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Cabrolier J, Ceballos O, Rieloff F, Hardoy F, Tolosa R, Wevar O. Clinical outcomes of total femoral replacement. First Latin American experience. Surg Oncol 2024; 53:102038. [PMID: 38316087 DOI: 10.1016/j.suronc.2024.102038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/28/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION The femur is frequently affected by primary and metastatic bone tumors. In cases with substantial bone loss, Total Femur Replacement (TFR) remains the only viable limb preservation option. This study investigates the clinical outcomes of TFR patients in a Latin American setting, with a minimum 3-year follow-up. METHODS Retrospective review identifying cases of TFR at a single center from 2009 to 2020. Patients who had TFR either due to oncological indications or complications arising from oncology-related surgeries were included. Data on the indications for surgery and post-operative complications were recorded. To assess functional status, the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS) were used. RESULTS Fourteen patients met the inclusion criteria. Diagnoses included eight osteosarcomas, four chondrosarcomas, one Ewing sarcoma, and one giant cell tumor. Ten patients had undergone prior surgeries. Indication for TFR was a complication of a previous surgery in 78.6 % of cases. Post-TFR complications were experienced by 35.7 % of patients, requiring further surgeries. At the 3-year mark, average MSTS and TESS scores were 67.4 % and 70.8 %, respectively. CONCLUSION Total femur replacement serves as a valuable limb salvage solution for patients with significant femoral defects in oncological scenarios, however, there is a significant risk of complications. Given its potential benefits, it is essential for developing countries to consider incorporating TFR into their healthcare systems.
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Affiliation(s)
- Jorge Cabrolier
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martin 771, 8340220, Santiago, Región Metropolitana, Chile; Clinica Alemana - Universidad Del Desarrollo, Av Vitacura 5951, 7640745, Vitacura, Region Metropolitana, Chile.
| | - Oscar Ceballos
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martin 771, 8340220, Santiago, Región Metropolitana, Chile; Clínica Santa Maria, Bellavista 0415, 7520349, Providencia, Región Metropolitana, Chile.
| | - Fabiola Rieloff
- Hospital Santa Cruz, Federico Errazuriz 920, 3130671, Santa Cruz, O'Higgins, Chile.
| | - Francisco Hardoy
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martin 771, 8340220, Santiago, Región Metropolitana, Chile; Clínica Davila, Avenida Recoleta 464, Recoleta, Región Metropolitana, Chile.
| | - Ricardo Tolosa
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martin 771, 8340220, Santiago, Región Metropolitana, Chile; Clínica Davila, Avenida Recoleta 464, Recoleta, Región Metropolitana, Chile.
| | - Orlando Wevar
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martin 771, 8340220, Santiago, Región Metropolitana, Chile; Clínica Santa Maria, Bellavista 0415, 7520349, Providencia, Región Metropolitana, Chile.
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Ribera J, Payo-Ollero J, Serrano-Toledano D, Del Río-Arteaga M, Montilla FJ, Muela R. Megaprosthesis use in Paprosky III/IV femoral defects in non-oncological patients: analysis of survival, clinical, and functional outcomes after an average follow-up of five years. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1183-1192. [PMID: 38006463 DOI: 10.1007/s00590-023-03783-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/01/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE To determine the survival and patient-reported outcomes in non-oncological patients treated with proximal femoral resection (PFR) using MEG for femoral reconstruction. MATERIALS AND METHODS This retrospective study included 16 patients. Demographic variables and complications developed were analyzed. Clinical-functional outcomes were measured using the modified Harris score (mHSS), numeric Pain Rating Scale (NPRS) and Musculoskeletal Tumor Society (MSTS) score. MEG survival was estimated using a Kaplan-Meier survival analysis. RESULTS Average follow-up was 5 years (range, 1-9). The 75% of patients were overweight and women with an average age of 74.2 ± 5.9-years (BMI of 28.5 ± 4.2 kg/m2). The main cause of MEG was periprosthetic infection (43.7%). The 50% of patients had post-surgical complications regarding with MEG, being the most frequent seromas and MEG dislocation. Implant survival was 93.4% and 80.9% at 3 and 7 years of follow-up, respectively. The functional results at the end of the follow-up with respect to the pre-surgical state improved from 9.5 ± 2.6 to 3 ± 0.9 mean NPRS and 26.5 ± 6.8 to 69.5 ± 13.5 mean mHHS, p < 0.001, respectively. The mean MSTS score was 68.1% that these results were considered excellent. CONCLUSIONS The MEG for reconstruct III-IV femoral defects is a good therapeutic option that offers an acceptable clinical-functional result. Short-term and medium-term survival was greater than 80%. The most frequent complications are seromas and MEG dislocation. The use of constrained liner and abductor system reconstruction is essential to prevent the dislocation.
