoral cement mantle under direct vision is safe and reproducible with excellent clinical and radiographic results.
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Affiliation(s)
- Rajpreet Sahemey
- Orthopaedic Department, University Hospitals Coventry and Warwickshire, Coventry, UK.
| | - Kanai Garala
- Orthopaedic Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Gurdip Chahal
- Orthopaedic Department, Warwick Hospital, Warwick, UK
| | - Trevor Lawrence
- Orthopaedic Department, University Hospitals Birmingham, Birmingham, UK
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9
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Malahias MA, Mancino F, Agarwal A, Roumeliotis L, Gu A, Gkiatas I, Togninalli D, Nikolaou VS, Alexiades MM. Cement-in-cement technique of the femoral component in aseptic total hip arthroplasty revision: A systematic review of the contemporary literature. J Orthop 2021; 26:14-22. [PMID: 34276146 DOI: 10.1016/j.jor.2021.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/27/2021] [Indexed: 10/21/2022] Open
Abstract
Background Clinical outcomes of cemented femoral stems revisions using the cement-in-cement technique in aseptic conditions after total hip arthroplasty have been widely described. Methods The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried. Results Twelve articles were included (620 revision THA). Revision rate for complications related to the femoral side was 1.4% at mid-term follow-up (5.4 years). Periprosthetic femoral fracture rate was 1.1%, aseptic loosening of the femoral component 0.3%. Conclusions Cement-in-cement revision technique of the femoral component is associated with a high mid-term success rates (98.6%) and is potentially less challenging than other revision techniques.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.,Department of Orthopedics and Traumatology, Clinica ARS Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | - Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amil Agarwal
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington, DC, 20037, USA
| | - Leonidas Roumeliotis
- Department of Trauma and Orthopaedics, Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Ioannis Gkiatas
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Danilo Togninalli
- Department of Orthopedics and Traumatology, Clinica ARS Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | - Vasileios S Nikolaou
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Michael M Alexiades
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
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10
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Simon S, Frank BJH, Aichmair A, Dominkus M, Hofstaetter JG. Reconstruction of Proximal Metaphyseal Femoral Defects Using Trabecular Metal Augments in Revision Total Hip Arthroplasty. Arthroplast Today 2021; 8:216-221. [PMID: 33937461 PMCID: PMC8079334 DOI: 10.1016/j.artd.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 12/13/2022] Open
Abstract
Porous tantalum augments are widely used in revision total hip arthroplasty for the reconstruction of severe bone defects. Here, we present the first 3 cases who underwent femoral revision arthroplasty using standard distal femoral and proximal tibial porous tantalum cones to reconstruct severe bone loss in the proximal femur. Cones were inserted press fit, followed by implantation of a cemented revision stem in all cases. After a mean follow-up period of 15.8 months, all patients showed an improved Harris-Hip-Score and no radiological signs of subsidence or loosening. Porous tantalum cones may be an option in the reconstruction of severe femoral defects in revision total hip arthroplasty. The shape of the tantalum cones should be optimized for the use in the proximal femur.
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Affiliation(s)
- Sebastian Simon
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Bernhard J H Frank
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Alexander Aichmair
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Martin Dominkus
- II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Jochen G Hofstaetter
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
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11
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Picado CHF, Savarese A, Cardamoni VDS, Sugo AT, Garcia FL. Clinical, radiographic, and survivorship analysis of a modular fluted tapered stem in revision hip arthroplasty. J Orthop Surg (Hong Kong) 2020; 28:2309499019891638. [PMID: 31833457 DOI: 10.1177/2309499019891638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Modular fluted tapered stems are one of the most commonly used implants in femoral revision surgery. Due to the relative lack of studies on the Restoration modular fluted tapered stem, we conducted a study to evaluate its short- to mid-term clinical, radiographic, and survival outcomes. METHODS We identified all 45 patients treated with this revision stem at our institution. Five patients did not complete the minimum 2-year follow-up, leaving 40 patients (41 hips) for assessment. Mean follow-up was 5.1 years (range 2-11 years). Clinical outcomes were assessed using the Harris hip score (HHS). Radiographs were evaluated for subsidence and loosening. Kaplan-Meier survival analysis was performed using revision of the stem for any reason as end point. RESULTS The mean HHS improved from 44.6 points preoperatively to 78.4 points at the most recent follow-up (p < 0.0001). Nonprogressive subsidence occurred in 83% of the hips (mean 2.8 mm; range 1-7 mm). One stem (2.4%) showed progressive subsidence (20 mm) and was considered loose. The most common cause for reoperation was dislocation (three hips, 7.3%). The 10-year survivorship with revision of the stem for any reason as the end point was 93.5% (95% CI, 84.9-100%). CONCLUSION There was a significant improvement in the HHS and a low likelihood of revision at short- to mid-term follow-up, adding to the current evidence base for use of this implant in revision surgery. A longer follow-up and a larger number of cases are necessary to fully evaluate its role and performance.
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Affiliation(s)
| | - Aniello Savarese
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto (SP), Brazil
| | | | - Arthur Tomotaka Sugo
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto (SP), Brazil
| | - Flávio Luís Garcia
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto (SP), Brazil
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12
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Dabis J, Hutt JR, Ward D, Field R, Mitchell PA, Sandiford NA. Clinical outcomes and dislocation rates after hip reconstruction using the Bioball system. Hip Int 2020; 30:609-616. [PMID: 31257925 DOI: 10.1177/1120700019858345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Instability accounts for 1/3 of revision total hip arthroplasty (rTHA) performed in the UK. Removal of well-fixed femoral stems in rTHA is challenging with a risk of blood loss and iatrogenic damage to the femur. The Bioball universal adaptor (BUA), a modular head neck extension adaptor, provides a mechanism for optimisation of femoral offset, leg length and femoral anteversion. This can avoid the need for femoral stem revision in selected cases.The aim of this study is to present the clinical results and rate of instability following revision with this BUA at a minimum of 2 years follow-up. PATIENTS AND METHODS A review of our prospectively collected database was performed. All patients treated with the Bioball device were included. Clinical and radiologic review were performed pre- and post-surgery. Specific enquiry for instability was made. The Oxford Hip Score (OHS), EuroQol (EQ-5D) score and WOMAC scores were calculated pre-and post-operatively. Complications were recorded. RESULTS 32 rTHA procedures were performed using the Bioball device between 2013 and 2016. 4 patients did not wish to complete post-operative questionnaires. 2 patients (2/28, 7%) complained of recurrent dislocations following their rTHA procedure. 1 patient complained of instability but no dislocation. The median pre-operative EQ-5D was 0.195 (range -0.07-0.85), OHS was 20 (range 5-43) and WOMAC was 29.8 (range 15.5-52.3). The median EQ-5D was 0.85 (range 0.59-1), OHS was 39 (range 21-48) and WOMAC was 91.1 (range 44.5-99.2) at final follow-up. There were significant improvements in the EQ-5D (p = 0.0009), OHS (p = 0.0004) and WOMAC (p = 0.0001). CONCLUSION The BUA is associated with significant functional improvement and relatively low dislocation rates in revision THA. It is a viable option for use in the revision setting.
