1
|
Xin P, Yang J, Chen G, Wang Y, Wang Y, Zhang G. Clinical and radiographic outcomes of long monoblock, hydroxyapatite-coated stem in revision hip arthroplasty with extended trochanteric osteotomy: a multicenter study. J Orthop Surg Res 2024; 19:20. [PMID: 38167438 PMCID: PMC10763483 DOI: 10.1186/s13018-023-04377-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The distally fixed stem used in revision total hip arthroplasty (rTHA) with extended trochanteric osteotomy (ETO) is subject to periprosthetic fracture, stem subsidence, and stress shielding. The prospective multicentric study aimed to assess the clinical and radiographic outcomes, and complications of using the Corail revision stem in rTHA with ETO. METHODS Sixty-four patients undergoing rTHA with ETO using the Corail revision stem between 2019 and 2020 were enrolled in the study. We performed a postoperative follow-up of the patient and obtained radiographs and Harris hip scores (HHSs). These results were used to analyze ETO union, Engh scores, bone remodeling, stem stability and hip function. RESULTS The mean follow-up duration was 34 months (range 23-41). Sixty-two patients who underwent ETOs achieved complete healing at the final follow-up. Fifty-nine hips had bony ingrowth from the osteotomy fragment to the stem without radiolucent lines. The postoperative Engh score was 21.3 ± 3.59 (range 15.5-27.0). Forty-three hips had regeneration in the proximal femur. Two patients had transient thigh pain postoperatively. The postoperative HHS improved from 40.7 ± 16.67 (range 0-67) preoperatively to 82.1 ± 6.83 (range 73-93). CONCLUSION Corail revision stems are a viable and reliable option in rTHA with ETO. This stem had excellent clinical and radiographic outcomes, resulting in a high rate of ETO union and stem survival. The revision stem enabled restoration of proximal bone stock in femurs with prerevision bone defects, which were prepared for the next revision operation. Level of evidence Level IIb, Prospective self-control study.
Collapse
Affiliation(s)
- Peng Xin
- Department of Orthopedics, The First Medical Center of Chinese, PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Orthopedics, Chinese PLA Southern Theater Command General Hospital, Guangzhou, China
| | - Jianfeng Yang
- Department of Orthopedics, The First Medical Center of Chinese, PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guangxing Chen
- Department of Orthopedics, The Southwest Hospital of Army Medical University, Chongqing, China
| | - Yiming Wang
- Department of Orthopedics, The First Medical Center of Chinese, PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese People's Liberation Army, Beijing, China
| | - Yan Wang
- Department of Orthopedics, The First Medical Center of Chinese, PLA General Hospital, Beijing, China.
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Guoqiang Zhang
- Department of Orthopedics, The First Medical Center of Chinese, PLA General Hospital, Beijing, China.
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
2
|
Cacciola G, Giustra F, Bosco F, Aprato A, De Meo F, Cavaliere P, Vezza D, Giachino M, Sabatini L, Massè A. Extended trochanteric osteotomy is a safe procedure in two-stage hip revision: a systematic review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2695-2702. [PMID: 36849679 PMCID: PMC10504093 DOI: 10.1007/s00590-023-03497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Extended trochanteric osteotomy (ETO) has proved to be an effective technique in complicated stem removal in femoral aseptic loosening or periprosthetic fracture. Debate remains about its safety in periprosthetic joint infection (PJI). The primary aim of this study is to analyze the ETO reinfection and union rate in two-stage hip revision. MATERIAL AND METHODS A systematic literature review was performed regarding all studies reporting ETO outcomes in the two-stage revision for hip PJI up to October 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. A literature search was conducted in the following databases: MEDLINE/EMBASE, Scopus, Web of Science, and Cochrane. Quality assessment of the articles was performed using the Methodological Index for Non-Randomized Studies. This systematic review was registered in the International Prospective Registry of Systematic Reviews. Patient demographic, clinical, and surgical data were collected. RESULTS This systematic review included and analyzed nine clinical studies with a total of 382 ETO PJI hips in two-stage revision. The overall ETO reinfection rate was 8.9% (34 hips), consistent with the reinfection rate after two-stage revision in patients without ETO. The overall ETO union rate was 94.8% (347 hips), comparable to the ETO union rate in non-septic patients. Compared between a group of patients with ETO PJI and a group of patients with non-PJI ETO, there were no significant differences in postoperative complications, both septic and aseptic, and for postoperative HHS. CONCLUSION ETO proved to be a safe and effective procedure in PJI revisions. It may be a viable option in challenging femoral stem removal during the two-stage hip revision in PJI. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Giorgio Cacciola
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco - ASL Città di Torino, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco - ASL Città di Torino, Turin, Italy.
