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Reinbacher P, Hecker A, Friesenbichler J, Smolle M, Leitner L, Klim S, Draschl A, Colovic D, Brunnader K, Leithner A, Maurer-Ertl W. Simultaneous Bilateral Total Hip Arthroplasty with Straight-Stems and Short-Stems: Does the Short One Do a Better Job? J Clin Med 2023; 12:1028. [PMID: 36769676 PMCID: PMC9918178 DOI: 10.3390/jcm12031028] [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: 12/18/2022] [Revised: 01/22/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is known to be the most successful orthopaedic surgery of the last century, but it is still struggling with controversies concerning one-stage bilateral THA. The current study aimed to compare the clinical outcome of patients with unilateral or simultaneous bilateral THA by using short-stem and straight-stem designs and focusing on operation time, blood loss, and length of hospital stay (LOS). MATERIAL AND METHODS Between 2006 and 2018, 92 patients were enrolled in this study. Forty-six patients underwent a bilateral THA in one session, and forty-six matched patients underwent a unilateral THA. In each of the two groups (unilateral vs. bilateral), 23 patients received either a straight (unilateral: 10 females, 13 males, mean age 63; bilateral: 12 females, 11 males, mean age 53 years) or short stem (unilateral: 11 females, 12 males, mean age 60 years; bilateral: 12 females, 11 males, 53 mean age 62 years). The blood count was checked preoperatively as well as one and three days after surgery. Furthermore, the operation time and LOS were investigated. RESULTS Compared to THA with straight-stems, short-stem THA showed significantly less blood loss; there was no difference in the LOS of both groups. A significantly shorter operative time was only observed in the bilateral THA. CONCLUSION The current study showed that simultaneous bilateral THA appears to be safe and reliable in patients without multiple comorbidities. In addition, short-stem THA appears to be beneficial in terms of clinical performance and outcome, and it appears to be superior to straight-stem THA, regardless of whether the patient underwent unilateral or simultaneous bilateral THA.
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Affiliation(s)
- Patrick Reinbacher
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Joerg Friesenbichler
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Maria Smolle
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Sebastian Klim
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Alexander Draschl
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Danijel Colovic
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Kevin Brunnader
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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Conversion of failed internal fixation in proximal femur fractures using calcar-guided short-stem total hip arthroplasty. J Orthop Traumatol 2022; 23:34. [PMID: 35876963 PMCID: PMC9310680 DOI: 10.1186/s10195-022-00655-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Reoperations for secondary osteoarthritis, osteonecrosis, or hardware failure following failed internal fixation after intertrochanteric fracture (ITF) or femoral neck fracture (FNF) are common. An effective salvage treatment often involves complete removal of the hardware followed by total hip arthroplasty (THA). Almost no data are available regarding conversion to short-stem THA. This study aimed to evaluate clinical and radiological outcomes, potential complications, and the survival rate of short-stem THA following revision surgery. METHODS We investigated 27 patients who underwent conversion THA using a calcar-guided short stem. Patient-reported outcome measurements were obtained, including the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index, as well as pain and satisfaction on the visual analogue scale. Radiological follow-up was also performed. RESULTS We identified 18 (66.7%) patients diagnosed with FNF and 9 (33.3%) patients with ITF. Clinical and radiological outcomes were satisfactory at the last follow-up (30.56 ± 11.62 months). One patient required early revision surgery due to dislocation and greater trochanter fracture. At the last follow-up, none of the short stems required revision. No other major complications occurred. CONCLUSION Given the low rate of complications and 100% survival, our findings indicate that short stems for conversion THA due to failed internal fixation may be considered an option in a properly selected patient population. However, it should not be considered a standard procedure and should only be performed by experienced surgeons.