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Affiliation(s)
- Juan Ribera
- Clínica COT. C/ Juan Ramón, Jiménez 29, 41011, Seville, Spain
- Hospital Viamed Santa Ángela de La Cruz. Orthopaedic Surgery and Traumatology Department. Av. de Jerez, 59, 41014, Seville, Spain
| | - Jesús Payo-Ollero
- Clínica COT. C/ Juan Ramón, Jiménez 29, 41011, Seville, Spain.
- Hospital Viamed Santa Ángela de La Cruz. Orthopaedic Surgery and Traumatology Department. Av. de Jerez, 59, 41014, Seville, Spain.
| | - David Serrano-Toledano
- Clínica COT. C/ Juan Ramón, Jiménez 29, 41011, Seville, Spain
- Hospital Viamed Santa Ángela de La Cruz. Orthopaedic Surgery and Traumatology Department. Av. de Jerez, 59, 41014, Seville, Spain
| | - Marta Del Río-Arteaga
- Clínica COT. C/ Juan Ramón, Jiménez 29, 41011, Seville, Spain
- Hospital Viamed Santa Ángela de La Cruz. Orthopaedic Surgery and Traumatology Department. Av. de Jerez, 59, 41014, Seville, Spain
| | - Francisco Javier Montilla
- Clínica COT. C/ Juan Ramón, Jiménez 29, 41011, Seville, Spain
- Hospital Viamed Santa Ángela de La Cruz. Orthopaedic Surgery and Traumatology Department. Av. de Jerez, 59, 41014, Seville, Spain
| | - Rafael Muela
- Clínica COT. C/ Juan Ramón, Jiménez 29, 41011, Seville, Spain
- Hospital Viamed Santa Ángela de La Cruz. Orthopaedic Surgery and Traumatology Department. Av. de Jerez, 59, 41014, Seville, Spain
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Zou Z, Zou J, Zhang W, Tian K. Total femoral replacement for periprosthetic knee joint infection combined with large bone defect:A case report. Asian J Surg 2023; 46:5792-5794. [PMID: 37661478 DOI: 10.1016/j.asjsur.2023.08.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Zaijun Zou
- Department of Joint and Sports Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, China; School of Graduates, Dalian Medical University, Dalian, Liaoning, 116000, China.
| | - Jiyang Zou
- Department of Joint and Sports Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, China.
| | - Weiguo Zhang
- Department of Joint and Sports Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, China.
| | - Kang Tian
- Department of Joint and Sports Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, China.
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Corces A, Heifner J, Zavurov G. A Custom Device to Couple Proximal and Distal Femoral Stems: A Case Report and Literature Review. Arthroplast Today 2023; 19:101089. [PMID: 36713938 PMCID: PMC9873500 DOI: 10.1016/j.artd.2022.101089] [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: 12/03/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 01/20/2023] Open
Abstract
Complex periprosthetic fractures may occur with existing ipsilateral hip and knee implants. These cases are challenging with few options. We report on a custom coupler used to connect a hinged distal femoral replacement to an existing revision hip stem. This option was preferred to a total replacement of the femur. The custom coupler maintained the anatomic attachments of the proximal femur, preserved abductor strength during ambulation, and mitigated the morbidity which may arise from a total femur replacement. At 15 months postoperatively, the patient reported no pain, did not demonstrate an antalgic gait pattern, and had satisfactory range of motion at the hip and knee. The literature displays clinical and biomechanical efficacy for coupling devices although complications and device failure are quite variable.
