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Huang K, Zeng Y, Zhang Q, Tan J, Li H, Yang J, Xie H, Shen B. Atypical Periprosthetic Femoral Fracture Might be Considered a Distinct Subtype of Atypical Femoral Fracture: A Retrospective Study. Orthop Surg 2024; 16:2454-2463. [PMID: 39072929 PMCID: PMC11456720 DOI: 10.1111/os.14174] [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: 03/29/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE The exact relationship among atypical periprosthetic femoral fractures (APFFs), typical periprosthetic femoral fractures (PFFs), and atypical femur fractures (AFFs) remains unclear. This study aimed to investigate the prevalence of APFFs among PFFs and to identify the clinical characteristics, management, and prognosis that distinguish APFFs from typical PFFs and AFFs to further determine the relationship among these three fracture types. METHODS In this retrospective study, we reviewed the clinical data of 117 consecutive patients who had PFFs after hip arthroplasty between January 2012 and December 2022 and further classified them into an APFF group and a typical PFF group according to the revised ASBMR diagnostic criteria for AFF. Moreover, patients who had subtrochanteric or femoral shaft fractures in the same period and met the diagnostic criteria for AFF were recruited and classified into the AFF group. Demographic information, minor features of AFF, comorbidities, history of medication usage, management, and complications were collected and compared among patients with typical PFFs, APFFs, and AFFs. RESULTS Eleven PFFs were identified as APFFs, and the prevalence of APFFs among PFFs was 9.4%. Significant differences were found in generalized increase in cortical thickness (p = 0.019), prodromal symptoms (p < 0.001), and the incidence of bilateral fractures (p = 0.010) among the groups, where the incidences of these minor features in the APFF group and the AFF group were higher than those in the typical PFF group. Of note, the duration of fracture healing of APFFs was significantly longer than that of typical PFFs and AFFs (p < 0.001 and p = 0.004, respectively). In addition, the APFF group and the AFF group had higher proportions of patients with rheumatoid arthritis (p = 0.004 and p = 0.027, respectively), bisphosphonate (BP) usage (p = 0.026 and p < 0.001, respectively), and longer duration of BP usage (p = 0.003 and p = 0.007, respectively) than the typical PFF group. Furthermore, significant differences were found in management (p < 0.001) and complication rate (p = 0.020) among the groups, and the rate of complications in the APFF group and the AFF group was higher than that in the typical PFF group. CONCLUSIONS APFFs not only fulfilled the mandatory and major diagnostic criteria for AFF but also had many clinical characteristics, management and prognosis distinguishing them from typical PFFs but resembling AFFs; hence, the diagnostic criteria for AFF might be revised to incorporate APFF as a distinct subtype of the condition.
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Affiliation(s)
- Kai Huang
- Department of Orthopedics Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Yi Zeng
- Department of Orthopedics Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Qingyi Zhang
- Department of Orthopedics Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Jie Tan
- Department of Orthopedics Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Hexi Li
- Department of Orthopedics Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Jing Yang
- Department of Orthopedics Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Huiqi Xie
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Bin Shen
- Department of Orthopedics Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Li Y, Cao L. Management of Severe Bone Defects in Femoral Revision following Total Hip Arthroplasty. Hip Pelvis 2024; 36:101-107. [PMID: 38825819 PMCID: PMC11162874 DOI: 10.5371/hp.2024.36.2.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 06/04/2024] Open
Abstract
Treatment of femoral bone defects continues to be a challenge in revision total hip arthroplasty (THA); therefore, meticulous preoperative evaluation of patients and surgical planning are required. This review provides a concise synopsis of the etiology, classification, treatment strategy, and prosthesis selection in relation to femoral bone loss in revision THA. A search of literature was conducted for identification of research articles related to classification of bone loss, management of femoral revision, and comparison of different types of stems. Findings of a thorough review of the included articles were as follows: (1) the Paprosky classification system is used most often when defining femoral bone loss, (2) a primary-length fully coated monoblock femoral component is recommended for treatment of types I or II bone defects, (3) use of an extensively porouscoated stem and a modular fluted tapered stem is recommended for management of types III or IV bone defects, and (4) use of an impaction grafting technique is another option for improvement of bone stock, and allograft prosthesis composite and proximal femoral replacement can be applied by experienced surgeons, in selected cases, as a final salvage solution. Stems with a tapered design are gradually replacing components with a cylindrical design as the first choice for femoral revision; however, further confirmation regarding the advantages and disadvantages of modular and nonmodular stems will be required through conduct of higher-level comparative studies.