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Coutandin M, Afghanyar Y, Drees P, Dargel J, Rehbein P, Kutzner KP. Can hip resurfacing be safely revised with short-stem total hip arthroplasty? A case series of six patients. J Orthop 2021; 24:274-279. [PMID: 33897129 PMCID: PMC8050111 DOI: 10.1016/j.jor.2021.03.007] [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] [Received: 02/02/2021] [Accepted: 03/21/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The usage of short stems in primary total hip arthroplasty (THA) has constantly gained popularity over the last decade, however, to date, short stems are not eligible to be used as revision implants. The aim of this study was to retrospectively evaluate the outcome of revision surgery of failed hip resurfacing arthroplasty (HRA) using short-stem THA. METHODS In a single center, retrospective analysis, 6 consecutive patients who were treated with a calcar-guided short stem after failure of HRA were evaluated. The mean follow-up was 3.25 years (SD 0.45). Patient reported outcome measurements (PROMs) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The health status was evaluated by the EQ-5D-5L score. Pain and satisfaction were obtained using the visual analogue scale (VAS). Radiographic analysis was performed by evaluating osteolysis, stress shielding, alignement and signs of aseptic loosening. Complications were documented. RESULTS At last follow-up, clinical outcome was excellent (HHS ≥ 90) in 5 patients and good (HHS = 87) in 1 patient. The mean WOMAC score was 5.73% (SD 3.66%). The mean EQ-5D-5L index was 0.914 (SD 0.07). Pain and satisfaction on VAS was 1.83 (SD 5.18) and 8.67 (SD 0.94), respectively. Radiologically, no signs of subsidence, aseptic loosening, stress shielding and fracture were obvious. No major complications occurred. To date, no further revision surgery was needed. CONCLUSIONS The outcomes of the present case series propose that HRA can be safely revised using short-stem THA in a selected patient group. Clinical and radiological results are encouraging. Based on the present data, short stems may be considered as a revision implant for failed HRA for experienced surgeons.
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Affiliation(s)
- Marcel Coutandin
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Yama Afghanyar
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jens Dargel
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Rehbein
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Babu S, Singh P, Wiik A, Shastri O, Malik K, Bailey J, Ghosh K, Cobb J. A comparison of patient-reported outcome measures (PROMs) between short and conventional stem hip replacements: a systematic review and meta-analysis. Hip Int 2020; 30:513-522. [PMID: 31746234 DOI: 10.1177/1120700019888210] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Short stem hip replacements may allow preservation of proximal bone stock and minimise soft tissue disruption, easing future revision surgery. However patient satisfaction with these implants must be determined before widespread use. We aimed to compare patient reported outcome measures (PROMs) between short and conventional stem hip replacements. METHODS A systematic review was conducted according to PRISMA guidelines for studies comparing short and conventional stem hip replacements with validated PROMs. Meta-analyses were performed for studies reporting Harris Hip and WOMAC scores. Study bias was assessed with the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. RESULTS 24 studies, incorporating 2593 total hip replacements were included for qualitative analysis. 17 studies were included in the meta-analyses. Of the 7 excluded, 1 study reported the Japanese Orthopaedic Association score and 2 others reported the Oxford Hip score. All three showed no difference between the stems. A meta-analysis of 17 studies reporting Harris hip scores showed no statistically significant difference between short and conventional stems (standard mean difference (SMD) -0.06, 95% CI -0.20-0.07, p = 0.35). 6 studies reported WOMAC scores with higher scores indicating worse outcome. No difference was seen between the two groups (SMD 0.21, 95%CI, -0.01-0.42, p = 0.06). 4 studies reported higher WOMAC scores as better. Once again, a meta-analysis showed no statistically significant difference between the stems (SMD 0.28, 95% CI -0.07-0.63, p = 0.12). CONCLUSIONS Our systematic review showed no difference in PROMs between short and conventional stem total hip replacements. This is in keeping with previous evidence but is a more comprehensive analysis. Short stems may have an important role in younger individuals as they allow preservation of proximal femoral bone, minimal access surgery and are amenable to abnormal anatomy. The current literature is hindered by non-uniform methodologies and outcome assessments across studies. Further, standardised, high quality evidence is required before widespread changes in practice.
