Femoral medullary infarction secondary to canine total hip arthroplasty

OBJECTIVE

To evaluate the prevalence of femoral intramedullary infarction after total hip arthroplasty (THA) and to determine whether any specific femoral morphology predisposes to bone infarction.

STUDY DESIGN

Retrospective clinical study.

SAMPLE POPULATION

All dogs from our hospital population undergoing THA between 1984 and 1997 with radiographic follow-up available at 1 year or more postoperatively.

METHODS

A case control study was conducted within the THA group to determine risk factors predisposing to femoral infarction after THA. Medical records and radiographs were reviewed. Data were collected on clinical parameters, femoral morphology, prosthesis, and bone changes. Radiographic diagnosis was confirmed using histopathology in 11 femora. Radiographs of 50 age-matched control dogs weighing more than 20 kg with coxofemoral degenerative joint disease were randomly chosen to determine the prevalence of bone infarction in nonoperated dogs.

RESULTS

Ninety-one dogs with 110 THA were included in the study. Fifteen of the 110 femora with THA had radiographic evidence of infarction (14%). Infarction was not present in any femora in the control group. There was no significant difference in the prevalence of infarction between dogs that received cemented or uncemented prostheses. Clinical signs were not reported in any patient that developed femoral infarction. Young age (P = .03) and a distance between the greater trochanter and nutrient foramen greater than 79 mm (P = .008) predisposed dogs to femoral infarction. Over time, three infarcts decreased in size radiographically, five remained unchanged, and three expanded. An osteosarcoma developed at the site of a bone infarct in one dog.

CONCLUSION

Femoral intramedullary infarction occurred in 15 of 110 THA. Young age at the time of THA and a greater distance between the greater trochanter and the nutrient foramen predisposed to infarction.

CLINICAL RELEVANCE

Intramedullary infarction occurs after canine THA. These bone infarcts do not appear to cause clinical signs; however, they may present a diagnostic challenge. Malignant transformation could potentially result from medullary infarction.

Canine uncemented porous-coated anatomic total hip arthroplasty: results of a long-term prospective evaluation of 50 consecutive cases

OBJECTIVE

To evaluate the long-term clinical and radiographic results of a canine uncemented porous-coated anatomic (PCA) total hip arthroplasty (THA).

STUDY DESIGN

Prospective study of consecutive clinical patients using survival analysis.

ANIMALS

Forty-one dogs that underwent PCA THA; nine had bilateral PCA THA (50 prostheses).

METHODS

Gait observation, orthopedic examination, and radiographic assessment were conducted before THA, 6 months after THA, and yearly thereafter. A zonal analysis system was used to document osseous changes in the femur and the acetabulum. Acetabular cup and femoral stem subsidence and migration, femoral canal fill, and implant orientation were measured. Survival analysis of the procedure was conducted.

RESULTS

Long-term follow-up was available for 37 dogs (46 prostheses). The median follow-up was 63 months. Limb function was normal for 37 limbs and abnormal for 9 limbs because of dislocation (n = 3), lumbosacral disease (n = 2), degenerative myelopathy (n = 1), autoimmune disease (n = 1), brain tumor (n = 1), or osteosarcoma of the femur (n = 1). All prosthetic stems and cups were fixed by bone ingrowth fixation. Osteolysis was not observed. Bone infarction occurred in five femoral canals (four dogs). The 6-year survival rate for the procedure was 87% (95% confidence interval, 72%-96%).

CONCLUSIONS

Long-term fixation of the uncemented PCA acetabular cup and stem is successful in dogs, and long-term clinical function is excellent.

Single-stage revision using an uncemented, porous-coated, anatomic endoprosthesis in two dogs: case report

OBJECTIVE

To describe the clinical and radiographic features of septic and aseptic failure of two femoral endoprostheses and their successful revision.

STUDY DESIGN

Case report.

ANIMALS OR SAMPLE POPULATION

Two skeletally mature male research dogs.

METHODS

An uncemented porous-coated anatomic (PCA) endoprosthesis was implanted in a single-stage revision procedure after thorough debridement and lavage of the femoral canal. An autogenous cancellous bone graft was used in dog 2 (aseptic loosening). Serial clinical and radiographic examinations were performed postoperatively. The dogs were euthanatized 1 year (dog 1) and 2 years (dog 2) after revision surgery, and necropsy was performed. High-resolution contact radiographs and histopathologic evaluation of femoral sections were obtained.

