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Bicortical Contact Predicts Subsidence of Modular Tapered Stems in Revision Total Hip Arthroplasty. J Arthroplasty 2020; 35:2195-2199. [PMID: 32327285 DOI: 10.1016/j.arth.2020.03.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/18/2020] [Accepted: 03/26/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We describe the intraoperative parameters that affect stem subsidence rates in tapered modular femoral stems for revision total hip arthroplasty (THA). We also determine the effect of the stem bicortical contact on subsidence rates and whether there is a minimum threshold bicortical contact that must be achieved to avoid the complication of subsidence. METHODS This is a retrospective cohort study consisting of 109 hips in 105 patients (53 males and 52 females) at a minimum of 2 years of follow-up. All revisions were carried out for Paprosky type 3A and 3B femoral deficits. Clinical outcomes included the indication for revision, aseptic re-revision surgery, specifications of the stem inserted, and specifications of the femoral head and acetabular components implanted. Radiographic outcome measures included subsidence (mm) and bicortical contact (mm). RESULTS Using multivariate regression analysis, 3 parameters were associated with an increased rate of stem subsidence. A reduced bicortical contact distance (P < .001) and a stem length of ≤155 mm (P < .001) were both associated with higher subsidence rates. We also demonstrated a novel threshold of 20-mm bicortical contact which must be achieved to significantly reduce subsidence rates in these modular femoral stems for revision THA. CONCLUSION Subsidence rates of modular tapered femoral stems for revision THA can be significantly reduced by increasing the initial bicortical contact of the stem within the diaphysis and the overall length of the femoral stem >155 mm. We describe a minimum threshold bicortical contact distance of 20 mm that should ideally be exceeded to significantly reduce the risk of stem subsidence within the femoral canal.
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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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Ding ZC, Ling TX, Yuan MC, Qin YZ, Mou P, Wang HY, Zhou ZK. Minimum 8-year follow-up of revision THA with severe femoral bone defects using extensively porous-coated stems and cortical strut allografts. BMC Musculoskelet Disord 2020; 21:218. [PMID: 32268894 PMCID: PMC7140549 DOI: 10.1186/s12891-020-03250-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/30/2020] [Indexed: 02/08/2023] Open
Abstract
Background Revision total hip arthroplasty (THA) with severe femoral bone defects remains a major challenge. The purpose of this study is to report the minimum 8-year clinical and radiographic results of revision THA with severe femoral bone defects treated with extensively porous-coated stems and cortical strut allografts. Methods We retrospectively identified 44 patients diagnosed with Paprosky type III and IV femoral bone defects between January 2006 and July 2011. The exclusion criteria were patients not eligible for surgery, revised with extensively porous-coated stems alone, lost to follow-up and deceased. A total of 31 patients treated with extensively porous-coated stems and cortical strut allografts were finally included in this study. The degree of femoral bone defects was categorized as Paprosky type IIIA in 19 patients, type IIIB in 9 patients and type IV in 3 patients. The mean duration of follow-up was 11.0 ± 1.5 (range, 8.1–13.5) years. Results The mean Harris Hip Score improved significantly from 43.4 ± 10.5 points to 85.2 ± 6.6 points (P < 0.001). Similarly, WOMAC and SF-12 scores also significantly improved. Twenty-eight stems achieved stable bone ingrowth, two stems showed stable fibrous ingrowth, and one stem was radiologically unstable. Complete union and bridging between cortical strut allografts and host bone was achieved in all 31 patients. The femoral width was augmented with cortical strut allografts after revision surgery (an increase of 10.5 ± 0.5 mm) and showed a slight decrease of 2.5 ± 4.8 mm after the 10-year follow-up. Using re-revision for any reason as an endpoint, the Kaplan-Meier cumulative survival rate of the stem was 96.2% (95% confidence interval, 75.7–99.5%) at 10 years. Conclusion Our data demonstrate that the use of extensively porous-coated stems combined with cortical strut allografts in revision THA with Paprosky type III and IV femoral bone defects can provide satisfactory clinical and radiographic outcomes with a minimum follow-up of 8 years.