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Affiliation(s)
- John Dabis
- Complex Arthroplasty Unit, St George's University Hospital, London, UK
| | - Jonathan R Hutt
- Complex Arthroplasty Unit, St George's University Hospital, London, UK
| | - David Ward
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, UK
| | - Richard Field
- South West London Elective Orthopaedic Centre, Epsom, UK
| | - Philip A Mitchell
- Complex Arthroplasty Unit, St George's University Hospital, London, UK
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13
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Xará-Leite F, Pereira AD, Andrade R, Sarmento A, Sousa R, Ayeni OR, Espregueira-Mendes J, Soares D. The cement-in-cement technique is a reliable option in hip arthroplasty revision surgery: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:7-22. [PMID: 32666308 DOI: 10.1007/s00590-020-02736-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The cement-in-cement technique for revision hip arthroplasty has many potential advantages and has recently gained widespread interest but still lacks evidence to support it. Our aim was to examine the surgical and patient-reported outcomes after cement-in-cement revision hip arthroplasty. MATERIALS AND METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and EMBASE databases were searched up to February 2019 for original studies reporting the outcomes of revision hip arthroplasty surgeries using the cement-in-cement technique. The methodological quality was assessed using the methodological index for non-randomized studies scale. RESULTS Sixteen non-comparative studies met the eligibility criteria, comprising 1899 hips in 1856 patients (72.2 mean age, 37% male), with a mean follow-up of 7.2 years. Most studies reported only primary revisions and focused on the stem component. Intraoperative complications such as femoral or acetabular fractures (5.3%) were low and easily manageable with no relevant sequelae, as were dislocation rates (2.8% of uncomplicated events and 1.6% of cases requiring re-revision). Failure (considered if there was aseptic loosening of the cement-in-cement revised component, 2%), re-revision (9.3%), implant survival and late complication rates were favourable. Functional patient-reported outcomes showed an overall improvement above the minimal clinically important difference at final follow-up. CONCLUSION The cement-in-cement technique is a viable option for hip arthroplasty revision surgery with low intraoperative and late complication rates, dislocations and immediate post-operative morbidity, resulting in good functional patient-reported outcomes and favourable medium-term implant survival.
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Affiliation(s)
- Francisco Xará-Leite
- GRIP Unit, Orthopaedics Department, Centro Hospitalar e Universitário do Porto, Largo do Prof Abel Salazar, 4099-001, Porto, Portugal.
| | | | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Faculty of Sports, University of Porto, Porto, Portugal
| | - André Sarmento
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Orthopaedics Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Sousa
- GRIP Unit, Orthopaedics Department, Centro Hospitalar e Universitário do Porto, Largo do Prof Abel Salazar, 4099-001, Porto, Portugal
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Orthopaedics Department, Minho University, Minho, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Daniel Soares
- GRIP Unit, Orthopaedics Department, Centro Hospitalar e Universitário do Porto, Largo do Prof Abel Salazar, 4099-001, Porto, Portugal
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Optimizing humeral stem fixation in revision reverse shoulder arthroplasty with the cement-within-cement technique. J Shoulder Elbow Surg 2020; 29:S9-S16. [PMID: 32360178 DOI: 10.1016/j.jse.2020.01.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 01/21/2020] [Accepted: 01/28/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to report on the clinical outcomes of patients undergoing revision reverse shoulder arthroplasty (RSA) by the cement-within-cement technique, as well as to identify whether surgical technique can affect subsequent humeral loosening. METHODS In 98 patients, cemented humeral components that were revised to RSA using the cement-within-cement technique were identified and included in this study. We compared 8 patients in whom humeral stem loosening developed with 90 patients whose stem remained fixed. Preoperative and postoperative radiographs of each patient were downloaded in DICOM (Digital Imaging and Communications in Medicine) format and analyzed in Mimics. The total area of the cement mantle (in square millimeters) and of the stem (in square millimeters), as visualized on 2-dimensional plain films, was measured in each subject on both preoperative and postoperative radiographs. Outcomes at a minimum of 2 years of follow-up were analyzed. RESULTS Clinical outcomes were available in 57 patients, with a mean follow-up period of 54 months (range, 21-156 months). Patients demonstrated significantly improved functional outcome scores and shoulder range of motion. In the group without loosening, the mean increase in the cement mantle area was 4380 ± 12701 mm2 (P < .0001). In the group with loosening, the mean increase in the cement mantle area was only 811 ± 4014 mm2 (P = .484). CONCLUSIONS Use of the cement-within-cement technique for fixation of the humeral component in revision RSA is effective in improving functional outcome scores and shoulder range of motion. Furthermore, these findings suggest that efforts to maximize the cement volume during reimplantation may lessen the chance of humeral stem loosening requiring additional revision.
