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Li Y, Cao L. Management of Severe Bone Defects in Femoral Revision following Total Hip Arthroplasty. Hip Pelvis 2024; 36:101-107. [PMID: 38825819 PMCID: PMC11162874 DOI: 10.5371/hp.2024.36.2.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 06/04/2024] Open
Abstract
Treatment of femoral bone defects continues to be a challenge in revision total hip arthroplasty (THA); therefore, meticulous preoperative evaluation of patients and surgical planning are required. This review provides a concise synopsis of the etiology, classification, treatment strategy, and prosthesis selection in relation to femoral bone loss in revision THA. A search of literature was conducted for identification of research articles related to classification of bone loss, management of femoral revision, and comparison of different types of stems. Findings of a thorough review of the included articles were as follows: (1) the Paprosky classification system is used most often when defining femoral bone loss, (2) a primary-length fully coated monoblock femoral component is recommended for treatment of types I or II bone defects, (3) use of an extensively porouscoated stem and a modular fluted tapered stem is recommended for management of types III or IV bone defects, and (4) use of an impaction grafting technique is another option for improvement of bone stock, and allograft prosthesis composite and proximal femoral replacement can be applied by experienced surgeons, in selected cases, as a final salvage solution. Stems with a tapered design are gradually replacing components with a cylindrical design as the first choice for femoral revision; however, further confirmation regarding the advantages and disadvantages of modular and nonmodular stems will be required through conduct of higher-level comparative studies.
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Affiliation(s)
- Yicheng Li
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Li Cao
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Innocenti M, Smulders K, Andreotti M, Willems JH, Van Hellemondt G, Nijhof MW. The use of a standard-length conical tapered stem in hip revision arthroplasty to address Paprosky type I-II femoral defects: a prospective study of 87 patients. Arch Orthop Trauma Surg 2023; 143:5945-5955. [PMID: 36806987 PMCID: PMC10449674 DOI: 10.1007/s00402-023-04797-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/22/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Low-grade femoral defects in revision total hip arthroplasty (rTHA) might be preferably treated with a primary implant. Almost no previous study reported the use of standard-length conical tapered (SLCT) stems in these cases. We analyzed a series of cases using a SLCT stem in rTHA with Paprosky type I-II femoral defects. The purpose of the study was to determine clinical and radiographic outcomes in this series of rTHA. MATERIALS AND METHODS We prospectively followed 87 patients undergoing a femoral component rTHA: 53 Paprosky type I and 34 type II femoral defects. Patient-reported measures (Oxford Hip Score, EQ-5D, VAS pain during rest and activity) were administered at baseline, 1 and 2 years post-operatively. Radiographic subsidence overtime was scored. Kaplan-Meier curves were used to evaluate the subsidence over time, the complication-free survival, and the implant survivorship with reoperation and stem revision as endpoints. RESULTS The mean follow-up was 72.5 (SD ± 23.9) months. All PROMs significatively improved over time. The average subsidence was 2.8 (SD ± 3.2), 3.6 (SD ± 4.4), and 4.0 (SD ± 4.9) mm at 4, 12, and 24 months respectively. 6 stems had subsidence > 10 mm. The survival without complication was 0.85 (95% CI 0.94-0.77), while the implant survival without reoperation was 0.83 (95% CI 0.95-0.72). The overall stem survival rate was 93.7% (95% CI 0.91-0.97) at 2 years. CONCLUSION The use of a SLCT stem in rTHA with Paprosky type I-II femoral defects demonstrated good survival with low subsidence rates during the first 2 years after surgery. Surgeons should consider the use of this primary prosthesis as a potential treatment during stem revision in cases with limited femoral bone loss.