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Affiliation(s)
- Arturo Corces
- Larkin Hospital Department of Orthopaedic Surgery, Coral Gables, FL, USA
| | - John Heifner
- St George’s University College of Medicine, Greta River, NY, USA,Corresponding author. St George’s University College of Medicine, 8905 SW 87th Ave, Miami, FL 33176, USA. Tel.: +1 305 667 8686.
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[Strategies for stem revision : Surgery planning, implant removal and reimplantation]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:21-34. [PMID: 35802156 PMCID: PMC9842594 DOI: 10.1007/s00132-022-04277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PLANNING Femoral revision represents a challenging procedure in its surgical planning and technical execution. The results are mainly dependent on the bone loss present, the quality of the implant removal and the choice of revision system. Patient-specific factors such as age, comorbidities, bone quality or even the localization of the cement have a decisive influence on the surgical strategy. Appropriate preoperative preparation, including the presence of the necessary special instruments, which are essential for gentle implant removal, is indispensable to achieve the best possible result. THERAPY A bone-sparing implant removal can be particularly challenging, especially in the case of well-fixed stems and cement residues, which may extend far beyond the isthmus. In such situations, a transfemoral approach should be considered. Cementless reimplantation using modular or non-modular titanium stems is currently the preferred treatment of choice for most revisions. In elderly, low-demand patients or with poor bone quality, cemented revision remains a good alternative treatment option.
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Di Martino A, Pederiva D, Bordini B, Di Carlo G, Panciera A, Geraci G, Stefanini N, Faldini C. Proximal femoral replacement for non-neoplastic conditions: a systematic review on current outcomes. J Orthop Traumatol 2022; 23:18. [PMID: 35348913 PMCID: PMC8964877 DOI: 10.1186/s10195-022-00632-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/19/2022] [Indexed: 11/10/2022] Open
Abstract
Proximal femoral replacement (PFR) is a well-established treatment for neoplasia of the proximal femur. The use of this surgical technique for non-neoplastic conditions has increased over the years. We carried out a systematic review of the literature to study the indications, complications, and functional results when PFR is used for non-neoplastic conditions. Twenty-seven studies were included in the review with a total of 828 PFRs with a mean follow-up of 50 months (range 1-225 months). The main indications were infection (28%), periprosthetic fracture (27%), aseptic loosening (22%), and fracture (16%). The rate of reoperation was 20.3% overall. The overall revision rate was 15.4%. The main complications were dislocation (10.2%) and infection (7.3%). After 2010, the rates of reoperation (25.5% versus 18.2%), loosening (9.4% versus 3.2%), and dislocation (15.7% versus 7.9%) were lower than before 2010. The 30-day mortality ranged from 0% to 9%. The hip function scores improved post-surgery. In conclusion, the use of PFR in non-neoplastic conditions remains a marginal tool, associated with low direct mortality and high complication rates, but we expect its use to increase in the near future.