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Affiliation(s)
- Yicheng Li
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Li Cao
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Ding ZC, Li H, Huang C, Yuan MC, Cao J, Wang HY, Zhou ZK. Significant Analgesic Benefits of Perioperative Duloxetine in Patients Who Have Depressive Symptoms Undergoing Total Hip Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2023; 38:519-524. [PMID: 36252745 DOI: 10.1016/j.arth.2022.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Major symptoms of depression are commonly observed in patients requiring total hip arthroplasty (THA), and this is associated with increased pain scores and opioid consumption. We aimed to investigate the analgesic effect of duloxetine in these high-risk patients. METHODS Among 263 patients scheduled for primary unilateral THA, 67 patients who scored at least 8 on the 17-item Hamilton Depression Scale (HAMD) were enrolled in this study. Patients were randomized to the duloxetine group (60 mg daily, from the day of surgery to postoperative day 6) or the placebo group. The postoperative visual analog scale (VAS) score during walking, the VAS score during hip flexion, and resting VAS score was measured. Postoperative morphine consumption, hip range of motion (ROM), Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function, postoperative length of stay (LOS), and adverse events were recorded. RESULTS The duloxetine group had significantly lower VAS scores during walking and hip flexion from postoperative day 3 to week 3 than the placebo group. With regard to the resting VAS score, duloxetine showed a better analgesic effect from postoperative day 3 to week 2 than placebo. Patients in the duloxetine group had less consumption of morphine. The duloxetine group exhibited better hip function scores, including ROM, HHS, and WOMAC function scores than the placebo group. No significant difference was observed in LOS or adverse events between groups. CONCLUSION Perioperative short-term duloxetine provides advantages in decreasing pain, reducing morphine consumption, and increasing hip function in THA patients who have depressive symptoms.
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Affiliation(s)
- Zi-Chuan Ding
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Hao Li
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China; Department of Joint Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Chao Huang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Ming-Cheng Yuan
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Jian Cao
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Hao-Yang Wang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
| | - Zong-Ke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
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Revision Hip Arthroplasty Using a Modular, Cementless Femoral Stem: Long-Term Follow-Up. J Arthroplasty 2022; 38:903-908. [PMID: 36535440 DOI: 10.1016/j.arth.2022.12.018] [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: 08/10/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND As the number of primary total hip arthroplasty (THA) cases increase, so does the demand for revision operations. However, long-term follow-up data for revision THA is lacking. METHODS A retrospective review was completed of patients who underwent revision THA at a single institution between January 2002 and October 2007 using a cementless modular stem. Patient demographic, clinical, and radiographic data was collected. Preoperative and postoperative patient-reported outcome scores were compared at a minimum of fourteen-year follow-up. RESULTS Eighty-four patients (89 hips) with a median age of 69 years (range, 28 to 88) at operation were included. Indications for revision included aseptic loosening (84.2%), infection (12.4%), and periprosthetic fracture (3.4%). Twenty-two hips sustained at least 1 complication: intraoperative fracture (7.9%), dislocation (6.7%), prosthetic joint infection (4.5%), deep venous thrombosis (3.4%), and late periprosthetic fracture (2.2%). There were no modular junction complications. Eight patients underwent reoperations; only three involved the stem. Thirty-eight patients (45%) were deceased prior to final follow-up without known reoperations. Twenty-seven patients (32%) were lost to follow-up. Twenty-one patients (23%) were alive at minimum fourteen-year follow-up. Complete patient-reported outcomes were available for nineteen patients (range, 14 to 18.5 years of follow-up). Significant improvement was seen in UCLA activity, VR-12 physical, hip disability and osteoarthritis outcome score , joint replacement., and Harris Hip score pain and function scores. CONCLUSION Challenges of long-term follow-up include patient migration, an unwillingness to travel for re-examination, medical comorbidities, advanced age, and death. The cementless modular revision stem demonstrated long-term clinical success and remains a safe and reliable option for complex revision operations.