| | - Alessandro Aprato
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Federico De Meo
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy
| | - Pietro Cavaliere
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy
| | - Daniele Vezza
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Matteo Giachino
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| |
Collapse
|
3
|
Salomon K, Shen V, Sullivan A, Grayson C, Lyons S, Palumbo BT. The Watson Extraction System for removal of well-fixed femoral stems: A retrospective review of 10 cases. J Orthop 2023; 43:6-10. [PMID: 37521949 PMCID: PMC10374600 DOI: 10.1016/j.jor.2023.07.012] [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: 07/08/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023] Open
Abstract
Background Revision of well-fixed cementless femoral stems is a challenging and time-consuming aspect of revision hip arthroplasty. The Watson Extraction System (WES) is a novel, size-specific 3-D fabricated instrument that mimics the outer geometry of the implanted femoral stem. The device acts to cut circumferentially around the stem as it is impacted into place, effectively disrupting the bone-implant interface. Methods This is a retrospective review assessing the experience of 3 fellowship-trained adult reconstruction surgeons who used the WES to extract 10 well-fixed femoral stems during rTHA between 11/7/2020 and 11/7/2022. Outcomes and measures included: ability to remove the stem without a femoral osteotomy, femoral stem extraction time, incidence of femoral fracture, stem type used for reconstruction, blood loss, total surgical time, post-operative complications. Results No femoral osteotomies were required. The mean time for stem extraction was 7 min (range, 2-13), and there were 2 (20%) intra-operative femoral fractures. The stem type utilized for reconstruction included: 4 (40%) modular, tapered style stems, 3 (30%) antibiotic spacers, 2 (20%) primary style stems, and 1 (10%) ream and broach proximally porous stem. The mean blood loss was 425 ml (range, 200-800), total surgical time was 160 min (range, 107-232), and duration of follow-up was 7 months (range, 2-22 months). Conclusion The WES may mitigate the need for femoral osteotomy, reduce femoral stem extraction and overall intraoperative time, and decrease blood loss in rTHA. Further, reduced bone loss with use of this device may permit final reconstruction with a primary style stem.
Collapse
Affiliation(s)
- Kevin Salomon
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
- Foundation for Orthopaedic Research and Education, 4115 W Spruce St, Tampa, FL, 33607, USA
| | - Victor Shen
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
- Foundation for Orthopaedic Research and Education, 4115 W Spruce St, Tampa, FL, 33607, USA
| | - Alex Sullivan
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
- Florida Orthopaedic Institute, 13020 Telecom Parkway N, Temple Terrace, FL, 33637, USA
| | - Christopher Grayson
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
- Florida Orthopaedic Institute, 13020 Telecom Parkway N, Temple Terrace, FL, 33637, USA
| | - Steven Lyons
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
- Florida Orthopaedic Institute, 13020 Telecom Parkway N, Temple Terrace, FL, 33637, USA
| | - Brian T. Palumbo
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
- Florida Orthopaedic Institute, 13020 Telecom Parkway N, Temple Terrace, FL, 33637, USA
| |
Collapse
|
4
|
Almaslmani S, Entezari B, Safir OA, Gross AE, Kuzyk PR. Clinical and Functional Outcomes of Extended Trochanteric Osteotomy in 2-Stage Revision Total Hip Arthroplasty for Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis. J Arthroplasty 2023; 38:1900-1907. [PMID: 37001623 DOI: 10.1016/j.arth.2023.03.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/04/2023] [Accepted: 03/24/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Extended trochanteric osteotomy (ETO) has long been used in 2-stage revision surgeries of the hip, for both aseptic and septic indications. The purpose of this systematic review is to summarize the cumulative occurrence rates of the clinical and functional outcomes associated with the use of ETO in 2-stage revision total hip arthroplasty for periprosthetic joint infection. METHODS PubMed/MEDLINE and the Cochrane Database of Systematic Reviews databases were searched for articles published from January 1980 to January 2022 using the following keywords: "extended" AND "trochanteric" AND "osteotomy" AND "infection." Cumulative occurrence rates of outcomes and complications were calculated. A fixed-effects model and a 95% CI were applied. A P value of .05 was considered the significance threshold. RESULTS Nine studies were in full compliance with the inclusion criteria, with a total population size across all studies of 378. Union and infection eradication rates among studies were 95.1% (95% CI, 92.7-97.1, P = .018) and 94.0% (95% CI, 91.1-96.4, P = .089), respectively. Postoperation complications occurred in 15.34% of patients (95% CI, 10.34-21.22, P = .066). Occurrence rates for stem subsidence, dislocation, and femoral fractures were 6.2% (95% CI, 3.3-9.9, P = .187), 7.6% (95% CI, 4.8-10.9, P = .075), and 9.1% (95% CI, 5.8-13, P = .106), respectively. CONCLUSION With high rates of union and infection eradication, and low rates of postoperation complications, this study concludes the use of ETO in performing 2-stage revision total hip arthroplasty for the septic hip to be effective and safe.