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Affiliation(s)
- Zi-Chuan Ding
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, P.R. China
| | - Ting-Xian Ling
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, P.R. China
| | - Ming-Cheng Yuan
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, P.R. China
| | - Yong-Zhi Qin
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, P.R. China.,Department of Orthopaedics, The People's Hospital of Guang'an City, 1# the Fourth Section of Bin He Road, Guang'an, P.R. China
| | - Ping Mou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, P.R. China
| | - Hao-Yang Wang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, P.R. China
| | - Zong-Ke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, P.R. China.
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Sheth NP, Melnic CM, Rozell JC, Paprosky WG. Management of severe femoral bone loss in revision total hip arthroplasty. Orthop Clin North Am 2015; 46:329-42, ix. [PMID: 26043047 DOI: 10.1016/j.ocl.2015.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Femoral bone loss is a complex problem in revision total hip arthroplasty. The Paprosky classification is used when determining the degree and location of bone loss. Meticulous operative planning is essential where severe bone loss is a concern. One must correctly identify the bone loss pattern, safely remove the existing components, and proceed with the proper reconstruction technique based on the pattern of bone loss. This article discusses the etiology and classification of bone loss, clinical and radiographic evaluation, components of effective preoperative planning, and clinical results of various treatment options with a focus on more severe bone loss patterns.
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Affiliation(s)
- Neil P Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania, 800 Spruce Street, 8th Floor Preston Building, Philadelphia, PA 19107, USA
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA 19104, USA.
| | - Joshua C Rozell
- Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA 19104, USA
| | - Wayne G Paprosky
- Department of Orthopaedic Surgery, Midwest Orthopaedics, Rush University, 1655 West Harrison Street, Chicago, IL 60612, USA
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Tangsataporn S, Safir OA, Vincent AD, Abdelbary H, Gross AE, Kuzyk PRT. Risk Factors for Subsidence of a Modular Tapered Femoral Stem Used for Revision Total Hip Arthroplasty. J Arthroplasty 2015; 30:1030-4. [PMID: 25701193 DOI: 10.1016/j.arth.2015.01.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/30/2014] [Accepted: 01/11/2015] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to determine the incidence, and the clinical and radiographic risk factors for significant subsidence of a cementless, modular tapered revision femoral stem. Femoral stem subsidence of at least 10 mm or subsidence requiring revision was considered significant subsidence. Ninety-seven patients (99 hips) were included with minimum radiographic follow-up of one year (mean 34 months; range, 12-91 months). The mean stem subsidence was 4.5 mm (range, 0-44 mm). Fourteen out of 99 (14.1%) stems had significant subsidence and 6 (6.1%) stems required revision due to subsidence. Patient weight greater than 80 kg (P=0.04) and femoral stem press-fit distance of less than 2 cm (P<0.01) were both independent risk factors for significant stem subsidence.
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Affiliation(s)
- Suksan Tangsataporn
- Mount Sinai Hospital, Toronto, Ontario, Canada; University of Toronto, Division of Orthopaedic Surgery, Department of Surgery, Toronto, Ontario, Canada
| | - Oleg A Safir
- Mount Sinai Hospital, Toronto, Ontario, Canada; University of Toronto, Division of Orthopaedic Surgery, Department of Surgery, Toronto, Ontario, Canada
| | - Alexander D Vincent
- Mount Sinai Hospital, Toronto, Ontario, Canada; University of Toronto, Division of Orthopaedic Surgery, Department of Surgery, Toronto, Ontario, Canada
| | - Hesham Abdelbary
- Mount Sinai Hospital, Toronto, Ontario, Canada; University of Toronto, Division of Orthopaedic Surgery, Department of Surgery, Toronto, Ontario, Canada
| | - Allan E Gross
- Mount Sinai Hospital, Toronto, Ontario, Canada; University of Toronto, Division of Orthopaedic Surgery, Department of Surgery, Toronto, Ontario, Canada
| | - Paul R T Kuzyk
- Mount Sinai Hospital, Toronto, Ontario, Canada; University of Toronto, Division of Orthopaedic Surgery, Department of Surgery, Toronto, Ontario, Canada
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The management of femoral bone stock in THA revision: indications and techniques. Hip Int 2014; 24 Suppl 10:S37-43. [PMID: 24970033 DOI: 10.5301/hipint.5000174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2014] [Indexed: 02/04/2023]
Abstract
Following the increasing number of total hip arthroplasties, the amount of hip revision procedures continue to rise. Careful patient selection and bone loss evaluation is crucial for a correct management of femoral revision procedures. The key point in femoral revision is to obtain a reliable primary stability of the stem, with the least invasive implant as possible, to preserve and if possible to restore the bone stock. In this article we present the indications and the techniques for the femoral revisions most commonly used in Europe, referring to the evidence in the literature and our personal experiences.
