1
|
Carender CN, Larson DR, Trousdale RT, Lewallen DG, Berry DJ, Abdel MP. Aseptic Revision Total Hip Arthroplasty Using Modular Fluted Tapered Stems. J Bone Joint Surg Am 2024:00004623-990000000-01144. [PMID: 38935701 DOI: 10.2106/jbjs.23.00921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND Modular fluted tapered (MFT) femoral components are frequently utilized in aseptic revision total hip arthroplasties (THAs). However, long-term follow-up has been limited. The purpose of this study was to update our prior series at long-term follow-up, with specific emphasis on implant survivorship, radiographic results, and complications in a large cohort of aseptic revision THAs using MFT stems. METHODS We retrospectively identified 515 aseptic femoral revisions performed with 2 MFT stem designs in the total joint registry of a single tertiary care academic institution from 1999 to 2013. Serial radiographs were reviewed for subsidence of >5 mm. The mean follow-up (and standard deviation) was 10 ± 5 years (range, 2 to 21 years). A competing risk model accounting for death was utilized. RESULTS The 15-year cumulative incidence of any revision was 12%. There were 57 revisions, 27 of which involved revision of the fluted tapered component (FTC). Dislocation (n = 19), periprosthetic joint infection (n = 15), and aseptic loosening of the FTC (n = 11) were the most common reasons for revision. The 15-year cumulative incidence of any reoperation was 16%. The 15-year cumulative incidences were 6% for any FTC revision and 2% for FTC revision for aseptic loosening. Stem subsidence of >5 mm occurred in 2% of unrevised cases, and all but 1 stem was stable at the most recent follow-up. CONCLUSIONS This large series of MFT stems used in aseptic revision THAs had a 2% incidence of subsequent revision of the FTC for aseptic loosening at 15 years. Dislocation and infection were the most common reasons for any revision. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
2
|
Shaarani SR, Jaibaji M, Yaghmour KM, Vles G, Haddad FS, Konan S. Early clinical and radiological outcomes of the new porous titanium shell in combination with locking screw in revision total hip arthroplasty. ARTHROPLASTY 2023; 5:24. [PMID: 37158971 PMCID: PMC10169346 DOI: 10.1186/s42836-023-00177-4] [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: 10/03/2022] [Accepted: 02/28/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Extensive acetabular bone loss and poor bone quality are two key challenges often encountered in revision total hip arthroplasty. A new 3D-printed porous acetabular shell has been made available with the option to insert multiple variable-angle locking screws. We sought to evaluate the early clinical and radiological outcomes of this construct. METHODS A retrospective review of patients operated by two surgeons was performed in a single institution. Fifty-nine revision hip arthroplasties were performed in 55 patients (34 female; mean age 68.8 ± 12.3 years) for Paprosky defects I (n = 21), IIA/B (n = 22), IIC (n = 9), III (n = 7) between February 2018 and January 2022 using the novel porous titanium acetabular shell and multiple variable angle locking screws. Postoperative clinical and radiographic outcomes were locally maintained. Patient-reported outcome measures collected included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Hip Score, and the 12-item Short Form Survey. RESULTS After a mean follow-up of 25.7 ± 13.9 months, two cases of shell migration were noted. One patient had a failed constrained mechanism and received revision to a cemented dual mobility liner. No other acetabular shells showed any evidence of radiographic loosening at the final follow-up. Preoperatively, 21 defects were classified as Paprosky grade I, 19 grade IIA, 3 grade IIB, 9 IIC, 4 grade IIIA, and 3 IIIB. The mean postoperative WOMAC function score was 84 (SD 17), WOMAC (stiffness) 83 (SD 15), WOMAC (pain) 85 (SD 15), and WOMAC (global) 85 (SD 17). The mean postoperative OHS was 83 (SD 15), and mean SF-12 physical score was 44 (SD 11). CONCLUSION The additional augmentation of porous metal acetabular shells with multiple variable-angle locking screws provides reliable initial fixation with good clinical and radiological outcomes in the short term. Further studies are needed to establish the medium- and long-term outcomes. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Shahril R Shaarani
- Department of Trauma & Orthopaedics, University College London Hospital, London, NW1 2BU, UK.