Collapse
Affiliation(s)
- Saud Almaslmani
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Surgery, Faculty of Medicine, Al-Qunfudhah, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Bahar Entezari
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Oleg A Safir
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Allan E Gross
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Paul R Kuzyk
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Ismailidis P, Mündermann A, Stoffel K. A Monocortical Screw for Preventing Trochanteric Escape in Extended Trochanteric Osteotomy: A Simple Solution to a Complicated Problem? J Clin Med 2023; 12:jcm12082947. [PMID: 37109281 PMCID: PMC10145078 DOI: 10.3390/jcm12082947] [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: 01/21/2023] [Revised: 03/26/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Extended trochanteric osteotomy (ETO) is an established method in revision total hip arthroplasty. Proximal migration of the greater trochanter fragment and the resulting non-union of the osteotomy remains a major problem, and several techniques have been developed to prevent its occurrence. This paper describes a novel modification of the original surgical technique in which a single monocortical screw is placed distally to one of the cerclages used for the fixation of the ETO. The contact between the screw and the cerclage counteracts the forces applied on the greater trochanter fragment and prevents trochanteric escape under the cerclage. The technique is simple and minimally invasive, does not require special skills or additional resources, or add to surgical trauma or operating time, and therefore represents a simple solution to a complicated problem.
Collapse
Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| |
Collapse
|
6
|
Charalambous LT, Wixted CM, Kim BI, Cochrane NH, Belay ES, Joseph HL, Seyler TM. Cost Drivers in Two-Stage Treatment of Hip Periprosthetic Joint Infection With an Antibiotic Coated Cement Hip Spacer. J Arthroplasty 2023; 38:6-12. [PMID: 35872231 DOI: 10.1016/j.arth.2022.07.011] [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: 06/22/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The current gold standard for treating chronic Periprosthetic Joint Infection (PJI) is a 2-stage revision arthroplasty. There has been little investigation into what specific patient and operative factors may be able to predict higher costs of this treatment. METHODS An institutional electronic health record database was retrospectively queried for patients who developed a PJI after a total hip arthroplasty, and underwent removal of the prosthesis and implantation of an antibiotic-impregnated articulating hip cement spacer. Patient demographics, surgical variables, hospital readmissions, emergency department visits, and post-operative complications were collected. Total costs were captured through an internal accounting database through 2 years post-operatively. Negative binomial regressions were utilized for multivariable analyses. A total of 55 hips with PJI were available for cost analyses. RESULTS A comorbidity index score was associated with a 70% increase (Odds Ratio (OR): 1.7 [1.18-2.5], P = .003) in total costs at 2-years. Illicit drug use was associated with a 70% increase in costs at 1-year post-operatively (OR 1.7 [1.18-2.5], P = .003). Metal-on-poly liners were associated with a 22% decrease in cost at 2-years post-operatively when compared to Cement-on-Bone articulating spacers, and Metal-on-poly -constrained liners accounted for 38% lower costs at 1-year (OR 0.62 [0.44-0.87], P = .004). Use of an intraoperative extended trochanteric osteotomy was associated with a 46 and 61% increase in cost at 1-year (OR 1.46 [1.14-1.89]) and 2-years (OR 1.61 [1.26-2.07], P < .001) post-operatively. CONCLUSION Age, comorbidity index score, drug use, and extended trochanteric osteotomy were associated with increased costs of PJI treatment. This may be used to improve reimbursement models and target areas of cost savings.