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Affiliation(s)
- Matteo Innocenti
- Department of Orthopaedic Surgery, University of Florence, Florence, Italy
| | - Katrijn Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Mattia Andreotti
- Department of Orthopaedic, Ospedale Riuniti Padova, Padua, Italy
| | - Jore H. Willems
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Gijs Van Hellemondt
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Marc W. Nijhof
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
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Xing SX, Huang Q, Li ZJ, Li YK, Ban ZN. Revision total hip arthroplasty using a fluted, tapered, modular stem follow-up method for a mean of three years: A preliminary study. Front Physiol 2023; 14:873584. [PMID: 37288436 PMCID: PMC10242095 DOI: 10.3389/fphys.2023.873584] [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: 02/11/2022] [Accepted: 04/14/2023] [Indexed: 06/09/2023] Open
Abstract
Objective: This study aimed to evaluate the results and complications related to revision total hip arthroplasty within a short-to-medium follow up period. Methods: From January 2016 to January 2020, we reviewed 31 prosthetic hip arthroplasty stem revisions using a fluted, tapered modular stem with distal fixation. The median age of the patients was 74.55-79 years. The survival rate was 100%, and there were no re-revisions. The Harris hip score improved from an average of 36.5 ± 7.8 before surgery to 81.8 ± 6.2 at the final follow-up. Results: The average final follow-up was 36 (24-60) months. During this time, there was no periprosthetic infection, no prosthesis loosening or breakage, and no sciatic nerve injury. Complications included four (12.9%) intraoperative fractures and eight (25.8%) dislocations that had no stem fractures. The postoperative limb was lengthened by 17.8 ± 9.8 mm. In most cases, bone regeneration was an early and important finding. Three cases underwent extended trochanteric osteotomy, and bone healing was achieved by the final follow-up. Conclusion: The modular tapered stem reviewed in this study was very versatile, could be used in most femoral revision cases, and allowed for rapid bone reconstruction. However, a long-term follow-up study is needed to confirm these results.
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Can machine learning models predict failure of revision total hip arthroplasty? Arch Orthop Trauma Surg 2022; 143:2805-2812. [PMID: 35507088 DOI: 10.1007/s00402-022-04453-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/15/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Revision total hip arthroplasty (THA) represents a technically demanding surgical procedure which is associated with significant morbidity and mortality. Understanding risk factors for failure of revision THA is of clinical importance to identify at-risk patients. This study aimed to develop and validate novel machine learning algorithms for the prediction of re-revision surgery for patients following revision total hip arthroplasty. METHODS A total of 2588 consecutive patients that underwent revision THA was evaluated, including 408 patients (15.7%) with confirmed re-revision THA. Electronic patient records were manually reviewed to identify patient demographics, implant characteristics and surgical variables that may be associated with re-revision THA. Machine learning algorithms were developed to predict re-revision THA and these models were assessed by discrimination, calibration and decision curve analysis. RESULTS The strongest predictors for re-revision THA as predicted by the four validated machine learning models were the American Society of Anaesthesiology score, obesity (> 35 kg/m2) and indication for revision THA. The four machine learning models all achieved excellent performance across discrimination (AUC > 0.80), calibration and decision curve analysis. Higher net benefits for all machine learning models were demonstrated, when compared to the default strategies of changing management for all patients or no patients. CONCLUSION This study developed four machine learning models for the prediction of re-revision surgery for patients following revision total hip arthroplasty. The study findings show excellent model performance, highlighting the potential of these computational models to assist in preoperative patient optimization and counselling to improve revision THA patient outcomes. LEVEL OF EVIDENCE Level III, case-control retrospective analysis.
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El Ashmawy AA, Hosny HAH, El-Bakoury A, Yarlagadda R, Keenan J. Mid- to long-term results of the Cone-Conical modular system in revision hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 46:531-539. [PMID: 34635943 DOI: 10.1007/s00264-021-05237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Modular design in revision hip surgery allows some flexibility intra-operatively to address leg length discrepancy, version, and offset while allowing the surgeon to bypass a deficient proximal femur and achieve axial and rotational stability distally. The purpose of this study was to analyze the mid-term to long-term survival and clinical and radiological outcomes using a conical fluted stem and a cone-shaped hydroxyapatite-coated proximal body "The Cone-Conical modular system (Stryker)" in revision hip surgery. METHODS We retrospectively reviewed all the patients who underwent hip revision surgery using Cone-Conical modular system between January 2006 and January 2015 at our institution. Seventy patients (72 hips) were included with a mean age of 71.3 years. We had a mean follow-up period of 8.6 years (range 5-15). All patients had a minimum follow-up of five years. A Kaplan-Meier analysis was used to determine the survival of the implant. Functional outcomes were assessed using Oxford Hip Score. Plain radiographs were performed to assess implant fixation and osseointegration. RESULTS The mean OHS improved significantly from 12 pre-operatively to 34 at the final follow-up (P < .001). The Cone-Conical system survivorship for aseptic loosening as an end point was 100%. The all-cause survivorship was 97.2%. Two hips had revisions for recurrence of infection. CONCLUSIONS The Cone-Conical femoral modular revision system has demonstrated excellent mid-term to long-term clinical and radiographic results with low failure rate and minimal complications. Longer-term follow-up would be of value to assess the ongoing survival of this implant.