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15
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Gu A, Wei C, Chen AZ, Malahias MA, Fassihi SC, Ast MP, Liu J, Cross MB, Sculco PK. Operative time greater than 120 minutes is associated with increased pulmonary and thromboembolic complications following revision total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1393-1400. [PMID: 32524203 DOI: 10.1007/s00590-020-02712-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/31/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to determine the impact of operative time on the development of early postoperative complications in patients undergoing revision total hip arthroplasty (THA). METHODS In this retrospective cohort study, data were collected through the American College of Surgeons National Quality Improvement Program Database. All patients who underwent revision THA between 2007 and 2016 were identified and stratified into groups based on operative time|: 0-60 min, 61-120 min, 121-180 min, and > 180 min. The incidence of early postoperative adverse events with 30 days, including cardiac, pulmonary, renal, septic, thromboembolic, urinary tract, and wound complications, death, length of stay > 7 days, and unplanned return to the operating room were collected. The complications rates following revision THA were evaluated with univariate and multivariate analyses with significance set at p < 0.05. RESULTS A total of 6271 revision THA patients were included for analysis. Patients who had > 120 min of operative time had a significantly increased risk of the development of pulmonary (OR: 1.339; 95% CI: 1.08-1.661; p = 0.008) and thromboembolic complications (OR: 1.34; 95% CI: 1.053-1.707; p = 0.017) and also had an extended length of stay greater than 7 days (OR: 1.413; 95% CI: 1.295-1.541; p < 0.001). CONCLUSIONS Increased operative time (> 120 min) during revision THA is associated with increased risk of pulmonary and thromboembolic complications, and prolonged hospitalizations (greater than seven days).
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Affiliation(s)
- Alex Gu
- Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA. .,Department of Medicine, George Washington School of Medicine and Health Sciences, 2300 Eye St, Washington, DC, 20037, USA.
| | - Chapman Wei
- Department of Medicine, George Washington School of Medicine and Health Sciences, 2300 Eye St, Washington, DC, 20037, USA
| | - Aaron Z Chen
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Michael-Alexander Malahias
- Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Safa C Fassihi
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington DC, 20037, USA
| | - Michael P Ast
- Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Jiabin Liu
- Department of Anesthesiology, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Michael B Cross
- Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Peter K Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
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16
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Cassar-Gheiti AJ, McColgan R, Kelly M, Cassar-Gheiti TM, Kenny P, Murphy CG. Current concepts and outcomes in cemented femoral stem design and cementation techniques: the argument for a new classification system. EFORT Open Rev 2020; 5:241-252. [PMID: 32377392 PMCID: PMC7202038 DOI: 10.1302/2058-5241.5.190034] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Cemented implant fixation design principles have evolved since the 1950s, and various femoral stem designs are currently in use to provide a stable construct between the implant-cement and cement-bone interfaces.Cemented stems have classically been classified into two broad categories: taper slip or force closed, and composite beams or shaped closed designs. While these simplifications are acceptable general categories, there are other important surgical details that need to be taken into consideration such as different broaching techniques, cementing techniques and mantle thickness.With the evolution of cemented implants, the introduction of newer implants which have hybrid properties, and the use of different broaching techniques, the classification of a very heterogenous group of implants into simple binary categories becomes increasingly difficult. A more comprehensive classification system would aid in comparison of results and better understanding of the implants' biomechanics.We review these differing stem designs, their respective cementing techniques and geometries. We then propose a simple four-part classification system and summarize the long-term outcomes and international registry data for each respective type of cemented prosthesis. Cite this article: EFORT Open Rev 2020;5:241-252. DOI: 10.1302/2058-5241.5.190034.
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Affiliation(s)
| | | | - Martin Kelly
- Connolly Hospital, Orthopaedic Department, Dublin, Ireland
| | | | - Paddy Kenny
- Cappagh National Orthopaedic Hospital, Dublin, Ireland
- Connolly Hospital, Orthopaedic Department, Dublin, Ireland
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Kumar A, Porter M, Shah N, Gaba C, Siney P. Outcomes of Cement in Cement Revision, in Revision Total Hip Arthroplasty. Open Access Maced J Med Sci 2019; 7:4059-4065. [PMID: 32165952 PMCID: PMC7061388 DOI: 10.3889/oamjms.2019.710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The cement-in-cement femoral revision technique involves removing a femoral component from a well-fixed femoral cement mantle and cementing a new stem into the original mantle. This technique, when carried out for the correct indications, is fast, relatively inexpensive and carries a reduced short-term risk for the patient compared with conventional way of removing well-fixed cement. AIM To analyze the effectiveness of cement in cement revision of the femoral stem while performing a revision Total Hip Arthroplasty (THA). METHODS We analyzed a consecutive series of 79 patients who underwent a cement in cement revision THA between June-2015 to June-2018. All the patients were retrospectively analysed for operative time, complications, clinical and radiological outcomes. RESULTS Average age was 76 years (49-86). The mean follow-up was 16.2 months (12-45). The average operative time was 184.6 (90-290) minutes. Most common indication was cup loosening in 28 patients (42.4%), dislocation in 14 patients (21.2%) and stem loosening in 12 patients (18.2%) Nine patients (11%) had one or more complications. Pre-operatively, 10 patients (13%) had lucency at the cement bone interface. Recent review has shown that 8 of these patients' radiographs have remained unchanged, and in 2 of them there is a slight progression of lucency. Common post op clinical complaintswere persistent pain and abductor weakness. Five (6.3%) patients required a re-revision. Most of the patients had a good or satisfactory outcome.No stems showed radiological loosening. CONCLUSION The cement-in-cement technique for revision of the femoral component gave promising results and had the advantages of speed, less blood or bone stock loss, less risk of femoral perforation or fracture, decreased financial costs and reduced post op morbidity.