Collapse
Affiliation(s)
| | | | - Billy I Kim
- Duke University School of Medicine, Durham, North Carolina
| | - Niall H Cochrane
- Duke University Medical Center, Department of Orthopaedics, Durham, North Carolina
| | - Elshaday S Belay
- Duke University Medical Center, Department of Orthopaedics, Durham, North Carolina
| | - Hayden L Joseph
- Duke University Medical Center, Department of Orthopaedics, Durham, North Carolina
| | - Thorsten M Seyler
- Duke University Medical Center, Department of Orthopaedics, Durham, North Carolina
| |
Collapse
|
7
|
Tang J, Wu T, Shao H, Zhou Y. Greater trochanter fixed with a claw plate and cable system in complex primary and revision total hip arthroplasty: long-term follow-up. INTERNATIONAL ORTHOPAEDICS 2022; 46:2553-2560. [PMID: 35997803 DOI: 10.1007/s00264-022-05538-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Maintaining continuity of the greater trochanter and restoring abductor function are of paramount importance in primary and revision total hip arthroplasty. Failure to rigidly fix the greater trochanter can lead to failure. Because of the lack of reports on the clinical results of greater trochanter fixation with a claw plate and cable system, we aimed to analyze the indications for the use of such a system that produces the best clinical results. METHODS We retrospectively studied 41 consecutive patients who had undergone primary or revision total hip arthroplasty at our institution between January 2004 and December 2014 using a claw plate and cable system to achieve stable fixation of the greater trochanter. RESULTS The mean follow-up duration was ten years. The median Harris hip score improved from 47 points before surgery to 87 points after surgery (p < 0.01). Significant improvements were observed in the range of motion, hip function, and routine activity. Osseous and fibrous union occurred in all patients, and one patient had severe complications (sciatica). Based on the Beals and Tower classification, 67%, 21%, and 13% of outcomes were considered excellent, good, and poor, respectively. CONCLUSIONS Our data support the use of a claw plate and cable system for greater trochanter fixation in complex primary and revision hip arthroplasty. The system showed promising results in patients with floating greater trochanters, intertrochanteric fractures requiring extra devices to maintain rotational stability, and extended trochanteric osteotomy fragments with a weakened proximodistal junction. The use of this system should be further investigated and compared to other methods.
Collapse
Affiliation(s)
- Jing Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, China
| | - Tiemure Wu
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, China.
| |
Collapse
|
8
|
Oe K, Iida H, Toyoda T, Nakamura T, Okamoto N, Saito T. Endofemoral Shooting Technique for Removing Well-fixed Cementless Stems. Arthroplast Today 2022; 17:36-42. [PMID: 36032794 PMCID: PMC9399389 DOI: 10.1016/j.artd.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background The removal of a well-fixed cementless stem poses technical challenges. The aim of this study was to evaluate the outcomes of our endofemoral extraction technique established in 2001. Methods Between January 2001 and December 2016, 118 consecutive revisions following bipolar or total hip arthroplasty, which required cementless femoral stem removal, were performed at our institution. This retrospective study evaluated 106 patients (108 hips) who were followed up for a mean of 9.2 years (range, 5-20 years). The patients included 15 men and 91 women with a mean age of 65 years (range, 33-87 years). Endofemoral extracted stem removal was performed as follows. Multiple Kirschner wires were sequentially inserted into the interface between the implant and cortical bone, after which the implant was detached using a thin chisel. After the cementless stem was removed, it was replaced with a cemented stem using an autograft, as needed. Radiological loosening of the femoral stem was defined as definite or probable loosening, based on the criteria of Harris et al. Prosthesis survival was analyzed using the Kaplan-Meier method, with the endpoint set as repeat revision surgery for stem loosening or femoral fracture. Results Re-revision surgery was performed in 7 hips. Stem loosening was observed in 4 hips, and the mean subsidence was 0.3 mm (0-3 mm). The 10-year survival rate was 97.7% (95% confidence interval, 93.2-100). Conclusions Our technique for removing well-fixed cementless stems yielded successful results.