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Affiliation(s)
- Abd-Allah El Ashmawy
- Department of Trauma and Orthopaedic Surgery, University of Alexandria, Alexandria, Egypt.
| | - Hazem A H Hosny
- Department of Trauma and Orthopaedic Surgery, University of Alexandria, Alexandria, Egypt.,Department of Orthopaedic Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Ahmed El-Bakoury
- Department of Trauma and Orthopaedic Surgery, University of Alexandria, Alexandria, Egypt.,Department of Orthopaedic Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Rathan Yarlagadda
- Department of Orthopaedic Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jonathan Keenan
- Department of Orthopaedic Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
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Park KS, Jin SY, Lim JH, Yoon TR. Long-term outcomes of cementless femoral stem revision with the Wagner cone prosthesis. J Orthop Surg Res 2021; 16:375. [PMID: 34116695 PMCID: PMC8194185 DOI: 10.1186/s13018-021-02457-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/04/2021] [Indexed: 01/15/2023] Open
Abstract
Background The procedure of femoral stem revision is challenging, and bone conservation with less stress shielding is a mandatory effort in these cases. Although there are several reports of stem revision with stems designed for primary total hip arthroplasty (THA), there is no report on stem revision with the Wagner cone prosthesis. Methods Between 1996 and 2008, 41 hips of 41 consecutive patients were subjected to femoral revision THA using the Wagner cone prosthesis. The mean age during revision surgery was 56.1 years, and the mean follow-up period was 14.8 years. The clinical results were evaluated, and the femoral component was assessed radiologically. Results The results showed that the average period from the first operation to revision THA was 8.0 years. Additionally, the mean Harris hip score improved from 52 points preoperatively to 83 points at the final follow-up. All stems showed bone integration in the radiological evaluation. A subsidence of more than 5 mm was observed in 3 out of 28 (10.7%) femoral stems. Two patients needed an acetabular revision for acetabular cup loosening during the follow-up period. Furthermore, one patient had recurrent dislocation and had to undergo revision surgery for soft tissue augmentation. Conclusions We achieved favorable clinical and radiological long-term outcomes in femoral stem revision using the Wagner cone prosthesis. This cementless femoral stem could be an option for femoral stem revision in cases with relatively good bone stock.
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Affiliation(s)
- Kyung-Soon Park
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322 Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Gwangju, Jeonnam, 519-809, Republic of Korea
| | - Sheng-Yu Jin
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322 Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Gwangju, Jeonnam, 519-809, Republic of Korea
| | - Jun-Hyuk Lim
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322 Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Gwangju, Jeonnam, 519-809, Republic of Korea
| | - Taek-Rim Yoon
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322 Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Gwangju, Jeonnam, 519-809, Republic of Korea.
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Fink B. Technical Note for Transfemoral Implantation of Tapered Revision Stems. The Advantage to Stay Short. Arthroplast Today 2021; 9:16-20. [PMID: 33997203 PMCID: PMC8099717 DOI: 10.1016/j.artd.2021.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 11/29/2022] Open
Abstract
Background The aim was to test the hypothesis that during transfemoral implantation of a conical revision stem, the fixation of the stem at the distal tip leads to a low rate of periprosthetic fractures. Material and Methods Two hundred eighty-two stem revisions by a transfemoral approach in cases of Paprosky Type II and IIIA-defects (with a sufficient isthmus) were carried out and analyzed during and radiographically after the surgery for unintentional periprosthetic fractures below the osteotomy. Results In all cases, fixation was always achieved at the tip of the distal component in the isthmus of the femur. No periprosthetic fractures were observed. Conclusions When the isthmus of the femur is intact, a transfemoral implantation of a tapered revision stem at the distal end reduces the risk of periprosthetic fractures by preventing bypassing the isthmus with the stem. Knowing the difference between the nominal diameter and the diameter at the distal start of the conical zone can help to create this fixation technique resulting in short revision stems.