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Ding Z, Li J, Xu B, Cao J, Li H, Zhou Z. Preoperative High Sleep Quality Predicts Further Decrease in Length of Stay after Total Joint Arthroplasty under Enhanced Recovery Short-stay Program: Experience in 604 Patients from a Single Team. Orthop Surg 2022; 14:1989-1997. [PMID: 35855669 PMCID: PMC9483073 DOI: 10.1111/os.13382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/16/2022] [Accepted: 06/04/2022] [Indexed: 02/05/2023] Open
Abstract
Objective To investigate the safety, efficiency and cost of total joint arthroplasty (TJA) under the enhanced recovery after surgery (ERAS) program and identify predictors facilitating further decrease in length of stay (LOS). Methods We retrospectively collected the information of patients who underwent primary unilateral TJA by a single surgical team between January 2017 and June 2019. A total of 604 patients with LOS ≤ 3 was enrolled in this study. All patients completed 12‐month or longer follow‐up. Patients received the same ERAS protocol, mainly including preoperative preparation (patient education, preoperative functional exercises, nutritional support), blood management, pain management, sleep management, prevention of infection, prevention of thrombosis and strict discharge criteria. Preoperative characteristics of patients were collected from the medical record system and were compared between the LOS ≤ 2 group and the LOS = 3 group. Factors with significant difference were included in multivariate logistic regression analysis to find independent preoperative predictors for LOS. Joint function at the latest follow‐up, adverse events rate and hospitalization costs were compared between the LOS ≤ 2 group and the LOS = 3 group. Results Of the enrolled 604 patients, 271 patients (44.9%) had a LOS of 2 days or less while 333 patients (55.1%) had a LOS of 3 days. Pittsburgh Sleep Quality Index score (odds ratio [OR] = 1.084, 95% confidence interval [CI] = 1.024–1.147, P = 0.005), preoperative albumin level (OR = 0.945, 95% CI = 0.905–0.988, P = 0.012), digestive diseases (OR = 1.084, 95% CI = 1.024–1.147, P = 0.005) and total hip arthroplasty (THA) (OR = 0.273, 95% CI = 0.170–0.439, P < 0.001) were predictors of LOS ≤ 2 in the multivariate logistic analysis model. The postoperative joint function scores and adverse event rates were comparable between the LOS ≤ 2 group and the LOS = 3 group. The hospital costs were lower in the LOS ≤ 2 group than the LOS = 3 group. Conclusion Under the rigorous ERAS program, 2‐day discharge in unselected TJA patients can be routinely applied. Patients with high preoperative sleep quality, high preoperative albumin level, free of digestive disease and undergoing THA procedure are more likely to be discharged within 2 days.
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Affiliation(s)
- Zichuan Ding
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P. R. China
| | - Jinlong Li
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, P. R. China
| | - Bing Xu
- Department of Orthopedics, Chengdu Second People's Hospital, Chengdu, P. R. China
| | - Jian Cao
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P. R. China
| | - Hao Li
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P. R. China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P. R. China
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Nomura J, Takezawa A, Zhang H, Kitamura M. Design optimization of functionally graded lattice infill total hip arthroplasty stem for stress shielding reduction. Proc Inst Mech Eng H 2022; 236:9544119221075140. [PMID: 35139695 DOI: 10.1177/09544119221075140] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Reducing stress shielding of stem-inserted femurs in total hip arthroplasty caused by the high stiffness of the stem is an emerging medical engineering issue. In this study, a numerical design optimization methodology lattice infill stem was developed to realize a stem, balancing the low stiffness and strength requirements. Two pairs of models and loading conditions were introduced for the stress shielding and strength criteria. The objective function was set as the weighted sum of the criteria. Its effective density distribution was optimized by handling the representative size of the lattice as a design variable, assuming that the so-called body-centered cubic lattice was the base shape of the lattice. In the optimization, the approximated model of the lattice was handled as a solid material with the effective physical properties of the lattice derived by the homogenization method. After optimization, the detailed lattice stem geometry was modeled based on the obtained optimal lattice distribution, and the actual performance was numerically evaluated. The developed stem increased the stress applied to the remaining femur by 32.4% compared with the conventional stem.
