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Castagnini F, Pardo F, Lucchini S, Rotini M, Cavalieri B, Dalla Rosa M, Vitacca S, Di Martino A, Faldini C, Traina F. Cementless Primary Stems in Revision Hip Arthroplasty: A Narrative Review. J Clin Med 2024; 13:604. [PMID: 38276110 PMCID: PMC10816713 DOI: 10.3390/jcm13020604] [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: 12/28/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Cementless primary stems in revision hip arthroplasties may be conservative options to preserve bone stock and provide adequate reconstruction of the hip biomechanics. However, there is still little evidence about indications, limitations, and outcomes. This narrative review showed that conventional standard stems were adopted in different revision settings, up to Paprosky IIIA grade bone defects. In cases of acceptable metaphyseal bone stock, when a scratch fit of at least 4 cm can be achieved, a conventional cementless stem may be an adequate solution. Mid-term clinical and radiographic outcomes and survival rates were similar to long revision stems, whereas complications, surgical time, and costs were lower among conventional stems. However, unsuitable contexts for conventional stems included canal diameters larger than 18 mm and failed revision stems with cortical weakening. Even short stems can be considered in revisions, in order to preserve bone stock and stay proximal to femoral remodeling zones and bone/cement plugs. Short stems were successfully adopted up to Paprosky IIIA bone defects, achieving mid-term survival rates not inferior to long revision stems. Ageing, osteoporosis, and intraoperative femoral fractures were the main negative prognostic factors. In very select cases, a downsizing technique (from longer to shorter stems) may be adopted to simplify the procedure and reduce complications.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Francesco Pardo
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Stefano Lucchini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Marco Rotini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Bruno Cavalieri
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Mattia Dalla Rosa
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Stefano Vitacca
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Alberto Di Martino
- 1 Orthopedics and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (A.D.M.); (C.F.)
- Department of Biomedical and Neuromotor Sciences—DIBINEM, University of Bologna, 40126 Bologna, Italy
| | - Cesare Faldini
- 1 Orthopedics and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (A.D.M.); (C.F.)
- Department of Biomedical and Neuromotor Sciences—DIBINEM, University of Bologna, 40126 Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
- Department of Biomedical and Neuromotor Sciences—DIBINEM, University of Bologna, 40126 Bologna, Italy
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Tornago S, Cavagnaro L, Mosconi L, Chiarlone F, Zanirato A, Patroniti N, Formica M. Vancouver type B2 periprosthetic femoral fractures: clinical and radiological outcomes from a tertiary care center. Arch Orthop Trauma Surg 2023; 143:6919-6926. [PMID: 37392216 PMCID: PMC10542289 DOI: 10.1007/s00402-023-04955-2] [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: 01/29/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION The purpose of this study was to report mid-term clinical and radiographic results after hip arthroplasty revision in Vancouver type B2 femoral periprosthetic fractures (PPFx). Specifical focus of the paper is as follows: (1) the description of a standardized and reproducible surgical technique, (2) functional outcomes presentation and (3) type and number of complications and implants' survival rate analysis. METHODS We retrospectively reviewed all patients treated for hip revision with non-modular tapered fluted titanium stem in patients with Vancouver type B2 femur PPFx at a single institution. At least 18 months' follow-up period was required. Harris Hip Scores and SF-12 were obtained, and radiographical follow-up was performed. Complications were reported and analyzed. RESULTS The authors included 114 patients (114 hips) with a mean follow-up of 62.8 ± 30.6 months. All patients were treated with Wagner SL revision hip stem (Zimmer-Biomet), metal cerclage wires ± trochanteric plate. The mean HHS and SF-12 score at the last follow-up evaluation were respectively 81.3 ± 9.7 and 32.5 ± 7.6. Seventeen (14.9%) complications occurred. We observed five cases of dislocations, two of periprosthetic joint infections and six cases of new PPFx. The stem-related revision rate for any cause at the final FU was 1.7%, due to PJI. No patients underwent stem revision surgery for aseptic loosening. Fracture healed in all the included patients with a union-rate of 100%. The re-operation rate for any cause was 9.6%, with an implant survival rate for overall failure of 96.5%. CONCLUSION The presented standard and reproducible surgical technique obtains optimal clinical and radiological results with limited complication rate at mid-term follow up. Preoperative planning as well as careful intraoperative surgical technique is of a paramount importance.