| | | | | | - Georges Vles
- Department of Trauma & Orthopaedics, University College London Hospital, London, NW1 2BU, UK
| | - Fares S Haddad
- Department of Trauma & Orthopaedics, University College London Hospital, London, NW1 2BU, UK
| | - Sujith Konan
- Department of Trauma & Orthopaedics, University College London Hospital, London, NW1 2BU, UK
| |
Collapse
|
3
|
Baryeh K, Sochart DH. Post-operative peri-prosthetic fracture rates following the use of cemented polished taper-slip stems for primary total hip arthroplasty: a systematic review. Arch Orthop Trauma Surg 2022; 142:4075-4085. [PMID: 35048171 DOI: 10.1007/s00402-021-04302-3] [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: 09/03/2021] [Accepted: 12/04/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Peri-prosthetic fractures (PPFs) are a serious complication of total hip arthroplasty (THA) associated with significant morbidity, mortality and re-operation similar to the rates seen following femoral neck fractures. When exploring the PPF rates around cemented stems, many studies combine the results of composite beam and taper-slip stems despite their different philosophies. This review looks specifically at PPFs with the use of cemented stems of the taper-slip philosophy to evaluate the demographics, PPF rate and fracture patterns in this patient cohort. MATERIALS AND METHODS A systematic search of Embase, Medline and CINAHL databases was performed to seek studies involving the use of cemented, polished, taper-slip stems, reporting on a rate of post-operative PPF and not involving patient cohorts that were exclusively hip fracture or revision arthroplasty. RESULTS 27 studies reported on 505 PPFs with an average time from primary operation to PPF of 71.2 months (2-301 months). The average age of patients who sustained PPFs was 70.6 years (53.5-82 years) and the majority were female (64.2%). The Vancouver B2 fracture type was most common (39.5%). Open reduction and internal fixation represented the management of choice in 61.2% of PPFs. There was a re-operation rate of 11.4%. CONCLUSION This review suggests an association with being older and female, and a greater risk of PPFs secondary to low energy falls in cemented polished taper-slip stems.
Collapse
Affiliation(s)
- Kwaku Baryeh
- Education Centre, West Middlesex University Hospital, Twickenham Road, Middlesex, TW7 6AF, UK.
| | - David H Sochart
- The Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK
| |
Collapse
|
4
|
Schopper C, Luger M, Hipmair G, Schauer B, Gotterbarm T, Klasan A. The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) - a systematic review. BMC Musculoskelet Disord 2022; 23:280. [PMID: 35321671 PMCID: PMC8944079 DOI: 10.1186/s12891-022-05240-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Periprosthetic femoral fractures (PFFs) represent a major cause for surgical revision after hip arthroplasty with detrimental consequences for patients. The Vancouver classification has been traditionally used since its introduction in 1995. The Unified Classification System (UCS) was described in 2014, to widen the spectrum by aiming for a more comprehensive approach. The UCS also aimed to replace the Vancouver classification by expanding the idea of the Vancouver classification to the whole musculoskeletal apparatus. After introduction of the UCS, the question was raised, whether the UCS found its place in the field of analysing PFFs. Therefore, this systematic review was performed to investigate, the use of the UCS compared to the established Vancouver classification. Methods Medline was searched for reports published between 1 January 2016 and 31 November 2020, without language restriction. Included were original articles, irrespective of the level of evidence and case reports reporting on a PFF and using either the Vancouver or the UCS to classify the fractures. Excluded were reviews and systematic reviews. Results One hundred forty-six studies were included in the analysis. UCS has not been used in a single registry study, giving a pooled cohort size of 3299 patients, compared to 59,178 patients in studies using the Vancouver classification. Since 2016, one study using UCS was published in a top journal, compared to 37 studies using the Vancouver classification (p=0.29). During the study period, the number of yearly publications remained stagnant (p=0.899). Conclusions Despite valuable improvement and expansion of the latter UCS, to date, the Vancouver system clearly leads the field of classifying PFFs in the sense of the common use. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05240-w.
Collapse
Affiliation(s)
- Clemens Schopper
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria.
| | - Günter Hipmair
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Bernhard Schauer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Antonio Klasan
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| |
Collapse
|
5
|
Astore F, Molho NM, Piccaluga F, Comba F, Slullitel PA, Buttaro MA. Impaction Bone Grafting for Severe Femoral Bone Loss. JBJS Essent Surg Tech 2022; 12:ST-D-20-00043. [DOI: 10.2106/jbjs.st.20.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
6
|
Liu YB, Pan H, Chen L, Ye HN, Wu CC, Wu P, Chen L. Total hip revision with custom-made spacer and prosthesis: A case report. World J Clin Cases 2021; 9:7605-7613. [PMID: 34616833 PMCID: PMC8464474 DOI: 10.12998/wjcc.v9.i25.7605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Both periprosthetic joint infections (PJIs) and severe femoral segmental defects are catastrophic complications of total hip arthroplasty (THA), and both present a significant challenge in revisional surgery. There are limited data available to guide clinical decision making when both occur concurrently.