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Affiliation(s)
- Jumpei Nomura
- Division of Advanced Science and Engineering, Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
| | - Akihiro Takezawa
- Department of Applied Mechanics and Aerospace Engineering, School of Fundamental Science and Engineering, Waseda University, Tokyo, Japan
| | - Heng Zhang
- Department of Applied Mechanics and Aerospace Engineering, School of Fundamental Science and Engineering, Waseda University, Tokyo, Japan
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Mitsuru Kitamura
- Division of Advanced Science and Engineering, Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
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Zhang X, Tang X, Li Z, Zhang X, Li F, Tao C, Liu T. Clinical and radiological outcomes of combined modular prothesis and cortical strut for revision proximal femur in giant cell tumor of bone patients. J Orthop Surg (Hong Kong) 2022; 30:10225536221095202. [PMID: 35491561 DOI: 10.1177/10225536221095202] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Femoral bone deficiency is a challenging problem in revision proximal femoral replacement. The purpose of this study is to evaluate the clinical and radiological outcomes of revision proximal femoral replacement as a salvage treatment for severe bone loss after oncologic proximal replacement surgery in patient with benign giant cell tumor of bone. METHODS 16 patients (6 men and 10 women) were included in this retrospective study, with a mean age of 46.6 year at the time of revision surgery. All patients underwent revision proximal femoral replacement with the use of modular prosthesis and cortical strut allografts. The modified Harris Hip Score, Short Form 36, and musculoskeletal Tumor Society Score were used for patient evaluation. Regular follow-up was performed to evaluate the recurrence and metastases rate, limb function, and long-term complications of patients. RESULTS The average follow-up was 46.3 months (range, 26-75 months), during which there was no local recurrence and metastases of patient. At the latest follow-up, the mean modified Harris Hip Score was 70.6 points, which was significantly improved compared with that of preoperative (p < 0.05). The final follow-up results of Short Form 36, Musculoskeletal Tumor Society Score, and limb-length discrepancy were also significantly improved compared to that of preoperative (p < 0.05). At the latest follow-up, the implanted femoral stems were all stable and all cortical strut allografts were also incorporated to their own bone. CONCLUSION Using modular prosthesis and cortical strut allografts in revision, proximal femur replacement is an acceptable procedure for relatively young patient with severe proximal femoral bone loss after oncologic surgery with benign giant cell tumor of bone. More attentions should be paid to reduce the risk of complications in these complex reconstructions.