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Affiliation(s)
- Abhijeet Kumar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | - Martyn Porter
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | - Nikhil Shah
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | | | - Paul Siney
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
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18
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Liddle A, Webb M, Clement N, Green S, Liddle J, German M, Holland J. Ultrasonic cement removal in cement-in-cement revision total hip arthroplasty: What is the effect on the final cement-in-cement bond? Bone Joint Res 2019; 8:246-252. [PMID: 31346452 PMCID: PMC6609863 DOI: 10.1302/2046-3758.86.bjr-2018-0313.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objectives Previous studies have evidenced cement-in-cement techniques as reliable in revision arthroplasty. Commonly, the original cement mantle is reshaped, aiding accurate placement of the new stem. Ultrasonic devices selectively remove cement, preserve host bone, and have lower cortical perforation rates than other techniques. As far as the authors are aware, the impact of ultrasonic devices on final cement-in-cement bonds has not been investigated. This study assessed the impact of cement removal using the Orthosonics System for Cemented Arthroplasty Revision (OSCAR; Orthosonics) on final cement-in-cement bonds. Methods A total of 24 specimens were manufactured by pouring cement (Simplex P Bone Cement; Stryker) into stainless steel moulds, with a central rod polished to Stryker Exeter V40 specifications. After cement curing, the rods were removed and eight specimens were allocated to each of three internal surface preparation groups: 1) burr; 2) OSCAR; and 3) no treatment. Internal holes were recemented, and each specimen was cut into 5 mm discs. Shear testing of discs was completed by a technician blinded to the original grouping, recording ultimate shear strengths. Scanning electron microscopy (SEM) was completed, inspecting surfaces of shear-tested specimens. Results The mean shear strength for OSCAR-prepared specimens (33.6 MPa) was significantly lower than for the control (46.3 MPa) and burr (45.8 MPa) groups (p < 0.001; one-way analysis of variance (ANOVA) with Tukey’s post hoc analysis). There was no significant difference in shear strengths between control and burr groups (p = 0.57). Scanning electron microscopy of OSCAR specimens revealed evidence of porosity undiscovered in previous studies. Conclusion Results show that the cement removal technique impacts on final cement-in-cement bonds. This in vitro study demonstrates significantly weaker bonds when using OSCAR prior to recementation into an old cement mantle compared with cement prepared with a burr or no treatment. This infers that care must be taken in surgical decision-making regarding cement removal techniques used during cement-in-cement revision arthroplasty, suggesting that the risks and benefits of ultrasonic cement removal need consideration. Cite this article: A. Liddle, M. Webb, N. Clement, S. Green, J. Liddle, M. German, J. Holland. Ultrasonic cement removal in cement-in-cement revision total hip arthroplasty: What is the effect on the final cement-in-cement bond? Bone Joint Res 2019;8:246–252. DOI: 10.1302/2046-3758.86.BJR-2018-0313.R1.
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Affiliation(s)
- A Liddle
- Northern Deanery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - M Webb
- St George's Hospital London, London, UK
| | - N Clement
- Freeman Hospital, Newcastle upon Tyne, UK
| | - S Green
- Clinical Director, South Tyneside & Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, UK
| | - J Liddle
- Innovation Agent Ltd, West Haddon, UK
| | - M German
- Newcastle University, Newcastle upon Tyne, UK
| | - J Holland
- Freeman Hospital, Newcastle upon Tyne, UK
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Aalirezaie A, Abolghasemian M, Busato T, Dennis D, Ghazavi M, Holst DC, Kelly M, Kissin YD, Kuijpers M, Lange J, Lichstein P, Moojen DJ, Poolman R, Schreurs BW, Velázquez Moreno JD, Veltman ES. Hip and Knee Section, Treatment, Two-Stage Exchange: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S439-S443. [PMID: 30348583 DOI: 10.1016/j.arth.2018.09.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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20
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Wagner ER, Houdek MT, Hernandez NM, Cofield RH, Sánchez-Sotelo J, Sperling JW. Cement-within-cement technique in revision reverse shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:1448-1453. [PMID: 28233712 DOI: 10.1016/j.jse.2017.01.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/02/2017] [Accepted: 01/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the complications and results of cement-within cement-humeral fixation in revision reverse shoulder arthroplasty. METHODS In 38 shoulders, a cemented humeral component was revised to a cemented reverse humeral component using a cement-within-cement technique. The mean follow-up time was 3.7 (2.0-7.0) years. Clinical, radiologic, and hard outcomes were assessed using the Kaplan-Meier survival method, Fisher exact test, and Student t-test. RESULTS The average operative time for the cement-within-cement technique was 153 minutes. There were 7 (18%) nondisplaced intraoperative fractures involving the greater tuberosity that occurred on implant removal; all healed at last follow-up. A second revision surgery was performed in 3 (8%) patients who underwent cement-in-cement humeral component revision for glenoid loosening (n = 1), periprosthetic instability associated with glenoid loosening (n = 1), and periprosthetic humerus fracture (n = 1). The overall implant revision-free survival at 2 and 5 years was 95% and 91%, respectively. Patients experienced significant pain relief, improvements in their shoulder range of motion, and high satisfaction. There was 1 "at-risk" humeral component (grade 4 or higher humeral lucency, moderate subsidence) that did not undergo revision surgery. There were 2 other humeral components with grade 3 humeral lucency, no subsidence. CONCLUSIONS Cement-within-cement fixation of the humeral component in revision reverse shoulder arthroplasty is associated with a reasonable operative time, good medium-term survival rates, and good pain relief and functional outcomes with low complications. This technique is an important consideration to preserve humeral bone stock and potentially humeral component and implant stability.
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Affiliation(s)
- Eric R Wagner
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matthew T Houdek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Robert H Cofield
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - John W Sperling
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Cnudde PHJ, Kärrholm J, Rolfson O, Timperley AJ, Mohaddes M. Cement-in-cement revision of the femoral stem. Bone Joint J 2017; 99-B:27-32. [DOI: 10.1302/0301-620x.99b4.bjj-2016-1222.r1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 01/04/2017] [Indexed: 11/05/2022]
Abstract
Aims Compared with primary total hip arthroplasty (THA), revision surgery can be challenging. The cement-in-cement femoral revision technique involves removing a femoral component from a well-fixed femoral cement mantle and cementing a new stem into the original mantle. This technique is widely used and when carried out for the correct indications, is fast, relatively inexpensive and carries a reduced short-term risk for the patient compared with the alternative of removing well-fixed cement. We report the outcomes of this procedure when two commonly used femoral stems are used. Patients and Methods We identified 1179 cement-in-cement stem revisions involving an Exeter or a Lubinus stem reported to the Swedish Hip Arthroplasty Register (SHAR) between January 1999 and December 2015. Kaplan-Meier survival analysis was performed. Results Survivorship is reported up to six years and was better in the Exeter group (91% standard deviation (sd) 2.8% versus 85% sd 5.0%) (p = 0.02). There was, however, no significant difference in the survival of the stem and risk of re-revision for any reason (p = 0.58) and for aseptic loosening (p = 0.97), between revisions in which the Exeter stem (94% sd 2.2%; 98% sd 1.6%) was used compared with those in which the Lubinus stem (95% sd 3.2%; 98% sd 2.2%) was used. The database did not allow identification of whether a further revision was indicated for loosening of the acetabular or femoral component or both. Conclusion The cement-in-cement technique for revision of the femoral component gave promising results using both designs of stem, six years post-operatively. Cite this article: Bone Joint J 2017;99-B(4 Supple B):27–32.