CASE SUMMARY A 61-year-old woman presented with a 6-mo history of a sinus tract at the site of her original THA incision. Radiological imaging revealed a total hip joint implant with an ipsilateral segmental femoral defect. Based on histological, radiological, laboratory, and clinical features, a diagnosis of concurrent chronic PJI and segmental femoral defect (Type IIIB, Paprosky classification) was made. After multidisciplinary team discussion, three-dimensional (3D)-printed, custom-made antibiotic spacers were created that could be used to mold antibiotic-loaded cement spacer. These were placed following PJI debridement in the first stage of revision surgery. After the PJI was eliminated, a 3D-printed, custom-made, femoral prosthesis was created to repair the considerable femoral defect. After 20-mo follow-up, the patient had excellent functional outcomes with a near-normal range of hip movement. So far, neither evidence of recurrent infection nor loosening of the prosthesis has been observed.
CONCLUSION We describe a case of “two-stage, custom-made” total hip revision to treat PJI with a concurrent segmental femoral defect. Use of a personalized, 3D-printed spacer and proximal femoral prosthesis led to satisfactory hip function and no early postoperative complications. Use of a customized implant provides surgeons with an alternative option for patients where no suitable spacer or implant is available. However, the long-term function, longevity, and cost-effectiveness of the use of custom-made prostheses have yet to be fully explored.
Collapse
Affiliation(s)
- Yang-Bo Liu
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Hao Pan
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Li Chen
- Orthopaedics Unit, St. Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Hao-Nan Ye
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Cong-Cong Wu
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Peng Wu
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Lei Chen
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| |
Collapse
|
7
|
Slullitel PA, Garcia-Barreiro GG, Oñativia JI, Zanotti G, Comba F, Piccaluga F, Buttaro MA. Selected Vancouver B2 periprosthetic femoral fractures around cemented polished femoral components can be safely treated with osteosynthesis. Bone Joint J 2021; 103-B:1222-1230. [PMID: 34192924 DOI: 10.1302/0301-620x.103b7.bjj-2020-1809.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty. METHODS We retrospectively reviewed the data of 112 PFFs, of which 47 (42%) B1 and 27 (24%) B2 PFFs were treated with internal fixation, whereas 38 (34%) B2 fractures underwent revision arthroplasty. Decision to perform internal fixation for B2 PFFs was based on specific radiological (polished femoral components, intact bone-cement interface) and clinical criteria (low-demand patient). Median follow-up was 36.4 months (24 to 60). Implant survival and mortality over time were estimated with the Kaplan-Meier method. Adverse events (measured with a modified Dindo-Clavien classification) and 90-day readmissions were additionally compared between groups. RESULTS In all, nine (8.01%) surgical failures were detected. All failures occurred within the first 24 months following surgery. The 24-month implant survival was 95.4% (95% confidence interval (CI) 89.13 to 100) for B1 fractures treated with internal fixation, 90% (95% CI 76.86 to 100) for B2 PFFs treated with osteosynthesis-only, and 85.8% (95% CI 74.24 to 97.36) for B2 fractures treated with revision THA, without significant differences between groups (p = 0.296). Readmissions and major adverse events including mortality were overall high, but similar between groups (p > 0.05). The two-year patient survival rate was 87.1% (95% CI 77.49 to 95.76), 66.7% (95% CI 48.86 to 84.53), and 84.2% (95% CI 72.63 to 95.76), for the B1 group, B2 osteosynthesis group, and B2 revision group, respectively (p = 0.102). CONCLUSION Implant survival in Vancouver B2 PFFs treated with internal fixation was similar to that of B1 fractures treated with the same method and to B2 PFFs treated with revision arthroplasty. Low-demand, elderly patients with B2 fractures around well-cemented polished femoral components with an intact bone-cement interface can be safely treated with internal fixation. Cite this article: Bone Joint J 2021;103-B(7):1222-1230.