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Migliorini F, Driessen A, Colarossi G, El Mansy Y, Gatz M, Tingart M, Eschweiler J. Short stems for total hip replacement among middle-aged patients. INTERNATIONAL ORTHOPAEDICS 2020; 44:847-855. [PMID: 32193611 DOI: 10.1007/s00264-020-04516-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/24/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The purpose of the present study was to investigate the role of short stem implants for primary total hip arthroplasty in middle-aged patients. For this purpose, a meta-analysis of the current literature was conducted. The focus was on clinical outcomes,radiological parameters, and further complications of both components. MATERIAL AND METHODS The study was performed according to the PRISMA guidelines. All randomized and non-randomized clinical trials comparing short stem versus standard stem prostheses for THA were considered for inclusion. Only studies reporting data concerning uncemented stems for primary total hip arthroplasty were included. Only studies reporting data concerning patients with a mean age of 45 to 69 were included. RESULTS A total of 2197 procedures in 2116 patients were analysed. The mean follow-up was 30.2 months. The short stem group showed a statistically significant higher WOMAC score and a reduced total estimated blood loss compared with the standard stem group. The short stem group showed a reduced rate of femoral fractures, dislocations, and revision, but without statistical significance. CONCLUSIONS According to the main findings of this meta-analysis and current evidence, we encourage the use of the uncemented short stems during primary total hip arthroplasty in middle-aged patients.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Arne Driessen
- Department of Orthopaedic Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Giorgia Colarossi
- Department of Thoracic Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Yasser El Mansy
- Department of Orthopaedic Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.,Department of Orthopaedics and Traumatology, Alexandria University, Alexandria, Egypt
| | - Matthias Gatz
- Department of Orthopaedic Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedic Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedic Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
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Lee PYF, Woodnutt DJ, Golding DM. A Short Femoral Stem in Revision Total Hip Replacement: An Alternative Solution for Prosthetic Fracture: A Case Report. JBJS Case Connect 2017; 7:e33. [PMID: 29244672 DOI: 10.2106/jbjs.cc.16.00174] [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 A 65-year-old farmer re-presented 5 years after sustaining a midshaft prosthetic fracture of a previous long-stem revision hip replacement. He was treated with a proximal-loading short femoral stem, and did not require an extended trochanteric osteotomy for removal of the well-fixed distal implant. He was able to fully bear weight immediately postoperatively, and he remained pain-free without functional loss at the 42-month follow-up. CONCLUSION This use of a modern short-stem prosthesis is a treatment option for a potentially complex prosthetic fracture in highly active patients, and it reduces intraoperative complexity.
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Affiliation(s)
- Paul Y F Lee
- South Wales Orthopaedic Research Network, Wales, United Kingdom
| | | | - David M Golding
- South Wales Orthopaedic Research Network, Wales, United Kingdom
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Arnholdt J, Gilbert F, Blank M, Papazoglou J, Rudert M, Nöth U, Steinert AF. The Mayo conservative hip: complication analysis and management of the first 41 cases performed at a University level 1 department. BMC Musculoskelet Disord 2017; 18:250. [PMID: 28599634 PMCID: PMC5466787 DOI: 10.1186/s12891-017-1613-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/02/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To prevent bone loss in hip arthroplasty, several short stem systems have been developed, including the Mayo conservative hip system. While there is a plethora of data confirming inherent advantages of these systems, only little is known about potential complications, especially when surgeons start to use these systems. METHODS In this study, we present a retrospective analysis of the patients' outcome, complications and the complication management of the first 41 Mayo conservative hips performed in 37 patients. For this reason, functional scores, radiographic analyses, peri- and postoperative complications were assessed at an average follow-up of 35 months. RESULTS The overall HHS improved from 61.2 pre-operatively to 85.6 post-operatively. The German Extra Short Musculoskeletal Function Assessment Questionnaire (XSFMA-D) improved from 30.3 pre-operatively to 12.2 post-operatively. The most common complication was an intraoperative non-displaced fracture of the proximal femur observed in 5 cases (12.1%). Diabetes, higher BMI and older ages were shown to be risk factors for these intra-operative periprosthetic fractures (p < 0.01). Radiographic analysis revealed a good offset reconstruction in all cases. CONCLUSION In our series, a high complication rate with 12.1% of non-displaced proximal femoral fractures was observed using the Mayo conservative hip. This may be attributed to the flat learning curve of the system or the inherent patient characteristics of the presented cohort.