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Affiliation(s)
- P. H. J. Cnudde
- Swedish Hip Arthroplasty Register, Registercentrum
Västra Götaland, SE 413 45 Gothenburg, Sweden
| | - J. Kärrholm
- Swedish Hip Arthroplasty Register, Registercentrum
Västra Götaland, SE 413 45 Gothenburg, Sweden
| | - O. Rolfson
- Swedish Hip Arthroplasty Register, Registercentrum
Västra Götaland, SE 413 45 Gothenburg, Sweden
| | - A. J. Timperley
- Royal Devon and Exeter NHS Foundation
Trust, Hip Unit, Princess
Elizabeth Orthopaedic Centre, Barrack Road, Exeter, EX2
5DW, UK
| | - M. Mohaddes
- Swedish Hip Arthroplasty Register, Registercentrum
Västra Götaland, SE 413 45 Gothenburg, Sweden
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Amanatullah DF, Pallante GD, Floccari LV, Vasileiadis GI, Trousdale RT. Revision Total Hip Arthroplasty Using the Cement-in-Cement Technique. Orthopedics 2017; 40:e348-e351. [PMID: 27992642 DOI: 10.3928/01477447-20161213-05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/31/2016] [Indexed: 02/03/2023]
Abstract
The cement-in-cement technique is useful in the setting of revision total hip arthroplasty (THA), especially to gain acetabular exposure, change a damaged or loose femoral component, or change the version, offset, or length of a fixed femoral component. The goal of this retrospective study was to assess the clinical and radiographic characteristics of revision THA using the cement-in- cement technique. Between 1971 and 2013, a total of 63 revision THAs used an Omnifit (Osteonics, Mahwah, New Jersey) or Exeter (Howmedica, Mahwah, New Jersey) stem and the cement-in-cement technique at the senior author's institution. Aseptic loosening (74%) was the predominant preoperative diagnosis followed by periprosthetic fracture (14%), instability (8%), and implant fracture (6%). Mean clinical follow-up was 5.5±3.8 years. The Harris Hip Score had a statistically significant increase of 18.5 points (P<.001) after revision THA using the cement-in-cement technique. There were 13 returns to the operating room, resulting in an overall failure rate of 21%. Eleven (18%) cases required revision THA, but only 1 (2%) revision THA was for aseptic removal of the femoral component. All other femoral implants had no evidence of component migration, cement mantel fracture, or circumferential lucent lines at final follow-up. The patients who underwent cement-in-cement revision THA at the senior author's institution had good restoration of function but a high complication rate. [Orthopedics. 2017; 40(2):e348-e351.].
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Sandiford NA, Jameson SS, Wilson MJ, Hubble MJW, Timperley AJ, Howell JR. Cement-in-cement femoral component revision in the multiply revised total hip arthroplasty: results with a minimum follow-up of five years. Bone Joint J 2017; 99-B:199-203. [PMID: 28148661 DOI: 10.1302/0301-620x.99b2.bjj-2016-0076.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 10/06/2016] [Indexed: 11/05/2022]
Abstract
AIMS We present the clinical and radiological results at a minimum follow-up of five years for patients who have undergone multiple cement-in-cement revisions of their femoral component at revision total hip arthroplasty (THA). PATIENTS AND METHODS We reviewed the outcome on a consecutive series of 24 patients (10 men, 14 women) (51 procedures) who underwent more than one cement-in-cement revision of the same femoral component. The mean age of the patients was 67.5 years (36 to 92) at final follow-up. Function was assessed using the original Harris hip score (HHS), Oxford Hip Score (OHS) and the Merle D'Aubigné Postel score (MDP). RESULTS The mean length of follow-up was 81.7 months (64 to 240). A total of 41 isolated acetabular revisions were performed in which stem removal facilitated access to the acetabulum, six revisions were conducted for loosening of both components and two were isolated stem revisions (each of these patients had undergone at least two revisions). There was significant improvement in the OHS (p = 0.041), HHS (p = 0.019) and MDP (p = 0.042) scores at final follow-up There were no stem revisions for aseptic loosening. Survival of the femoral component was 91.9% (95% confidence intervals (CI) 71.5 to 97.9) at five years and 91.7% (95% CI 70 to 97) at ten years (number at risk 13), with stem revision for all causes as the endpoint. CONCLUSION Cement-in-cement revision is a viable technique for performing multiple revisions of the well cemented femoral component during revision total hip arthroplasty at a minimum of five years follow-up. Cite this article: Bone Joint J 2017;99-B:199-203.
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Affiliation(s)
- N A Sandiford
- St Georges Hospital, Blackshaw Road, London SW17 0QT, UK
| | - S S Jameson
- The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
| | - M J Wilson
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK
| | - M J W Hubble
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK
| | - A J Timperley
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK
| | - J R Howell
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK
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Brown JM, Mistry JB, Cherian JJ, Elmallah RK, Chughtai M, Harwin SF, Mont MA. Femoral Component Revision of Total Hip Arthroplasty. Orthopedics 2016; 39:e1129-e1139. [PMID: 27575035 DOI: 10.3928/01477447-20160819-06] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023]
Abstract
Modern primary total hip arthroplasty (THA) is among the most successful operations in medicine. It has been a consistently effective treatment for end-stage osteoarthritis of the hip. With the increasing number of primary THA procedures being performed and the decreasing age of patients undergoing the procedure, there is an inevitable associated increase in revision burden for arthroplasty surgeons. Revision THA is most often indicated for instability, aseptic loosening, osteolysis, infection, periprosthetic fracture, component malposition, and catastrophic implant failure. Understanding the etiology of THA failure is essential for guiding clinical decision making. Femoral component revision presents a complex challenge to the arthroplasty surgeon because of modern implant design as well as bone loss in the proximal femur. Thorough patient evaluation, defect classification, and well-executed surgical reconstruction based on comprehensive preoperative planning may determine the postoperative results. Knowledge of various reconstructive options and the indications for each is necessary to achieve a successful outcome. This article highlights the most common indications for revision after THA and offers recommendations for how to approach revision of the femoral component. Specifically, the authors review preoperative assessment, common classification systems for femoral deficiency, techniques for component extraction, and modalities of femoral component fixation. [Orthopedics. 2016; 39(6):e1129-e1139.].