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Affiliation(s)
- Bernd Fink
- Orthopaedic Clinic Markgröningen, Joint Replacement, General and Rheumatic Orthopaedic, Markgröningen, Baden-Württemberg, Germany.,University-Hospital, Hamburg-Eppendorf, Orthopaedic Department, Hamburg, Germany
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8
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Abstract
Femoral bone loss is frequently encountered during revision total hip arthroplasty. The quality and quantity of remaining bone helps determine the best method for reconstruction. Extensively porous-coated cylindrical stems or titanium fluted tapered devices that achieve fixation in the diaphysis have both demonstrated excellent long-term survivorship. Titanium fluted tapered stems with a modular proximal body allow for more accurate leg length, offset, and version adjustments independent of the distal stem which may optimise hip biomechanics. Intraoperative fractures are more common with cylindrical stems and subsidence with tapered stems, particularly monoblock designs and in both dislocation continues to be one of the most common postoperative complications. In salvage situations in which an ectatic femoral canal is unable to support an uncemented device, impaction bone grafting, allograft-prosthetic composite, or a segmental proximal femoral replacement may be required.
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Midterm Outcomes of Revision Total Hip Arthroplasty Using a Modular Revision Hip System. J Arthroplasty 2016; 31:446-50. [PMID: 26432674 DOI: 10.1016/j.arth.2015.08.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/17/2015] [Accepted: 08/24/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The growth in hip arthroplasty surgery has meant a corresponding escalating revision burden with increasing challenges for the orthopaedic surgeon. The purpose of this study was to review clinical outcomes of a modular revision hip system within a single institution. METHODS We retrospectively reviewed a cohort of modular revision hip system stems performed in our institution between January 2005 and October 2012 giving a potential minimum follow-up of 2 years. Clinical outcomes data on complications, Oxford Hip Score (OHS, 0-48) and patient satisfaction were collected. Radiographic outcomes including subsidence were assessed. Implant survival was estimated using Kaplan Meier analysis. RESULTS 115 stems in 106 patients were identified. All cause survival was 82% (95%CIs: 73%-89%) at 6.1 years; survival excluding infection being 99% (95%CIs: 93%-100%). There was a low incidence of subsidence (seven stems) and no peri-prosthetic fractures. Primary cause of re-revision in this series was re-infection with only one re-revision for mechanical failure. Median Oxford Hip Score at mean follow up 4.1 years (2-9) was 40 (14-48) and 93% of patients reported being satisfied with their revision surgery. CONCLUSION This study showed good clinical outcomes and survival using a modular revision stem with low mechanical failure and subsidence. Recurrence of infection remains a challenge in revision surgery.
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Khatod M, Cafri G, Inacio MCS, Schepps AL, Paxton EW, Bini SA. Revision total hip arthoplasty: factors associated with re-revision surgery. J Bone Joint Surg Am 2015; 97:359-66. [PMID: 25740025 DOI: 10.2106/jbjs.n.00073] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The survivorship of implants after revision total hip arthroplasty and risk factors associated with re-revision are not well defined. We evaluated the re-revision rate with use of the institutional total joint replacement registry. The purpose of this study was to determine patient, implant, and surgeon factors associated with re-revision total hip arthroplasty. METHODS A retrospective cohort study was conducted. The total joint replacement registry was used to identify patients who had undergone revision total hip arthroplasty for aseptic reasons from April 1, 2001, to December 31, 2010. The end point of interest was re-revision total hip arthroplasty. Risk factors evaluated for re-revision total hip arthroplasty included: patient risk factors (age, sex, body mass index, race, and general health status), implant risk factors (fixation type, bearing surface, femoral head size, and component replacement), and surgeon risk factors (volume and experience). A multivariable Cox proportional hazards model was used. RESULTS Six hundred and twenty-nine revision total hip arthroplasties with sixty-three (10%) re-revisions were evaluated. The mean cohort age (and standard deviation) was 57.0 ± 12.4 years, the mean body mass index (and standard deviation) was 29.5 ± 6.1 kg/m(2), and most of the patients were women (64.5%) and white (81.9%) and had an American Society of Anesthesiologists score of <3 (52.9%). The five-year implant survival after revision total hip arthroplasty was 86.8% (95% confidence interval, 83.57% to 90.25%). In adjusted models, age, total number of revision surgical procedures performed by the surgeon, fixation, and bearing surface were associated with the risk of re-revision. For every ten-year increase in patient age, the hazard ratio for re-revision decreases by a factor of 0.72 (95% confidence interval, 0.58 to 0.90). For every five revision surgical procedures performed by a surgeon, the risk of revision decreases by a factor of 0.93 (95% confidence interval, 0.86 to 0.99). At the time of revision, a new or retained cemented femoral implant or all-cemented hip implant increases the risk of revision by a factor of 3.19 (95% confidence interval, 1.22 to 8.38) relative to a retained or new uncemented hip implant. A ceramic on a highly cross-linked polyethylene bearing articulation decreases the hazard relative to metal on highly cross-linked polyethylene by a factor of 0.32 (95% confidence interval, 0.11 to 0.95). Metal on constrained bearing increases the hazard relative to metal on highly cross-linked polyethylene by a factor of 3.32 (95% confidence interval, 1.16 to 9.48). CONCLUSIONS When evaluating patient, implant, and surgical factors at the time of revision total hip arthroplasty, age, surgeon experience, implant fixation, and bearing surfaces had significant impacts on the risk of re-revision.
