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Abstract
The results of modern cemented and uncemented total hip arthroplasties are outstanding and both systems have their advantages and disadvantages. This paper aims to examine the designs of different types of prostheses, some history behind their development and the reported results. Particular emphasis is placed on cemented stem design and the details of cementing technique.
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Affiliation(s)
- Joanna Maggs
- Princess Elizabeth Orthopaedic Centre, Exeter, EX2 5DW, UK
| | - Matthew Wilson
- Princess Elizabeth Orthopaedic Centre, Exeter, EX2 5DW, UK,Address for correspondence: Dr. Matthew Wilson, Princess Elizabeth Orthopaedic Centre, Exeter, EX2 5DW, UK. E-mail:
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Wilson MJ, Hook S, Whitehouse SL, Timperley AJ, Gie GA. Femoral impaction bone grafting in revision hip arthroplasty. Bone Joint J 2016; 98-B:1611-1619. [DOI: 10.1302/0301-620x.98b12.37414] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 08/24/2016] [Indexed: 11/05/2022]
Abstract
Aims Femoral impaction bone grafting was first developed in 1987 using morselised cancellous bone graft impacted into the femoral canal in combination with a cemented, tapered, polished stem. We describe the evolution of this technique and instrumentation since that time. Patients and Methods Between 1987 and 2005, 705 revision total hip arthroplasties (56 bilateral) were performed with femoral impaction grafting using a cemented femoral stem. All surviving patients were prospectively followed for a mean of 14.7 years (9.8 to 28.3) with no loss to follow-up. By the time of the final review, 404 patients had died. Results There were 76 further revisions (10.8%) involving the stem; seven for aseptic loosening, 23 for periprosthetic fracture, 24 for infection, one for malposition, one for fracture of the stem and 19 cement-in-cement exchanges of the stem during acetabular revision. The 20-year survival rate for the entire series was 98.8% (95% confidence interval (CI) 97.8 to 99.8) with aseptic loosening as the endpoint, and 87.7% (95% CI 82.8 to 92.6) for revision for any reason. Survival improved with the evolution of the technique, although this was not statistically significant due to the overall low rate of further revision. Conclusion This is the largest series of revision total hip arthroplasties with femoral impaction grafting, and the results support the continued use of this technique. Cite this article: Bone Joint J 2016;98-B:1611–19.
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Affiliation(s)
- M. J. Wilson
- Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Barrack Rd, Exeter, Devon, EX2 5DW, UK
| | - S. Hook
- St Richard’s Hospital, Chichester, PO19
6SE, UK
| | - S. L. Whitehouse
- Queensland University of Technology , Brisbane, Queensland, Australia
| | - A. J. Timperley
- Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Barrack Rd, Exeter, Devon, EX2 5DW, UK
| | - G. A. Gie
- Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Barrack Rd, Exeter, Devon, EX2 5DW, UK
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te Stroet MAJ, Rijnen WHC, Gardeniers JWM, van Kampen A, Schreurs BW. The outcome of femoral component revision arthroplasty with impaction allograft bone grafting and a cemented polished Exeter stem. Bone Joint J 2015; 97-B:771-9. [DOI: 10.1302/0301-620x.97b6.34526] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We report the clinical and radiographic outcomes of 208 consecutive femoral revision arthroplasties performed in 202 patients (119 women, 83 men) between March 1991 and December 2007 using the X-change Femoral Revision System, fresh-frozen morcellised allograft and a cemented polished Exeter stem. All patients were followed prospectively. The mean age of the patients at revision was 65 years (30 to 86). At final review in December 2013 a total of 130 patients with 135 reconstructions (64.9%) were alive and had a non re-revised femoral component after a mean follow-up of 10.6 years (4.7 to 20.9). One patient was lost to follow-up at six years, and their data were included up to this point. Re-operation for any reason was performed in 33 hips (15.9%), in 13 of which the femoral component was re-revised (6.3%). The mean pre-operative Harris hip score was 52 (19 to 95) (n = 73) and improved to 80 (22 to 100) (n = 161) by the last follow-up. Kaplan–Meier survival with femoral re-revision for any reason as the endpoint was 94.9% (95% confidence intervals (CI) 90.2 to 97.4) at ten years; with femoral re-revision for aseptic loosening as the endpoint it was 99.4% (95% CI 95.7 to 99.9); with femoral re-operation for any reason as the endpoint it was 84.5% (95% CI 78.3 to 89.1); and with subsidence ≥ 5 mm it was 87.3% (95% CI 80.5 to 91.8). Femoral revision with the use of impaction allograft bone grafting and a cemented polished stem results in a satisfying survival rate at a mean of ten years’ follow-up. Cite this article: Bone Joint J 2015; 97-B:771–9.