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McDougall CJ, Yu J, Calligeros K, Crawford R, Howie CR. A valuable technique for femoral stem revision in total hip replacement: The in-cement revision - A case series and technical note. J Orthop 2016; 13:294-7. [PMID: 27408507 DOI: 10.1016/j.jor.2016.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Indexed: 11/25/2022] Open
Abstract
Revision of a cemented femoral stem can be a challenging procedure. We present a series of cases utilising the "In-cement" revision, whereby the same size stem is introduced into the original cement mantle, without additional cementing. It requires a stable cement mantle in the correct version. We describe the technique and present a review of 23 revision total hip replacements performed over a 5 year period. At average follow-up of 67 months (12-128 months), the overall survivorship was 91.3% with no patient requiring re-revision for stem loosening or mechanical failure. Two patients required re-revision for infection and one of those patients is now deceased. No further operations were required in 21 patients. The "In-cement" revision can be a valuable technique for the revision arthroplasty surgeon. Early results suggest this is a safe and effective technique in the appropriate patient.
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Affiliation(s)
- C J McDougall
- The Royal Infirmary of Edinburgh, Edinburgh, UK; The Prince Charles Hospital, Brisbane, Australia
| | - J Yu
- The Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - R Crawford
- The Prince Charles Hospital, Brisbane, Australia
| | - C R Howie
- The Royal Infirmary of Edinburgh, Edinburgh, UK
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Fölsch C, Kellotat A, Rickert M, Ishaque B, Ahmed G, Pruss A, Jahnke A. Effect of thermodisinfection on mechanic parameters of cancellous bone. Cell Tissue Bank 2016; 17:427-37. [PMID: 27344440 DOI: 10.1007/s10561-016-9567-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022]
Abstract
Revision surgery of joint replacements is increasing and raises the demand for allograft bone since restoration of bone stock is crucial for longevity of implants. Proceedings of bone grafts influence the biological and mechanic properties differently. This study examines the effect of thermodisinfection on mechanic properties of cancellous bone. Bone cylinders from both femoral heads with length 45 mm were taken from twenty-three 6-8 months-old piglets, thermodisinfected at 82.5 °C according to bone bank guidelines and control remained native. The specimens were stored at -20 °C immediately and were put into 21 °C Ringer's solution for 3 h before testing. Shear and pressure modulus were tested since three point bending force was examined until destruction. Statistical analysis was done with non-parametric Wilcoxon, t test and SPSS since p < 0.05 was significant. Shear modulus was significantly reduced by thermodisinfection to 1.02 ± 0.31 GPa from 1.28 ± 0.68 GPa for unprocessed cancellous bone (p = 0.029) since thermodisinfection reduced pressure modulus not significantly from 6.30 ± 4.72 GPa for native specimens to 4.97 ± 2.23 GPa and maximum bending force was 270.03 ± 116.68 N for native and 228.80 ± 70.49 N for thermodisinfected cancellous bone. Shear and pressure modulus were reduced by thermodisinfection around 20 % and maximum bending force was impaired by about 15 % compared with native cancellous bone since only the reduction of shear modulus reached significance. The results suggest that thermodisinfection similarly affects different mechanic properties of cancellous bone and the reduction of mechanic properties should not relevantly impair clinical use of thermodisinfected cancellous bone.
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Affiliation(s)
- Christian Fölsch
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Andreas Kellotat
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Paul-Meimberg-Strasse 3, 35392, Giessen, Germany
| | - Markus Rickert
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Bernd Ishaque
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Gafar Ahmed
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Axel Pruss
- University Tissue Bank, Institute of Transfusion Medicine, Charité University Medical School, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexander Jahnke
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Paul-Meimberg-Strasse 3, 35392, Giessen, Germany
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Clinical–radiological evaluation of the impaction allografting and cemented stem technique in revision knee surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Mateo-Negreira J, López-Cuello P, Pipa-Muñiz I, Rodríguez García N, Murcia-Mazón A, Suárez-Suárez MA. [Clinical-radiological evaluation of the impaction allografting and cemented rod technique in revision knee surgery]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 60:141-7. [PMID: 26655209 DOI: 10.1016/j.recot.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 07/01/2013] [Accepted: 09/21/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Long term clinical and radiological evaluation of results, survival, and peri- operative and post-operative complications of the patients who have been operated on for revision total hip arthroplasty using the impaction allografting and cemented rod technique. MATERIAL AND METHODS An observational, analytical, prospective and non-random study was conducted on 26 patients who underwent revision total hip arthroplasty in our Hospital (1997-98). They were clinically and radiologically assessed, and a survival analysis of the implant was performed. RESULTS Statistically significant differences were identified in the pre- and post-operative values, according to Harris and Merle D́Aubigne scores. The femoral components survival was considered as an endpoint of the revision replacement, which was 84% at a mean of 13 years. There were 9 intraoperative complications (6 were fractures) and they significantly affected the length of hospital stay. No post-operative complications were observed in 70% of the patients. None of the analysed variables had any influence on the radiological subsidence of the femoral component. DISCUSSION Several techniques aim to solve the bone stock deficiency in revision total hip arthroplasty, but only impaction grafting attempts to recover it. CONCLUSIONS The Ling's technique shows an improvement over the Merle D́Aubigne and Harris scores, in the medium-long term. The intraoperative complications are mainly an increase in the length of hospital stay and the number of days needed to be able to sit down. Ling's technique is a good option to consider in young patients where it is foreseeable that there is a new revision surgery in the future.