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Affiliation(s)
- Stefano Tornago
- Joint Replacement Unit, Ortopedia e Traumatologia 2, Ospedale Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
| | - Luca Cavagnaro
- Joint Replacement Unit, Ortopedia e Traumatologia 2, Ospedale Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy.
| | - Lorenzo Mosconi
- Joint Replacement Unit, Ortopedia e Traumatologia 2, Ospedale Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
| | - Francesco Chiarlone
- UO 1' Sezione di Ortopedia e Traumatologia, Istituto Clinico San Rocco Gruppo San Donato, Via dei Sabbioni, 24, BS, 25050, Ome, Italy
| | - Andrea Zanirato
- Policlinico San Martino, Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
- DISC, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Viale Benedetto XV 6, 16132, Genoa, GE, Italy
| | - Nicolò Patroniti
- Anesthesia and Intensive Care Unit, Ospedale Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
- DISC, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Viale Benedetto XV 6, 16132, Genoa, GE, Italy
| | - Matteo Formica
- Policlinico San Martino, Clinica Ortopedica, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
- DISC, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Viale Benedetto XV 6, 16132, Genoa, GE, Italy
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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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Willems JH, Smulders K, Innocenti M, Bosker BH, van Hellemondt GG. Stay Short or Go Long in Revision Total Hip Arthroplasty With Paprosky Type II Femoral Defects: A Comparative Study With the Use of an Uncemented Distal Fixating Modular Stem and a Primary Monobloc Conical Stem With 5-Year Follow-Up. J Arthroplasty 2022; 37:2239-2246. [PMID: 35537612 DOI: 10.1016/j.arth.2022.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/21/2022] [Accepted: 05/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In the revisions for Paprosky type II femoral defects, diaphyseal fixating femoral stems are commonly used. To preserve bone stock, the use of a shorter primary conical stem could be an adequate alternative. The objective of this study is to compare the results of a primary conical stem to the more commonly used diaphyseal fixating modular revision stem in revision total hip arthroplasty surgery with Paprosky type II femoral defects. METHODS A total of 59 consecutive patients with Paprosky type II femoral defects from our prospective revision registry were included. Thirty patients who received a long distal fixating modular stem (Revision Stem, Lima Corporate) and 29 patients who received a primary conical short stem (Wagner Cone, Zimmer) were prospectively followed. Minimal follow-up time was 2 years for subsidence and patient-reported outcome measures and 5 years for complications, reoperation, and revision. We compared subsidence, perioperative complications, reoperations, femoral component survival, Oxford Hip Score, EuroQol 5 Dimension, visual analog scale (VAS) for pain at rest, and VAS for pain during activity between stems. RESULTS Both groups were comparable regarding demographic, clinical, and surgery-related characteristics. We found more perioperative complications and stem revisions with the modular revision stem than with the primary conical stem. There were no statistical differences in subsidence, EuroQol 5 Dimension, Oxford Hip Score, and VAS for pain at rest or during activity between both stems. CONCLUSION In revision total hip arthroplasty with Paprosky type II femoral defects, uncemented primary monobloc conical femoral stems showed the same clinical result as distal fixating modular stems with fewer complications and fewer stem revisions.
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Affiliation(s)
- Jore H Willems
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Katrijn Smulders
- Department for Scientific Research, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Matteo Innocenti
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Bart H Bosker
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Ubbergen, The Netherlands
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Conservative two-stage revision with primary components of infected total hip arthroplasty: An analysis of survival, clinical and radiographic outcomes. PLoS One 2020; 15:e0239981. [PMID: 33002069 PMCID: PMC7529346 DOI: 10.1371/journal.pone.0239981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Few studies provide an analysis of conservative two-stage revision of hip
periprosthetic joint infection (PJI) and its impact on final outcome. A
conservative revision is defined when soft tissues and bone quality enable the
use of primary prosthetic components. Data of patients treated for chronic hip
PJI who underwent two-stage revision between 2009 and 2016 and had a minimum of
2 years of follow-up were collected. Oxford Hip Score (OHS), Harris Hip Score
(HHS) and radiological and microbiological data were retrieved and analysed.