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Affiliation(s)
- Xianghong Zhang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Orthopedics, Liuzhou General Hospital of Guangxi Medical University, Liuzhou, China
| | - Xianzhe Tang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Orthopedics, Chenzhou No. 1 People's Hospital, Chenzhou, China
| | - Zhihong Li
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiangsheng Zhang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Fuming Li
- Department of Orthopedics, Liuzhou General Hospital of Guangxi Medical University, Liuzhou, China
| | - Cheng Tao
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tang Liu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China
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Kim YH, Jang YS, Park JW, Kim EJ. Combined Strut Onlay Allografting, Reduction Osteotomy, and Extensively Porous-Coated Stem for Reconstruction of Severe Femoral Defects During Revision Hip Arthroplasty. J Arthroplasty 2021; 36:3722-3727. [PMID: 34392992 DOI: 10.1016/j.arth.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/18/2021] [Accepted: 07/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to determine the long-term (up to 27 years) results of a modified technique applying strut allografts combined with a reduction osteotomy over an extensively porous-coated stem. METHODS We reviewed the results of 399 revision total hip arthroplasties (for aseptic loosening in 390 hips and septic loosening in 9 hips) in 369 patients (mean age 58 ± 13 years, range 22-65) performed with an extensively porous-coated femoral stem combined with a cortical strut onlay allograft. The mean follow-up was 23 years (range 20-27). RESULTS The mean Harris Hip Score was 84 ± 16 points (range 35-100) at the final follow-up. The mean Western Ontario and McMaster Universities Osteoarthritis Index score was 21 ± 16 points (range 12-53) at the final follow-up. The mean University of California Los Angeles activity score was 6.1 points (range 5-8). A Kaplan-Meier survivorship analysis at 23 years of follow-up showed that the survival rate of the femoral component was 95.5% (95% confidence interval 89-98) with aseptic loosening or revision for any reason and it was 91.5% (95% confidence interval 85-95) if septic loosening was included. CONCLUSION We found good results in terms of longevity and functional outcome using this modified technique. Future mechanical studies in addition to controlled clinical studies are warranted.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Young-Soo Jang
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Eun-Jung Kim
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
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Hasegawa M, Tone S, Naito Y, Wakabayashi H, Sudo A. Minimum ten-year results in revision total hip arthroplasty using titanium fully porous long stem. INTERNATIONAL ORTHOPAEDICS 2021; 45:1727-1733. [PMID: 33825004 DOI: 10.1007/s00264-021-05030-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/29/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE The fully porous long stem could be used for diaphyseal locking and achieve bypass fixation in revision total hip arthroplasty (THA). This study evaluated long-term results for fully porous long stems made of titanium alloy in revision THA. METHODS Between 2003 and 2010, 45 consecutive femoral revisions were performed using fully porous long stems. Thirty-eight hips had complete clinical and radiographic data for a mean of 13.8 years (range, 10-16.7 years). Femoral bone loss was Paprosky type II in 14 hips, type IIIA in 18 hips, and type IIIB in six hips. Clinical results were analyzed using the Merle d'Aubigné and Postel scoring system. Femoral stress shielding was graded. Radiological loosening of the femoral component was evaluated. Kaplan-Meier survival analysis was performed with revision for any reason as the end-point. RESULTS Mean Merle d'Aubigné and Postel score improved significantly from 10.7 before revision to 14.5 at latest follow-up (p < 0.001). Third-degree stress shielding was found in seven hips, and fourth degree in 11 hips. Radiological femoral loosening occurred in one hip, which was revised. Another hip was revised for stem fracture. Kaplan-Meier cumulative survival rate was 94.7% at both ten and 15 years. CONCLUSION Although stress shielding is a concern with fully porous stems, this stem was useful in revision THA and provided satisfactory long-term results in hips with Paprosky types II, IIIA, and IIIB.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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Ilyas I, Al-Mohrej OA. High Incidence of Irradiated Cortical Strut Allograft Resorption Following Revision of Femoral Stems. J Arthroplasty 2021; 36:1413-1419. [PMID: 33158636 DOI: 10.1016/j.arth.2020.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the widespread use of revision total hip arthroplasties using cementless stems and cortical strut allografts, graft resorption has not been explicitly studied. METHODS Between 2010 and 2018, 40 femoral strut grafts were used in the revision of femoral stems of 36 patients (18 males and 18 females; average age, 51.9 ± 12.9 years). The mean follow-up was 78.9 ± 37.3 months. Failure was defined as revision surgery for any reason and subsidence of greater than 5 mm. RESULTS The survival rate of the stem without the need for revision at 5 years was 95% (mean graft survival time, 10.8 [95% CI, 9.414-12.234] years). Overall survival with graft resorption as the endpoint was 90% at 5 years (mean graft survival time, 8.8 [95% CI, 7.5-10.2] years). Survival with graft nonunion as the endpoint was 90% at 3 years (mean survival time, 11.7 [95% CI, 10.5-12.8] years). CONCLUSION The resorption rate increases proportionally to the follow-up duration and can be very severe in a high percentage of cases. Long-term multicenter studies are required to assess the effect of resorption on prosthesis longevity.