Collapse
Affiliation(s)
- Kenichi Oe
- Corresponding author. Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan. Tel.: +81 72 804 2436.
| | | | | | | | | | | |
Collapse
|
9
|
Zhang B, Du Y, Zhang Y, Dong Y, Zhang T, Zhou Y. Comparison of Functional and Radiographic Outcomes Between Two Fixation Methods for Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty: A Retrospective Cohort Study. J Arthroplasty 2022; 37:1844-1850. [PMID: 35436529 DOI: 10.1016/j.arth.2022.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/28/2022] [Accepted: 04/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To compare the functional and radiographic outcomes between two fixation methods for extended trochanteric osteotomy (ETO) in revision total hip arthroplasty (rTHA). METHODS Included in this study were 64 patients who underwent ETO in rTHA using either claw-plate fixation (claw-plate group, n = 31) or cable-alone fixation (cable group, n = 33) in our hospital from 2008 to 2020. The functional and radiographic results and complications were compared between the groups during a mean follow-up period of 64 and 78 months. RESULTS The Harris hip score and visual analogue scale at the last follow-up improved significantly in both groups, showing no significant statistical difference between the two fixation methods. In the cable group, the mean abductor lever arm, the proximal migration, and medial migration in the affected hip were significantly decreased compared to those in the contralateral normal hip (P < .05), whereas in the claw-plate group no significant statistical differences were observed between two sides. No or slight limping occurred in 25 patients (81%) in the claw-plate group and 16 patients (48%) in the cable group (P = .007). A multiple logistic regression demonstrated that claw-plate fixation could reduce the incidence of postoperative moderate-to-severe limping. CONCLUSION Both claw-plate fixation and cable-alone fixation could improve the functional performance of rTHA with ETO, whereas claw-plate fixation could offer superior biomechanical results and gait improvement as compared with cable-alone fixation.
Collapse
Affiliation(s)
- Bohan Zhang
- Medical School of Chinese PLA, Beijing, People's Republic of China; Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Senior Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yinqiao Du
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Senior Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yanchao Zhang
- Medical School of Chinese PLA, Beijing, People's Republic of China; Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Senior Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yu Dong
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Senior Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Medical School of Nankai University, Tianjin, People's Republic of China
| | - Ti Zhang
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Senior Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Medical School of Nankai University, Tianjin, People's Republic of China
| | - Yonggang Zhou
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China; Senior Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| |
Collapse
|
10
|
Extended Trochanteric Osteotomy Closure Performed Before or After Canal Preparation and Stem Impaction Does Not Affect Axial Stability. J Arthroplasty 2022; 37:S964-S970. [PMID: 34392990 DOI: 10.1016/j.arth.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/02/2021] [Accepted: 07/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND An extended trochanteric osteotomy (ETO) safely addresses femoral component removal during challenging revision total hip arthroplasty. However, no prior study has evaluated whether a difference in axial stability exists between ETO closure performed before (reconstitution) or after (scaffolding) canal preparation and stem impaction. We hypothesized that given the absence of clinical reports of outcome differences despite the wide use of both practices, no significant difference in the initial axial stability would exist between the 2 fixation techniques. METHODS ETOs were performed and repaired using the reconstitution technique for the 6 right-sided femora and the scaffolding technique for the six left-sided femora. The 195-mm long, 3.5°-tapered splined titanium monobloc stems were impacted into 6 matched pairs of human fresh cadaveric femora. Three beaded cables were placed in a standardized fashion on each specimen, 1 for prophylaxis against osteotomy propagation during reaming/impaction and 2 to close the ETO. Stepwise axial loading was performed to 2600 N or until failure, which was defined as subsidence >5 mm or femoral/cable fracture. RESULTS All specimens successfully resisted axial testing, with no stem in either ETO repair group subsiding >2 mm. The mean subsidence for the reconstitution group was 0.9 ± 0.4 mm, compared to 1.2 ± 0.5 mm for the scaffolding group (P = .2). CONCLUSION In this cadaveric model with satisfactory proximal bone stock, no difference existed between the reconstitution and scaffolding ETO repair techniques, and both provide sufficient immediate axial stability in a simulated revision total hip arthroplasty setting under physiologic loads.