Collapse
Affiliation(s)
- Pablo A Slullitel
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gonzalo G Garcia-Barreiro
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - José I Oñativia
- Adult Reconstructive Surgery Unit, Department of Orthopaedic Surgery, Sanatorio del Norte, Tucumán, Buenos Aires, Argentina
| | - Gerardo Zanotti
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Fernando Comba
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Piccaluga
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Martin A Buttaro
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
8
|
Otero JE, Martin JR, Rowe TM, Odum SM, Mason JB. Radiographic and Clinical Outcomes of Modular Tapered Fluted Stems for Femoral Revision for Paprosky III and IV Femoral Defects or Vancouver B2 and B3 Femoral Fractures. J Arthroplasty 2020; 35:1069-1073. [PMID: 31870582 DOI: 10.1016/j.arth.2019.11.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/14/2019] [Accepted: 11/16/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Extensive femoral bone loss poses a challenge in revision total hip arthroplasty (rTHA). Many techniques have been developed to address this problem including fully porous cylindrical stems, impaction bone grafting, and cementation of long stems, which have had varied success. Modular tapered fluted femoral stems (MTFS) show favorable results. We sought to determine the minimum 2-year radiographic and clinical performance of MTFS in rTHA in a population with extensive proximal femoral bone loss. METHODS Our clinical database was queried retrospectively for all patients who underwent rTHA with an MTFS. We included patients with Paprosky 3 and 4 femoral bone loss and patients with Vancouver B2 and B3 periprosthetic femur fractures. Patients without 2-year follow-up were invited to return to clinic for X-ray evaluation and to complete clinical questionnaires. We assessed distance of stem subsidence and presence of stem fixation on final X-ray. We recorded all-cause revision and survival of the stem at final follow-up. RESULTS One hundred twenty-nine patients were available for follow-up. Average follow-up time was 3.75 years. One hundred twenty-two stems (95%) remained in place at final follow-up. Median subsidence was 1.4 mm (range 0-21). All-cause revision rate was 16.3% (21 patients). Of the hips revised, 10 were for instability, 6 for infection, 1 for aseptic loosening, and 1 for periprosthetic femur fracture. Three were revised for other reasons. The stem was revised in 7 patients (5.4%), and the most common reason for stem revision was infection (5 patients). The other 2 stems were revised for aseptic loosening in a Paprosky 4 femur and periprosthetic femur fracture. Survival of tapered modular fluted stems with aseptic failure as an endpoint was 98.4%. The mean Hip disability and Osteoarthritis Outcome Score, Joint Replacement score at final follow-up was 73, and mean Veterans Rand 12 item health survey physical and mental scores were 32.8 and 52.2, respectively. CONCLUSION In patients with Paprosky 3, 4 femoral defects or Vancouver type B2, B3 fractures, modular tapered fluted stems for femoral revision show excellent outcomes at minimum 2-year follow-up.
Collapse
Affiliation(s)
- Jesse E Otero
- OrthoCarolina Hip and Knee Center, OrthoCarolina Research Institute, Charlotte, NC
| | - John R Martin
- OrthoCarolina Hip and Knee Center, OrthoCarolina Research Institute, Charlotte, NC
| | - Taylor M Rowe
- OrthoCarolina Hip and Knee Center, OrthoCarolina Research Institute, Charlotte, NC
| | - Susan M Odum
- OrthoCarolina Hip and Knee Center, OrthoCarolina Research Institute, Charlotte, NC
| | - John B Mason
- OrthoCarolina Hip and Knee Center, OrthoCarolina Research Institute, Charlotte, NC
| |
Collapse
|
9
|
Menken LG, Rodriguez JA. Femoral revision for periprosthetic fracture in total hip arthroplasty. J Clin Orthop Trauma 2020; 11:16-21. [PMID: 32001978 PMCID: PMC6985170 DOI: 10.1016/j.jcot.2019.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/11/2019] [Indexed: 12/16/2022] Open
Abstract
Periprosthetic fracture can create significant morbidity in the arthroplasty population. Patients with periprosthetic fracture have been shown to have worse outcomes and higher mortality than patients undergoing elective revision THA. In this review, we will focus on Vancouver B2 and B3 fractures. Both of these fracture types are associated with a loose primary prosthesis and warrant revision surgery. There are many different options for fixation choice of the femoral prosthesis, and preference has been evolving over the last 30 years. Currently, we use monoblock, tapered, fluted, titanium stems for all periprosthetic fracture revision surgeries.
Collapse
Affiliation(s)
- Luke G. Menken
- Hospital for Special Surgery, 535 E 70th St, 10021, New York, NY, USA
| | | |
Collapse
|