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Fölsch C, Mittelmeier W, von Garrel T, Bilderbeek U, Timmesfeld N, Pruss A, Matter HP. Influence of thermodisinfection and duration of cryopreservation at different temperatures on pull out strength of cancellous bone. Cell Tissue Bank 2014; 16:73-81. [PMID: 24692177 DOI: 10.1007/s10561-014-9442-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 03/21/2014] [Indexed: 12/30/2022]
Abstract
Thermodisinfection of human femoral heads from living donors harvested during hip joint replacement is an established processing procedure. This study was designed to examine the influence of heat sterilization on pull out strength of cancellous bone and storage at different temperatures up to 2 years since we had previously studied the storage of unprocessed cancellous bone. Porcine cancellous bone resembling human bone structure was obtained from 140 proximal humerus of 6-8 months old piglets. Pull out strength of screws after thermodisinfection was compared with unprocessed cancellous bone and tested immediately and after 6, 12 and 24 months of storage at -20 and -80 °C. A three-way ANOVA was performed and significance level was 5 %. The thermodisinfected bone showed a pull out force of 2729 N (1657-3568 N). The reduction of pull out strength compared with unprocessed bone over all periods of storage was 276 N on average with 95 % confidence interval ranging from 166 N to 389 N (p < 0.0001). Different freezing temperatures did not influence this mechanic property within 24 months storage and showed no difference compared with fresh frozen bone. Thermodisinfection of cancellous bone preserves tensile strength necessary for clinical purposes. The storage at -20 °C for at least 2 years did not show relevant decrease of pull out strength compared with -80 °C without difference between thermodisinfected and fresh frozen bone. The increase of the storage temperature to -20 °C for at least 2 years should be considered.
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Affiliation(s)
- Christian Fölsch
- Department of Orthopaedic Surgery, Philipps University Medical School, Philipps University Marburg, Baldingerstrasse, 35043, Marburg, Germany,
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Petri M, Namazian A, Wilke F, Ettinger M, Stübig T, Brand S, Bengel F, Krettek C, Berding G, Jagodzinski M. Repair of segmental long-bone defects by stem cell concentrate augmented scaffolds: a clinical and positron emission tomography--computed tomography analysis. INTERNATIONAL ORTHOPAEDICS 2013; 37:2231-7. [PMID: 24013459 DOI: 10.1007/s00264-013-2087-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/14/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE Treating segmental long-bone defects remains a major challenge. For defects >3 cm, segmental transport represents the gold standard, even though the method is time consuming and afflicted with several complications. The aim of this study was to evaluate healing of such defects after grafting an osteogenic scaffold previously seeded with stem cell concentrate. METHODS We evaluated five patients with segmental long-bone defects (3-14 cm) treated with bone marrow aspirate concentrates (BMAC) seeded onto a bovine xenogenous scaffold. The healing process was monitored by X-rays and positron emission tomography-computed tomography (PET-CT) three months after surgery. RESULTS Centrifugation led to a concentration of leukocytes by factor 8.1 ± 7.5. Full weight bearing was achieved 11.3 ± 5.0 weeks after surgery. PET analysis showed an increased influx of fluoride by factor 8.3 ± 6.4 compared with the contralateral side (p < 0.01). Bone density in the cortical area was 75 ± 16 % of the contralateral side (p < 0.03). The patient with the largest defect sustained an implant failure in the distal femur and finally accomplished therapy by segmental transport. He also had the lowest uptake of fluoride of the patient collective (2.2-fold increase). CONCLUSION Stem cell concentrates can be an alternative to segmental bone transport. Further studies are needed to compare this method with autologous bone grafting and segmental transport.
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Affiliation(s)
- Maximilian Petri
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Germany,
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