Collapse
|
11
|
Smith EB. Save the Greater Trochanter: A Novel Modification to the Extended Trochanteric Osteotomy. Arthroplast Today 2022; 16:107-111. [PMID: 35677941 PMCID: PMC9168376 DOI: 10.1016/j.artd.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022] Open
Abstract
The extended trochanteric osteotomy is the workhorse for removal of well-fixed femoral stems during total hip revision arthroplasty. Despite its reliable performance in exposing the implants for removal and accessing the femoral canal, significant complications can occur. Though these complications are rare, trochanteric nonunion, trochanteric escape, and femoral implant subsidence can have a significant negative impact on gait mechanics and patient outcome. If access to the canal was still possible and the greater trochanter could remain in place, these complications could be minimized or possibly even eliminated. This paper describes a novel technique using a lateral cortical window just distal to the greater trochanter that allows removal of a well-fixed stem and leaves the greater trochanter intact.
Collapse
Affiliation(s)
- Eric B. Smith
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
12
|
Calek AK, Schöfl T, Zdravkovic V, Zurmühle P, Ladurner A. Aseptic Revision of Total Hip Arthroplasty With a Single Modular Femoral Stem and a Modified Extended Trochanteric Osteotomy-Treatment Assessment With the Forgotten Joint Score-12. Arthroplast Today 2022; 15:159-166. [PMID: 35601994 PMCID: PMC9121271 DOI: 10.1016/j.artd.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/20/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Aseptic loosening is among the most common reasons for revision total hip arthroplasty (RTHA). Modular revision stems implanted through an extended trochanteric osteotomy (ETO) promise good results, but patient-reported outcome measures (PROMs) are rarely conveyed. This study used the Forgotten Joint Score-12 (FJS-12) to assess patient-reported outcome in patients who had undergone RTHA for aseptic stem loosening using a modified ETO approach with a tapered, fluted modular stem. Material and methods A single-center analysis of aseptic RTHA was performed (2007–2019). Clinical results (range of motion, walking ability, function), radiographic results (ETO healing, stem subsidence), and PROMs (FJS-12, Harris Hip Score, European Quality of Life 5D Score) were assessed. Minimum follow-up duration was 1 year. Complications including revisions were recorded. Results Primary outcome parameters were assessed on 72 patients (mean age 73.3 years, mean body mass index 27.6kg/m2). Additional PROMs were collected by phone interviews from 41 patients (mean follow-up 5.7 years). In 76%, leg length was restored, and a normal gait was achieved. After 1 year, the ETO was healed in 93%; subsidence occurred in 8.3% of cases. The mean FJS-12 at the final follow-up was 85.6 ± 23.6, and the respective Harris Hip Score and European Quality of Life 5D Score averaged 87 ± 17.8 and 72.9 ± 15.9. Complication and revision rates were 33.3% and 13.9%, respectively. Conclusion Aseptic RTHA as presented here resulted in excellent PROMs in the medium term. FJS-12 score averaged 85.6 with a mean follow-up of 5.7 years. Treatment using a modular implant and a modified ETO was associated with good clinical and radiographic outcomes. Complication and revision rates were 33.3% and 13.9%, respectively.
Collapse
Affiliation(s)
- Anna-Katharina Calek
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Thomas Schöfl
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Vilijam Zdravkovic
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Pia Zurmühle
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Andreas Ladurner
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| |
Collapse
|
13
|
Hamad K, Konan S. Extended trochanteric osteotomy in revision hip arthroplasty: a case series study and systematic literature review. ARTHROPLASTY 2022; 4:14. [PMID: 35366949 PMCID: PMC8976970 DOI: 10.1186/s42836-022-00115-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023] Open
Abstract
Background Extended trochanteric osteotomy (ETO) in revision hip arthroplasty provides direct access to the femoral medullary canal and facilitates removal of implants and re-implantation. This study looks at objective outcomes of ETO from a systematic review of the literature and a case series of revision total hip arthroplasty (THA) cases with ETOs from the authors’ local institution. Methods (1) The National Institutes of Health (NIH) national library of medicine was searched for studies related to ETO and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) technique were followed. (2) Case series of 23 revision THAs with ETOs from University College London Hospital (UCLH) were retrospectively analyzed with a minimum of 2-year follow-up for radiological outcomes. Results (1) The main revision THAs diagnoses were aseptic loosening (880/1,386; 63.4%), prosthetic joint infection (PJI) (301/1,386; 21.7%) and periprosthetic THA fractures (78/1,386; 5.6%). Other diagnoses, including non-specified reasons for THA revision in the chosen studies, accounted for 9.2% (127/1,386). The total mean was a union rate of 95.2%, an infection eradication rate of 91.6%, a femoral stem subsidence rate of 16.6%, with the rate of subsidence more than 5 mm being 10.7%. ETO proximal migration was reported in 7.8% of ETOs; however, it rarely required re-attachment (0.9%). Intraoperative fracture during revision THA with ETO was reported to be at a rate of 5%; while postoperative femoral fracture rate was at 7.8%. (2) All 24 cases had radiographic union at 3 to 6 months and there was no reported femoral stem subsidence. Conclusion The overall outcome of this literature review provides moderate-quality evidence indicating that ETO provides safe outcome for revision THAs in single and 2-stage revision surgeries with low ETO non-union, femoral stem subsidence, greater trochanter (GT) proximal migration and fracture rates in the different diagnoses groups of revision THA at over 2-year follow up. In the case series group, there was radiographic union of all ETOs with no reported femoral stem subsidence or periprosthetic fractures.