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Affiliation(s)
- Alberto Di Martino
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy. .,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy.
| | - Davide Pederiva
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Lab, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Gabriele Di Carlo
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Alessandro Panciera
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Giuseppe Geraci
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Niccolò Stefanini
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Cesare Faldini
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
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de Waard S, van der Vis J, Venema PAHT, Sierevelt IN, Kerkhoffs GMMJ, Haverkamp D. Short-term success of proximal bone stock preservation in short hip stems: a systematic review of the literature. EFORT Open Rev 2021; 6:1040-1051. [PMID: 34909223 PMCID: PMC8631238 DOI: 10.1302/2058-5241.6.210030] [Citation(s) in RCA: 3] [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] [Indexed: 11/21/2022] Open
Abstract
Total hip arthroplasty is performed more frequently in younger patients nowadays, making long-term bone stock preservation an important topic. A mechanism for late implant failure is periprosthetic bone loss, caused by stress shielding around the hip stem due to different load distribution. Short stems are designed to keep the physical loading in the proximal part of the femur to reduce stress shielding. The aim of this review is to give more insight into how short and anatomic stems behave and whether they succeed in preservation of proximal bone stock. A systematic literature search was performed to find all published studies on bone mineral density in short and anatomic hip stems. Results on periprosthetic femoral bone mineral density, measured with dual-energy X-ray absorptiometry (DEXA), were compiled and analysed per Gruen zone in percentual change. A total of 29 studies were included. In short stems, Gruen 1 showed bone loss of 5% after one year (n = 855) and 5% after two years (n = 266). Gruen 7 showed bone loss of 10% after one year and –11% after two years. In anatomic stems, Gruen 1 showed bone loss of 8% after one year (n = 731) and 11% after two years (n = 227). Gruen 7 showed bone loss of 14% after one year and 15% after two years. Short stems are capable of preserving proximal bone stock and have slightly less proximal bone loss in the first years, compared to anatomic stems.
Cite this article: EFORT Open Rev 2021;6:1040-1051. DOI: 10.1302/2058-5241.6.210030
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Affiliation(s)
- Sheryl de Waard
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands.,Academic Medical Centre (AMC), Amsterdam, Netherlands
| | - Jacqueline van der Vis
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands
| | - Pascale A H T Venema
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands
| | - Inger N Sierevelt
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands
| | | | - Daniël Haverkamp
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands
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Lal DN, Roza GDL, Damron TA. Total Femoral Replacement for Complicated Echinococcus Infection: Sixteen-Year Follow-up. JBJS Case Connect 2021; 11:01709767-202112000-00047. [PMID: 34762606 DOI: 10.2106/jbjs.cc.21.00408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Osseous hydatidosis caused by Echinococcus is rare, especially in long bones. To the best of our knowledge, this is the third femoral hydatidosis case with successful osseous eradication through total femoral resection and total femoral megaprosthesis. Unlike the previous 2 cases, we uniquely illustrate recurrent soft-tissue hydatidosis episodes requiring additional hydatid resections for local control with no evidence of disease at final 16-year follow-up, the longest follow-up period of the 3 reported cases. CONCLUSION Despite radical bone resection for osseous hydatidosis eradication, additional complex surgical interventions may be needed to locally control soft-tissue disease.
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Affiliation(s)
- Divakar N Lal
- Department of Orthopedic Surgery, Upstate Medical University, Syracuse, New York
| | | | - Timothy A Damron
- Department of Orthopedic Surgery, Upstate Medical University, Syracuse, New York
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Femoral neck fracture to total femoral replacement: a case report. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Simon S, Frank BJH, Aichmair A, Dominkus M, Hofstaetter JG. Reconstruction of Proximal Metaphyseal Femoral Defects Using Trabecular Metal Augments in Revision Total Hip Arthroplasty. Arthroplast Today 2021; 8:216-221. [PMID: 33937461 PMCID: PMC8079334 DOI: 10.1016/j.artd.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 12/13/2022] Open
Abstract
Porous tantalum augments are widely used in revision total hip arthroplasty for the reconstruction of severe bone defects. Here, we present the first 3 cases who underwent femoral revision arthroplasty using standard distal femoral and proximal tibial porous tantalum cones to reconstruct severe bone loss in the proximal femur. Cones were inserted press fit, followed by implantation of a cemented revision stem in all cases. After a mean follow-up period of 15.8 months, all patients showed an improved Harris-Hip-Score and no radiological signs of subsidence or loosening. Porous tantalum cones may be an option in the reconstruction of severe femoral defects in revision total hip arthroplasty. The shape of the tantalum cones should be optimized for the use in the proximal femur.