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Affiliation(s)
- J Mateo-Negreira
- Departamento de Cirugía Ortopédica y Traumatología, Hospital de Cabueñes, Gijón, Asturias, España.
| | - P López-Cuello
- Departamento de Cirugía Ortopédica y Traumatología, Hospital de Cabueñes, Gijón, Asturias, España
| | - I Pipa-Muñiz
- Departamento de Cirugía Ortopédica y Traumatología, Hospital de Cabueñes, Gijón, Asturias, España
| | - N Rodríguez García
- Departamento de Cirugía Ortopédica y Traumatología, Hospital de Cabueñes, Gijón, Asturias, España
| | - A Murcia-Mazón
- Departamento de Cirugía Ortopédica y Traumatología, Hospital de Cabueñes, Gijón, Asturias, España; Facultad de Medicina y Ciencia de la Salud, Universidad de Oviedo
| | - M A Suárez-Suárez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital de Cabueñes, Gijón, Asturias, España; Facultad de Medicina y Ciencia de la Salud, Universidad de Oviedo
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Ghoz A, Broadhead ML, Morley J, Tavares S, McDonald D. Outcomes of dual modular cementless femoral stems in revision hip arthroplasty. Orthop Rev (Pavia) 2014; 6:5247. [PMID: 24822088 PMCID: PMC4017333 DOI: 10.4081/or.2014.5247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 02/10/2014] [Indexed: 11/23/2022] Open
Abstract
With an increasing number of primary hip replacements being performed every year, the burden of revision hip arthroplasty, for septic and aseptic loosening, recurrent dislocation or periprosthetic fracture, is also increasing. In recent years, different approaches to revising the femoral prosthesis have emerged; including both cemented and cementless techniques. With a stable cement mantle and good bone quality, or through the use of impaction bone grafting when bone stock is lacking, it is possible to re-cement a femoral prosthesis. Alternatively, a cementless modular femoral prosthesis may be used, providing the surgeon with further options for restoring leg length, hip offset, anteversion and stability. Studies evaluating the use of modular cementless prostheses have so far been limited to midterm studies, with results comparable to primary hip arthroplasty. There are some concerns, however, regarding tribological complications such as stem fracture, corrosion, and failure, and long-term studies are required to further evaluate these concerns. This review outlines the current evidence for the use of both cemented and cementless modular femoral prostheses in the setting of revision hip arthroplasty. Results of prospective and retrospective studies will be outlined, along with results obtained from national joint registries.
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Affiliation(s)
- Ali Ghoz
- Royal Berkshire NHS Trust , Reading, UK
| | - Matthew L Broadhead
- University of New South Wales , Kensington NSW, Australia ; Australian Orthopaedic Research Group , Melbourne, Australia
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Abstract
Femoral revision after cemented total hip replacement (THR) might include technical difficulties, following essential cement removal, which might lead to further loss of bone and consequently inadequate fixation of the subsequent revision stem. Femoral impaction allografting has been widely used in revision surgery for the acetabulum, and subsequently for the femur. In combination with a primary cemented stem, impaction grafting allows for femoral bone restoration through incorporation and remodelling of the impacted morsellized bone graft by the host skeleton. Cavitary bone defects affecting meta-physis and diaphysis leading to a wide femoral shaft, are ideal indications for this technique. Cancellous allograft bone chips of 1 mm to 2 mm size are used, and tapered into the canal with rods of increasing diameters. To impact the bone chips into the femoral canal a prosthesis dummy of the same dimensions of the definitive cemented stem is driven into the femur to ensure that the chips are very firmly impacted. Finally, a standard stem is cemented into the neo-medullary canal using bone cement. To date several studies have shown favourable results with this technique, with some excellent long-term results reported in independent clinical centres worldwide. Cite this article: Bone Joint J 2013;95-B, Supple A:92–4.
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Affiliation(s)
- T. Gehrke
- Helios Endo Klinik Hamburg, Holstenstr.2, 22767
Hamburg, Germany
| | - M. Gebauer
- Helios Endo Klinik Hamburg, Holstenstr.2, 22767
Hamburg, Germany
| | - D. Kendoff
- Helios Endo Klinik Hamburg, Holstenstr.2, 22767
Hamburg, Germany
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31
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Zampelis V, Tägil M, Lidgren L, Isaksson H, Atroshi I, Wang JS. The effect of a biphasic injectable bone substitute on the interface strength in a rabbit knee prosthesis model. J Orthop Surg Res 2013; 8:25. [PMID: 23899023 PMCID: PMC3734137 DOI: 10.1186/1749-799x-8-25] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/25/2013] [Indexed: 12/20/2022] Open
Abstract
Background In joint prosthetic surgery, various methods are used to provide implant stability. We used an injectable bone substitute, composed of calcium sulfate/hydroxyapatite, as bone defect filler to stabilize a tibia prosthesis in an experimental rabbit model. The aim of the study was to investigate and compare the stability of prosthetic fixation with and without the use of an injectable bone substitute. Methods Sixteen rabbits were used and the tibia prostheses were implanted bilaterally, one side with the prosthesis alone and the other side with the prosthesis and calcium sulfate/hydroxyapatite (Cerament™). The rabbits were randomly divided into two groups and euthanized after 6 and 12 weeks, respectively. The prosthesis was extracted measuring the pull-out force in an Instron tester, and the bone surrounding the former prosthesis site was analyzed by histology, histomorphometry, and micro-computed tomography. Results At 6 weeks no difference in maximum pull-out force was found between the prostheses fixed with or without Cerament™. At 12 weeks the maximum pull-out force for the prostheses with Cerament™ was significantly higher than that for the prostheses without Cerament™ (p = 0.04). The maximum pull-out force at 12 weeks was significantly higher than that at 6 weeks for the prostheses fixed with Cerament™ (p = 0.03) but not for the prostheses without. Conclusion We conclude that early prosthesis-bone interface strength is not influenced by a bone substitute. However, during remodeling, the bone substitute might provide improved mechanical support for the prosthesis. The results support further studies of the use of injectable calcium sulfate/hydroxyapatite in fixation of prosthetic joint implants.
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Affiliation(s)
- Vasilis Zampelis
- Department of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
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Franke J, Zheng G, Wendl K, Grützner PA, von Recum J. Clinical experience with computer navigation in revision total hip arthroplasty. Proc Inst Mech Eng H 2013; 226:919-26. [PMID: 23636955 DOI: 10.1177/0954411912456792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The biomechanically and anatomically correct placement of hip prostheses components is the main challenge in revision hip arthroplasty. The orientation of the cup and stem with the restoration of leg length, offset and hip centre is hampered by the defect situations frequently present. In primary hip arthroplasty, it has been demonstrated that the components can be accurately positioned using computer-navigated procedures. However, such procedures could also be of considerable benefit in revision hip arthroplasty. Systems that not only detect anatomical landmarks using pointers but also use image data for referencing may provide a possible solution for the defect situation. Literature about navigation in revision arthroplasty is very rare. This article comprises general considerations on this subject and presents our experience and possible clinical applications.