Clinical and functional outcome, survival, mortality, eradication, reinfection
and re-revision rates within subgroups of patients with primary components and
revision components are reported herein. A total of 148 patients underwent
two-stage hip exchange with a mean follow-up of 55.6 ± 23.1 months and a mean
age at surgery of 64.3 ± 12.7 years. Forty-four percent of patients underwent
conservative revision. The mean HHS significantly improved from 40.6 ± 9.4
points to the final value of 87.8 ± 10.5 points (p = .002), and the mean OHS
went from 20.3 ± 3.8 points to 40.3 ± 5. points (p< .001). Patients who were
treated with primary components or isolated revision stems in the second stage
had a significant reduction in surgical times (p< .001). The mortality rate
for all causes of death was 6.8%, the eradication rate was 89.9%, the
reinfection rate was 4.7% and the reoperation rate was 7.4% without differences
between conservative and non-conservative revisions. Two-stage exchange
arthroplasty for total hip arthroplasty (THA) PJI is a good strategy that
provides satisfactory results, high eradication rates and no further need for
revision. The conservative two-stage revision in patients with adequate bone
stock represents a feasible option with good results and survival rates.
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Chiarlone F, Cavagnaro L, Zanirato A, Alessio Mazzola M, Lovisolo S, Mosconi L, Felli L, Burastero G. Cup-on-cup technique: a reliable management solution for severe acetabular bone loss in revision total hip replacement. Hip Int 2020; 30:12-18. [PMID: 32907429 DOI: 10.1177/1120700020926932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The management of acetabular bone loss is a challenging problem in revision total hip arthroplasty (rTHA). The goals of treatment are a stable acetabular fixation, implant stability, and restoration of hip centre of rotation.This study aims to report clinical, radiological outcomes and complications at short-term to mid-term follow-up of the cup-on-cup technique in the management of severe acetabular bone loss in rTHA. METHODS We retrospectively reviewed the records of patient receiving rTHA performed with double porous tantalum cup technique in a single Joint Replacement Unit from 2014 to 2017. Objective and subjective clinical scores (Harris Hip Score, Oxford Hip Score, and visual analogue scale), radiological parameters (centre of rotation, leg-length discrepancy, heterotopic ossification, osseointegration, loosening and radiolucencies) and complications were recorded. We analysed the implant survival rate and periprosthetic joint infection rate. RESULTS We included 9 patients (9 hips) with a mean follow-up of 35.3 ± 10.8 months. Functional scores showed a statistically significant improvement at the final follow-up (p < 0.01). All patients rated their surgery as satisfactory. The cup-on-cup construct demonstrated radiological osseointegration with the centre of rotation restoration and leg length discrepancy improvement. In 1 patient, periprosthetic joint infection was diagnosed and treated with suppressive antibiotic therapy. No patients underwent acetabular components revision surgery for any reason. CONCLUSIONS Cup-on-cup technique is a valid and safe solution for reconstruction of selected Paprosky type IIIA and IIIB bone defects with satisfactory clinical and radiographic results at short-term and mid-term follow-up.
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Affiliation(s)
| | - Luca Cavagnaro
- Joint Replacement Unit/Bone Infection Unit, Hospital Santa Corona Pietra Ligure, Pietra Ligure, Italy
| | - Andrea Zanirato
- Orthopaedic Clinic, Hospital Policlinico San Martino, Genova, Italy
| | | | - Stefano Lovisolo
- Orthopaedic Clinic, Hospital Policlinico San Martino, Genova, Italy
| | - Lorenzo Mosconi
- Orthopaedic Clinic, Hospital Policlinico San Martino, Genova, Italy
| | - Lamberto Felli
- Orthopaedic Clinic, Hospital Policlinico San Martino, Genova, Italy
| | - Giorgio Burastero
- Joint Replacement Unit/Bone Infection Unit, Hospital Santa Corona Pietra Ligure, Pietra Ligure, Italy
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