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Affiliation(s)
- Sebastian Simon
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Bernhard J H Frank
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Alexander Aichmair
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Martin Dominkus
- II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Jochen G Hofstaetter
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
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Mau H, Citak M, Gehrke T, Abdelaziz H. What to Do When Revision Procedures Fail to Prevent Recurrent Hip Dislocation in THA? A Novel Simple Technique for Selected Patients. Arthroplast Today 2021; 8:89-91. [PMID: 33732831 PMCID: PMC7943961 DOI: 10.1016/j.artd.2021.02.006] [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: 06/08/2020] [Revised: 01/15/2021] [Accepted: 02/06/2021] [Indexed: 12/02/2022] Open
Abstract
Failure to achieve postoperative stability is disappointing for both surgeons and patients after revision total hip arthroplasty. In particular, when available revision options have been exhausted. We describe our modification of previously reported surgical techniques without revising any component in a high-risk female patient with persistent hip dislocation despite multiple cup revisions using different implants. To stabilize the hip through the posterolateral approach, a synthetic polyethylene tube was used. This relatively simple, modified technique may be a solution in disappointing cases with failure to achieve hip stability in revision total hip arthroplasty.
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Affiliation(s)
- Hans Mau
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Hussein Abdelaziz
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
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12
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Abdelaziz H, Saleri S, Mau H, Sandiford NA, Lausmann C, Zahar A, Gehrke T, Haasper C, Citak M. Interprosthetic Femoral Sleeves in Revision Arthroplasty: A 20-Year Experience. J Arthroplasty 2019; 34:1423-1429. [PMID: 30904363 DOI: 10.1016/j.arth.2019.02.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/18/2019] [Accepted: 02/25/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Interprosthetic femoral fractures in patients with ipsilateral stemmed total hip arthroplasty (THA) and total knee arthroplasty (TKA) can be technically demanding to treat surgically. Nonunion and implant failure are among the main complications following fixation of interprosthetic femoral (IF) fractures. Total femoral arthroplasty (TFA) is associated with a high incidence of infection and instability. IF sleeves have been designed to avoid the disadvantages of these techniques and to provide a stable construct. The aim of this study was to present the results with this device from a single center. METHODS We reviewed 26 patients who underwent revision arthroplasty procedures, using custom-made cemented IF sleeves between 1997 and December 2017 in our institution. Two-part sleeves were used in 18 patients and one-part sleeves in 8 patients. The most common indication was an IF fracture (18 patients). Patients were monitored for postoperative complications, implant failure, and re-revision. The minimum follow-up of the survivors with nonrevised sleeves was 12 months. RESULTS Twenty-three patients were included for the final analysis. The mean survivorship of the IF sleeve was 4.6 years at latest follow-up (mean 48.5 months; range 12 to 156). The overall rate of complications was 47.8%. The rate of mechanical failure was 21.7%. Late infections occurred in 3 patients (13%). At the latest follow-up, the mean Harris Hip Score was 69.9 points (range 39 to 94), and the mean functional Knee Society Score was 42.5 points (range 0 to 90), with average knee flexion of 95° (range 90° to 100°). CONCLUSION The IF sleeve is a valid technique for the management of selected patients with IF fractures, particularly when a stable fracture fixation is not possible. Hip instability is not a concern, and functional improvement is achievable. Careful planning is required preoperatively to avoid mechanical failure.
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Affiliation(s)
- Hussein Abdelaziz
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Solmaz Saleri
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Hans Mau
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | | | - Christian Lausmann
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Akos Zahar
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Carl Haasper
- Department of Orthopaedic Surgery, AMEOS Klinikum Seepark Geestland, Geestland, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
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