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Affiliation(s)
- Jörg Arnholdt
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstr. 11, 97074 Würzburg, Germany
| | - Fabian Gilbert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstr. 11, 97074 Würzburg, Germany
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Oberduerrbacher Str. 6, 97080 Würzburg, Germany
| | - Marc Blank
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstr. 11, 97074 Würzburg, Germany
| | - Jannis Papazoglou
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstr. 11, 97074 Würzburg, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstr. 11, 97074 Würzburg, Germany
| | - Ulrich Nöth
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstr. 11, 97074 Würzburg, Germany
- Department of Orthopaedic Surgery and Traumatology, Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße 555, 13589 Berlin, Germany
| | - Andre F. Steinert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstr. 11, 97074 Würzburg, Germany
- Department of Trauma and Orthopaedic Surgery, Agatharied Hospital, Norbert-Kerkel-Platz, 83734 Hausham, Germany
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Blood management may have an impact on length of stay after total hip arthroplasty. HSS J 2014; 10:124-30. [PMID: 25050095 PMCID: PMC4071463 DOI: 10.1007/s11420-014-9384-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 03/18/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The steady rise in demand for total hip arthroplasty constitutes a significant and increasing burden on health care resources. The biggest contributors to the total cost of hip replacement procedures other than the price of the implant are hospital stay and postoperative rehabilitation. Blood management is one of the most adjustable factors that can impact length of stay and cost-efficiency while improving patient safety. QUESTIONS/PURPOSES The primary purpose of this retrospective study was to assess the potential impact of blood management interventions on length of hospital stay after primary unilateral total hip arthroplasty. This was achieved by first identifying which patient and surgical factors are associated with an increased risk of prolonged hospital stay. Subsequently, the significant factors were controlled for through a multivariate regression analysis to quantify the association between blood transfusions and increased hospital stay. METHODS Retrospectively, the study included 2,104 primary total hip replacements. Eight hundred eighty-eight procedures were performed on males and 1,216 on females, with a mean age of 64 years at the time of the surgery (range 18-94 years) and BMI of 28.6 kg/m(2) (range 12-51.5 kg/m(2)). The correlation between each factor and length of stay was analyzed separately using univariate regression analysis. Those variables with p ≤ 0.05 in the univariate model were selected for inclusion in the multivariate logistic regressions. Multiple linear regression was used to analyze the effect of each significant factor and derive odds ratios with adjustment for the other variables. RESULTS Multivariate Poisson regression revealed that increased length of stay was significantly correlated to patient age (p = 0.05), the use of coumadin (p = 0.02) or lovenox/heparin (p = 0.007) as opposed to aspirin for anticoagulation, and allogeneic blood transfusion (p < 0.0001). The data shows that allogeneic blood transfusion is associated with a longer hospital stay regardless of absolute drop in hemoglobin level postoperatively or at discharge or the number of units transfused (OR = 1.18, 95% CI = 1.09 to 1.28, p < 0.001). CONCLUSION Transfusion of allogeneic blood is independently associated with increased hospital stay after total hip arthroplasty. Blood management modalities that can significantly reduce transfusion risk could impact length of stay as well as the total cost of hip replacement procedures.
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Schmidutz F, Wanke-Jellinek L, Jansson V, Fottner A, Mazoochian F. Revision of hip resurfacing arthroplasty with a bone-conserving short-stem implant: a case report and review of the literature. J Med Case Rep 2012; 6:249. [PMID: 22905765 PMCID: PMC3443644 DOI: 10.1186/1752-1947-6-249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 05/18/2012] [Indexed: 11/23/2022] Open
Abstract
Introduction Suitable treatment of early failure of total hip replacement is critical in younger patients, as bone stock is lost and the functional outcome is impaired. Case presentation We report the case of a 56-year-old Caucasian woman with early failure of hip resurfacing arthroplasty. While revision is usually performed with a conventional hip implant, this case report describes for the first time a revision procedure with a bone-conserving short-stem hip implant. Conclusions Our approach allows further conservation of femoral bone stock and provides a long-term solution to the patient, which maintains the possibility of using a conventional hip implant should a second revision become necessary.
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Affiliation(s)
- Florian Schmidutz
- Department of Orthopedic Surgery, University of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, Munich, 81377, Germany.
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