Collapse
|
14
|
Schöfl T, Calek AK, Zdravkovic V, Zurmühle P, Ladurner A. Mid-term outcomes following transfemoral revision of total hip arthroplasty for Vancouver B2/B3 periprosthetic fractures. Injury 2022; 53:653-660. [PMID: 34862036 DOI: 10.1016/j.injury.2021.11.036] [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: 05/25/2021] [Revised: 11/08/2021] [Accepted: 11/14/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Periprosthetic femoral fractures (PFF) are often the reason for revising total hip arthroplasty (RTHA). Converting these fractures into modified extended trochanteric osteotomy (mETO) facilitates stem revision. Modular revision stems are a common choice with good results. We present mid-term outcomes in patients undergoing RTHA for Vancouver B2/B3 PFF using a tapered, fluted modular stem with an mETO approach. MATERIALS AND METHODS A single-center analysis of patients with RTHA for Vancouver B2/B3 PFF using a single modular implant with mETO was performed (2007 - 2019). Clinical outcome (mobility, range of motion, function), radiological outcome (fracture healing, stem subsidence) and patient reported outcome measures (FJS-12, HHS, EQ-5D) were assessed. RESULTS Ninety-seven patients (mean age 78.1 years, BMI 25.8 kg/m2, 85.6% B2-fractures) were included; 80 patients had complete clinical and radiological follow-ups. Normal unaided gait without limping was achieved in 38/80 patients. After one year fracture / mETO healing occurred in 74/80 patients; 5.3 years after surgery, the respective FJS-12, HHS and EQ-5D (available in 34 patients) averaged 81.3 ± 30.2, 71.4 ± 18.7 and 0.8 ± 0.2. We documented 7 in-hospital deaths, 18.8% postoperative complications and 13.8% revisions with stem revisions being most commonly for subsequent PFF or subsidence. CONCLUSION Good clinical and radiological outcomes and rather low complication and revision rates (18.8% and 13.8%) were achieved. FJS-12 showed excellent results in patients undergoing RTHA for Vancouver B2/B3 PFF using a cementless, dual modular titanium revision stem and an mETO approach. Joint awareness was thereby similar to previously reported primary THA results at 5.3 years follow-up.
Collapse
Affiliation(s)
- Thomas Schöfl
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Anna-Katharina Calek
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Vilijam Zdravkovic
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Pia Zurmühle
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Andreas Ladurner
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St.Gallen, Switzerland.
| |
Collapse
|
15
|
Başarır K, Kalem M, Şahin E, Özbek EA, Karaca MO, Küçükkarapınar İ, Tönük E. The Relationship Between Arthroplasty Surgeons' Experience Level and Optimal Cable Tensioning in the Fixation of Extended Trochanteric Osteotomy. Geriatr Orthop Surg Rehabil 2021; 12:21514593211063324. [PMID: 34925952 PMCID: PMC8671821 DOI: 10.1177/21514593211063324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction In this study, our aim was to examine the relationship between the arthroplasty surgeons’ experience level and their aptitude to adjust the cable tension to the value recommended by the manufacturer when asked to provide fixation with cables in artificial bones that underwent extended trochanteric osteotomy (ETO). Materials and Methods A custom-made cable tensioning device with a microvoltmeter was used to measure the tension values in Newtons (N). An ETO was performed on 4 artificial femur bones. Surgeons at various levels of experience attending the IXth National Arthroplasty Congress were asked to fix the osteotomized fragment using 1.7-mm cables and the tensioning device. The participants’ demographic and experience data were investigated and recorded. The surgeons with different level of experience repeated the tensioning test 3 times and the average of these measurements were recorded. Results In 19 (35.2%) of the 54 participants, the force applied to the cable was found to be greater than the 490.33 N (50 kg) value recommended by the manufacturer. No statistically significant difference was determined between the surgeon’s years of experience, the number of cases, and the number of cables used and the tension applied over the recommended maximum value (P = .475, P = .312, and P = .691, respectively). Conclusions No significant relationship was found between the arthroplasty surgeon’s level of experience and the adjustment of the cable with the correct tension level. For this reason, we believe that the use of tensioning devices with calibrated tension gauges by orthopedic surgeons would help in reducing the number of complications that may occur due to the cable.