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Affiliation(s)
- Monti Khatod
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, 6041 Cadillac Avenue, Los Angeles, CA 90034. E-mail address for M. Khatod:
| | - Guy Cafri
- Surgical Outcomes and Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA 92108
| | - Maria C S Inacio
- Surgical Outcomes and Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA 92108
| | - Alan L Schepps
- Surgical Outcomes and Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA 92108
| | - Elizabeth W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA 92108
| | - Stefano A Bini
- Department of Orthopaedic Surgery, The Permanente Medical Group, 280 MacArthur Boulevard, Oakland, CA 94611
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Houdek MT, Perry KI, Wyles CC, Berry DJ, Sierra RJ, Trousdale RT. Use of a modular tapered fluted femoral component in revision total hip arthroplasty following resection of a previously infected total hip: minimum 5-year follow-up. J Arthroplasty 2015; 30:435-8. [PMID: 25534955 DOI: 10.1016/j.arth.2014.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/14/2014] [Accepted: 08/26/2014] [Indexed: 02/01/2023] Open
Abstract
Femoral reconstruction in the setting of two stage reimplantation can be difficult and substantial reoperation rates due to implant loosening have been reported. We retrospectively reviewed 28 male and 29 female patients who underwent a two-stage reimplantation using a modular, tapered femoral stem. The mean clinical follow-up was 62 months. The mean Harris Hip score at 5-year follow-up was 76. Two stems were revised for aseptic loosening. Reinfection occurred in 16% of patients. Stem survivorship was 87% at 5-years. Use of a modular tapered stem provided a high rate of stable femoral fixation and acceptable rate of reinfection in two stage treatment of infected THA.
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Affiliation(s)
- Matthew T Houdek
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota
| | - Kevin I Perry
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota
| | - Cody C Wyles
- Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Daniel J Berry
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota
| | - Rafael J Sierra
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota
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Wieding J, Wolf A, Bader R. Numerical optimization of open-porous bone scaffold structures to match the elastic properties of human cortical bone. J Mech Behav Biomed Mater 2014; 37:56-68. [DOI: 10.1016/j.jmbbm.2014.05.002] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 04/29/2014] [Accepted: 05/03/2014] [Indexed: 10/25/2022]
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Dzaja I, Lyons MC, McCalden RW, Naudie DDD, Howard JL. Revision hip arthroplasty using a modular revision hip system in cases of severe bone loss. J Arthroplasty 2014; 29:1594-7. [PMID: 24768500 DOI: 10.1016/j.arth.2014.02.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/15/2014] [Accepted: 02/28/2014] [Indexed: 02/01/2023] Open
Abstract
We sought to identify outcomes of the Restoration Modular Hip System in cases of severe femoral bone stock deficiency. We performed a retrospective review of 55 revTHAs with a mean follow-up of 32 months (24-60 months). Outcomes included the WOMAC and HHS. Preoperative bone loss was categorized as Paprosky 3A (n = 13), 3B (n = 14), and 4 (n = 17). Periprosthetic fractures were classified as Vancouver B2 (n = 6) and B3 (n = 5). 53 of 55 stems were in situ at time of final review. WOMAC improved from 46 ± 18 to 70 ± 22 and HHS improved from 47 ± 15 to 78 ± 15. Complications were identified in 9 patients, which included dislocation (3), subsidence (2), infection (2), and periprosthetic fracture (2). In cases of significant proximal femoral bone deficiency, this stem demonstrated improvement in clinical outcomes with good results at short-term follow up.
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Affiliation(s)
- Ivan Dzaja
- Division of Orthopaedic Surgery, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Matt C Lyons
- North Sydney Orthopaedics and Sport Medicine Centre, Wollstonecraft, Australia
| | - Richard W McCalden
- Division of Orthopaedic Surgery, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Douglas D D Naudie
- Division of Orthopaedic Surgery, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, University Hospital, London Health Sciences Centre, London, Ontario, Canada
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