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Affiliation(s)
- Jochen Franke
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany.
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Gross TP, Liu F. Total knee arthroplasty with fully porous-coated stems for the treatment of large bone defects. J Arthroplasty 2013; 28:598-603. [PMID: 23141862 DOI: 10.1016/j.arth.2012.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/23/2012] [Accepted: 07/16/2012] [Indexed: 02/01/2023] Open
Abstract
Between February1999 and April 2006, 25 patients (28 knees) underwent a TKA by a single surgeon. At an average final follow-up of 7±2years (range, 3-10years), 34 (100%) of 34 fully porous stems had achieved bone ingrowth. However, one case (3%) had a component loosening due to the de-bonding of sheets of beads from the stem. The remaining cases remained well fixed. Three well-fixed stems in 2 patients failed from deep infection. There was one reoperation required for a femoral periprosthetic fracture. Our 10-year experience shows that fully porous-coated stems reliably achieve durable fixation in complex primary and revision TKA allowing the surgeon to bypass large bone defects and gain fixation in diaphyseal bone.
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Yu L, Wang Y, Chen J. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: meta-analysis of randomized trials. Clin Orthop Relat Res 2012; 470:2235-43. [PMID: 22395872 PMCID: PMC3392403 DOI: 10.1007/s11999-012-2293-8] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 02/14/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most patients with displaced femoral neck fractures are treated by THA and hemiarthroplasty, but it remains uncertain which if either is associated with better function and lower risks of complications. QUESTIONS/PURPOSES We performed a meta-analysis of randomized controlled trials (RCTs) to determine whether THA was associated with lower rates of reoperations, mortality, complications, and better function compared with hemiarthroplasty. METHODS We searched the PubMed, Embase, Chinese Biomedicine Literature, and Cochrane Register of Controlled Trials databases and identified 12 RCTs (including a total of 1320 patients) for meta-analysis. Risk ratios (RRs) and weighted mean differences (WMDs) from each trial were pooled using random-effects or fixed-effects models depending on the heterogeneity of the included studies. RESULTS THA was associated with a lower risk of subsequent reoperations compared with hemiarthroplasty (RR = 0.53; 95% CI, 0.34-0.84). There was no difference in mortality between patients undergoing THA and hemiarthroplasty (RR = 0.81; 95% CI, 0.60-1.09). For complications, there was a higher risk of dislocation in patients undergoing THA (RR = 1.99; 95% CI, 1.26-3.15), but there were no differences in local infections (RR = 1.60; 95% CI, 0.74-3.46) and general complications (RR = 1.15; 95% CI, 0.91-1.45). Patients with THA had higher Harris hip scores at 1 year (WMD = 3.81; 95% CI, 0.87-6.74) and at 3 or 4 years (WMD = 10.07; 95% CI, 6.92-13.21). CONCLUSIONS Despite more dislocations, THA can benefit patients with displaced femoral neck fractures with a lower reoperation rate and higher functional scores.
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Affiliation(s)
- Ligang Yu
- Department of Orthopedics, Chinese General Hospital of People’s Liberation Army, 28 Fuxing Road, Bejing, 100853 China
| | - Yan Wang
- Department of Orthopedics, Chinese General Hospital of People’s Liberation Army, 28 Fuxing Road, Bejing, 100853 China
| | - Jiying Chen
- Department of Orthopedics, Chinese General Hospital of People’s Liberation Army, 28 Fuxing Road, Bejing, 100853 China
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Revision total hip arthroplasty using a cementless tapered revision stem in patients with a mean age of 82 years. INTERNATIONAL ORTHOPAEDICS 2011; 36:961-5. [PMID: 22038439 DOI: 10.1007/s00264-011-1379-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 09/26/2011] [Indexed: 10/16/2022]
Abstract
PURPOSE A tapered straight cementless stem was used for revision in a group of old and very old patients. We wanted to know whether the use of this implant could achieve satisfactory results despite age and osteoporosis. METHODS We retrospectively analysed data of 77 elderly patients (77 hips) who underwent revision in cemented and uncemented primary total hip arthroplasties (THA). The patients had a mean age of 82.2 years (range, 75-92 years) at revision surgery. They were monitored for a mean follow up of 7.1 years (range, 5.0-10.2 years). During the minimum follow-up period 11 patients died of unrelated causes, leaving 66 patients (66 hips) for evaluation. RESULTS During the period of study three stems failed due to aseptic loosening, three hips dislocated and were successfully treated by closed reduction and bracing. No infection, osteolysis or significant stress shielding around the stems was observed. The survivorship at an average of 7.1-year follow-up was 95.5%. CONCLUSIONS These results indicate that this stem is an excellent alternative in revision THA in patients of 75 years or older.
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Pattyn C, Mulliez A, Verdonk R, Audenaert E. Revision hip arthroplasty using a cementless modular tapered stem. INTERNATIONAL ORTHOPAEDICS 2011; 36:35-41. [PMID: 21701874 DOI: 10.1007/s00264-011-1299-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 06/03/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Here we report the short-term clinical and radiological results of the Profemur®-R cementless modular revision stem. METHODS Between June 2002 and May 2006, 68 revision hip arthroplasties were consecutively performed using this stem. Survival at a mean follow-up of 5.2 years was 94%. According to the Paprosky classification, the femoral defect was classified as type 1 in 39 hips (57.3%), type 2 in 18 hips (26.5%), type 3A in ten hips (14.7%) and type 3B in one hip (1.5%). RESULTS The Harris Hip Score was 49.57 before surgery and averaged 78.28 at the latest follow-up. The Merle d'Aubigne score improved from 9.15 preoperatively to 14.30 postoperatively. Stem stability rated according to the Agora Roentgenographic Assessment (ARA) scoring system averaged 5.22, suggesting a high likelihood of a durable implant. CONCLUSION The revision prosthesis examined in this study can be considered a viable and useful option in revision hip arthroplasty, even in patients with bony femoral defects.
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Affiliation(s)
- Christophe Pattyn
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
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Courpied JP, Caton JH. Total Hip Arthroplasty, state of the art for the 21st century. INTERNATIONAL ORTHOPAEDICS 2011; 35:149-50. [PMID: 21243356 PMCID: PMC3032113 DOI: 10.1007/s00264-011-1207-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 01/03/2011] [Indexed: 10/18/2022]
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