Collapse
Affiliation(s)
- Kerem Başarır
- Department of Orthopedics and Traumatology, University of Ankara, Ankara University Medicine Faculty, Ankara, Turkey
| | - Mahmut Kalem
- Department of Orthopedics and Traumatology, University of Ankara, Ankara University Medicine Faculty, Ankara, Turkey
| | - Ercan Şahin
- Faculty of Medicine, Department of Orthopedics & Traumatology, Bülent Ecevit University, Zonguldak, Turkey
| | - Emre Anıl Özbek
- Department of Orthopedics and Traumatology, University of Ankara, Ankara University Medicine Faculty, Ankara, Turkey
| | - Mustafa Onur Karaca
- Department of Orthopedics and Traumatology, University of Ankara, Ankara University Medicine Faculty, Ankara, Turkey
| | - İbrahim Küçükkarapınar
- Department of Orthopedic Surgery and Traumatology Polatlı State Hospital, Ankara, Turkey
| | - Ergin Tönük
- Department of Mechanical Engineering, Middle East Technical University, Ankara, Turkey
| |
Collapse
|
16
|
Garabano G, Gessara AM, Pesciallo CA, Alamino LP, Del Sel H. Extended trochanteric osteotomy (ETO) and fluted tapered modular stems in revision hip arthroplasty. Does ETO integrity or consolidation, really matter? J Orthop 2021; 23:250-255. [PMID: 33664557 DOI: 10.1016/j.jor.2021.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/03/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction The objective of this study was to assess if the fracture and/or non-union of extended trochanteric osteotomy (ETO) affected the behavior and survival of modular fluted and tapered distal fixation stems in revision total hip arthroplasties (rTHA). Methods We retrospectively analyzed 52 rTHA in 52 patients. Preoperative diagnoses were mechanical loosening (42 cases), septic loosening (8), periprosthetic fracture (1), and femoral stem fracture (1). According to the Paprosky classification, femoral bone stock deficiencies were 19 type-II, 26 type IIIA, and 7 type IIIB. We assessed the behavior of the osteotomy (union, fracture, migration) and the survival and behavior (integration and subsidence) of prosthetic femoral stems. Results ETO union and non-union rates were 84.61% (44 patients) and 15.38% (8 cases) respectively. There were twelve (23%) intra-operative fractures of the osteotomy fragment and 11 (21.15%) migrations (4.5 mm on average). We observed bone union in 39 (75%) stems and 13 (25%) stable fibrous unions. Nine (17.3%) stems subsided 7 mm (2-15 mm) on average before becoming stable. Stem subsidence and integration was not significantly affected by ETO fracture/no fracture or union/non-union. The postoperative Harris Hip Score (HHS) improved significantly as compared to the pre-operative HHS (38.41 ± 3.54 vs 85.29 ± 3.36; p < 0.01). Patients were followed up for 55 (24-100) months. The overall implant survival at the end of follow-up was 100%. Conclusions In this series, neither the non-union nor the intra-operative fracture of the ETO segment affected the behavior or medium-term survival of femoral stems.
Collapse
Affiliation(s)
- Germán Garabano
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Perdriel 74 (C1280 AEB), Buenos Aires, Argentina
| | - Alan Maximiliano Gessara
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Perdriel 74 (C1280 AEB), Buenos Aires, Argentina
| | - Cesar Angel Pesciallo
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Perdriel 74 (C1280 AEB), Buenos Aires, Argentina
| | - Leonel Perez Alamino
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Perdriel 74 (C1280 AEB), Buenos Aires, Argentina
| | - Hernán Del Sel
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Perdriel 74 (C1280 AEB), Buenos Aires, Argentina
| |
Collapse
|