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Affiliation(s)
- Imran Ilyas
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Omar A Al-Mohrej
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Cortical strut allografts in salvage revision arthroplasty: Surgical technique and clinical outcomes. J Clin Orthop Trauma 2021; 17:37-43. [PMID: 33680839 PMCID: PMC7919927 DOI: 10.1016/j.jcot.2021.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/30/2021] [Accepted: 01/30/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The aim of this study was to present our clinical outcomes and surgical technique in strut allografts preparation using staggered holes to enhance osteointegration and demineralised bone matrix (DBM) as an adjunct to cortical strut allografts in salvage revision arthroplasty patients. METHODS Retrospective consecutive series of patients who required strut allograft femoral reconstructions with minimum 2 years follow up between 2012 and 2018. Frozen washed irradiated, cortical struts were used and prepared adding 2 mm staggered drill holes along the length of the strut and applying DBM paste on the graft-host interface. Outcome measures included radiographic strut union, graft resorption, infection and complications. RESULTS 15 patients included; 3 males and 12 females with median age 72 years (range 60-93). All had significant bony defects (Paprosky III/IV in 12 cases including 3 cases of periprosthetic hip fractures and further 3 cases of periprosthetic knee fractures around revision hinged implants). At final follow up, median 3.8 years (range 2.7-7.2), 14/15 (93.3%) struts had united at a median 6 months (range 5-8), complete incorporation with cortical round-off was seen at median 12 months (range 8-48) in 12/15 (80%) struts, 2/15 (13.3%) show radiographic evidence of proximal minimal graft resorptions although the remainder of the strut had integrated and were asymptomatic. There were no cases of infection. CONCLUSIONS Use of strut allografts helps to reconstruct bone defects, restore bone stock, and provide stable fixation for complex patterns of periprosthetic fractures around hip/knee implants and salvage revision cases with 93.3% union rate at median 6 months.
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Ding Z, Ling T, Mou P, Wang D, Zhou K, Zhou Z. Bone restoration after revision hip arthroplasty with femoral bone defects using extensively porous-coated stems with cortical strut allografts. J Orthop Surg Res 2020; 15:194. [PMID: 32460781 PMCID: PMC7254662 DOI: 10.1186/s13018-020-01720-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/20/2020] [Indexed: 02/08/2023] Open
Abstract
Background Stress shielding and bone loss of the femur are of great concern after revision total hip arthroplasty (THA) with extensively porous-coated stems, especially in a femur with already bone loss. The femoral bone remodeling patterns after revision THA with femoral bone defects using extensively porous-coated stems with cortical strut allografts remain unclear. Methods We retrospectively reviewed 47 patients who underwent revision THA using extensively porous-coated stems combined with cortical strut allografts and 75 patients without allografts. The minimum follow-up was 2 years. Femoral bone remodeling signs, including stress shielding, bone restoration in bone defect area, distal cortical hypertrophy, and femoral width, were compared between patients with and without cortical strut allografts. Clinical outcomes were also compared between two groups. Results Patients with cortical strut allografts showed less severe stress shielding (P = 0.01) than patients without allografts. Patients with allografts had more osseous restoration in bone defect area than patients without allografts (63.8% vs 30.7%, P < 0.001). Femoral width was significantly higher in femur with allografts than in femur without allografts at the immediate postoperative stage and latest follow-up (both P < 0.001). The hip function score, re-revision rate, and complications were comparable between two groups. Conclusion The application of cortical strut allografts can decrease the severity of stress shielding, augment osseous restoration in bone defect area and improve femoral bone stock after revision THA using extensively porous-coated stems.
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Affiliation(s)
- Zichuan Ding
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People's Republic of China
| | - Tingxian Ling
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People's Republic of China
| | - Ping Mou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People's Republic of China
| | - Duan Wang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People's Republic of China
| | - Kai Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People's Republic of China.
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