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Affiliation(s)
- M. A. J. te Stroet
- Radboud University Medical Center, Geert
Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - W. H. C. Rijnen
- Radboud University Medical Center, Geert
Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - J. W. M. Gardeniers
- Radboud University Medical Center, Geert
Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - A. van Kampen
- Radboud University Medical Center, Geert
Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - B. W. Schreurs
- Radboud University Medical Center, Geert
Grooteplein 10, 6525 GA Nijmegen, The Netherlands
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Revision hip arthroplasty with an extensively
porous-coated stem - excellent long-term
results also in severe femoral bone stock loss. Hip Int 2014; 23:352-8. [PMID: 23813156 DOI: 10.5301/hipint.5000032] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 02/04/2023]
Abstract
UNLABELLED During the last 25 years uncemented hip stem revision relying on diaphyseal fixation has shown improving clinical results and stem survival. The purpose of this study was to present the long-term results of hip revision with the SOLUTION stem (DePuy, Warsaw Indiana).
Ninety-three consecutive SOLUTION hip stem revisions in 84 patients with a mean age of 69 years (range 33-86 years) were reviewed. Of these, clinical and radiographic follow-up examination by an independent observer was possible in 36 hips/29 patients after mean 14 years (range 10-18 years). Stem re-revision was documented by our own files and by the Danish Hip Arthroplasty Registry.
Stem re-revision had been performed in two hips for aseptic loosening, one due to deep infection and in one patient due to stem fracture. The 18 years cumulative survival, free of re-revision for any reason was calculated as 94.4% (88.9-99.8)% and for aseptic loosening to 97.6% (94.3-100%). Intraoperative complications were frequent with incidence of shaft fractures (14/93) and perforations (9/93) showing a significant learning curve. Mean Harris Hip Score was 85 (range 53-99). Osseointegration was seen in 34/36 stems with two stems fibrous fixated. Stress shielding was significant associated with stem diameters ≥15 mm. Severe preoperative bone deficiency had no negative bearing on stem survival and no significant influence on osseointegration of the stem or on Harris Hip Score.
CONCLUSION Femoral stem revision with an extensively porous-coated monoblock chrome-cobalt stem seems to be a reliable and reproducible technique resulting in excellent long-term survivorship and clinical outcome. It can be used in femurs with deficient bone stock.
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Masterson S, Lidder S, Scott G. Impaction femoral allografting at revision hip arthroplasty. ACTA ACUST UNITED AC 2012; 94:51-5. [DOI: 10.1302/0301-620x.94b1.27855] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the long-term results of revision total hip replacement using femoral impaction allografting with both uncemented and cemented Freeman femoral components. A standard design of component was used in both groups, with additional proximal hydroxyapatite coating in the uncemented group. A total of 33 hips in 30 patients received an uncemented component and 31 hips in 30 patients a cemented component. The mean follow-up was 9.8 years (2 to 17) in the uncemented group and 6.2 years (1 to 11) in the cemented group. Revision procedures (for all causes) were required in four patients (four hips) in the uncemented group and in five patients (five hips) in the cemented group. Harris hip scores improved significantly in both groups and were maintained independently of the extent of any migration of the femoral component within the graft or graft–cement mantle.
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Affiliation(s)
- S. Masterson
- The Royal London Hospital, Bone
and Joint Research Unit, Whitechapel Road, London E1
1BB, UK
| | - S. Lidder
- The Royal London Hospital, Bone
and Joint Research Unit, Whitechapel Road, London E1
1BB, UK
| | - G. Scott
- The Royal London Hospital, Bone
and Joint Research Unit, Whitechapel Road, London E1
1BB, UK
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Saino E, Maliardi V, Quartarone E, Fassina L, Benedetti L, De Angelis MGC, Mustarelli P, Facchini A, Visai L. In VitroEnhancement of SAOS-2 Cell Calcified Matrix Deposition onto Radio Frequency Magnetron Sputtered Bioglass-Coated Titanium Scaffolds. Tissue Eng Part A 2010; 16:995-1008. [DOI: 10.1089/ten.tea.2009.0051] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Enrica Saino
- Medicine Section, Department of Biochemistry, University of Pavia, Pavia, Italy
- Center for Tissue Engineering (C.I.T), Pavia, Italy
| | - Valentina Maliardi
- Center for Tissue Engineering (C.I.T), Pavia, Italy
- Department of Experimental Medicine, University of Pavia, Pavia, Italy
| | - Eliana Quartarone
- Center for Tissue Engineering (C.I.T), Pavia, Italy
- Department of Physical Chemistry, University of Pavia, Pavia, Italy
| | - Lorenzo Fassina
- Center for Tissue Engineering (C.I.T), Pavia, Italy
- Department of Computer and Systems Science, University of Pavia, Pavia, Italy
| | - Laura Benedetti
- Center for Tissue Engineering (C.I.T), Pavia, Italy
- Department of Experimental Medicine, University of Pavia, Pavia, Italy
| | | | - Piercarlo Mustarelli
- Center for Tissue Engineering (C.I.T), Pavia, Italy
- Department of Physical Chemistry, University of Pavia, Pavia, Italy
| | | | - Livia Visai
- Medicine Section, Department of Biochemistry, University of Pavia, Pavia, Italy
- Center for Tissue Engineering (C.I.T), Pavia, Italy
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