RESULTS

The cause of implant failure was septic loosening in dog 1 and aseptic loosening in dog 2. In both dogs, clinical function returned to normal after revision. Serial radiographic assessment after revision documented disappearance of the bone pedestal and the periprosthetic lucency. Cancellous hypertrophy seen adjacent to the proximal porous-coated region of the implants provided radiographic evidence of bony fixation. Histological evaluation of femoral sections documented successful implant integration with bone and fibrous tissue.

CONCLUSION

Revision with an uncemented implant in a single-stage procedure was successful in the two dogs described in this report.

CLINICAL RELEVANCE

This report provides a detailed description of the clinical course and serial radiographic assessment of septic and aseptic loosening of two femoral endoprostheses. Single-stage revision is a potential treatment for either condition as demonstrated by the successful outcome in these two dogs.

The effect of surgical approach on femoral stem position in canine cemented total hip replacement

A prospective clinical study was designed to determine the effect of surgical approach on femoral stem position in canine cemented total hip replacement. Candidates for total hip replacement were randomly placed into one of two groups. In one group (n = 10), a craniolateral approach to the hip joint was made, incorporating a femoral trochanteric osteotomy. In the other group (n = 11), a craniolateral approach to the hip joint was made without performing a femoral trochanteric osteotomy. Radiographs obtained immediately after the operation were evaluated by two independent examiners for femoral stem position (neutral, varus, or valgus) and percentage of femoral canal fill, using a defined protocol. There was no statistical difference in femoral stem position between the study groups, whereas a greater percentage of canal fill was associated with the neutral femoral stem position.

Radiographic assessment of a canine uncemented porous-coated anatomic total hip prosthesis

Thirty uncemented porous-coated anatomic total hip prostheses in 24 dogs were evaluated radiographically at 6 months, 12 months, or 18 months after arthroplasty. All dogs were fully weight bearing and free of lameness at the time of follow-up. Radiographs were assessed for prosthetic component alignment, percentage of femoral canal fill, resorptive and formative bony changes, and changes at the implant bone interface. No evidence of infection, loosening, or failure of component fixation was seen. Settling of the acetabular component and subsidence of the femoral stem was seen early after surgery. Cortical atrophy was seen in all femurs and was the most significant bony remodeling change. Early results of clinical and radiographic evaluation of uncemented total hip arthroplasty in dogs have been encouraging.

Implantation of an uncemented total hip prosthesis. Technique and initial results of 100 arthroplasties

A porous-coated modular total hip system was developed for uncemented implantation in dogs. The operative technique was developed in cadaver bones and live animals. One hundred uncemented total hip arthroplasties were performed in 92 dogs. Results were successful in 98% of the joints during follow-ups of 3 months or more. Complications included three luxations of the prosthetic joint, two fissure fractures of the femoral cortex, and one complete displacement of the acetabular component from its bony bed. Four complications were resolved successfully.

Pharmacokinetic disposition of cefazolin in serum and tissue during canine total hip replacement

Intraoperative cefazolin concentrations were measured in serum, joint capsule, cancellous bone of the acetabulum, and proximal cancellous bone of the femur in 15 dogs undergoing total hip replacement. Cefazolin (22 mg/kg intravenously [IV]) was administered every hour for three doses. The mean peak serum concentrations (+/- SEM) were 387.79 +/- 27.56 micrograms/mL, 521.71 +/- 28.00 micrograms/mL, and 542.20 +/- 30.91 micrograms/mL, respectively. Mean serum concentrations just before administration of doses 2 and 3 were 51.77 +/- 2.39 micrograms/mL, and 64.84 +/- 3.46 micrograms/mL, respectively. The mean cefazolin concentrations in the joint capsule, cancellous bone of the acetabulum, and cancellous bone of the femur were 34.71 +/- 2.50 micrograms/g, 28.70 +/- 7.40 micrograms/g, and 36.20 +/- 3.80 micrograms/g, respectively. The minimum inhibitory concentration of cefazolin for 90% of the common contaminants (MIC90) in this clinic is less than or equal to 2 micrograms/mL or per gram of tissue. Serum concentrations never fell below 15 times the MIC90 (lowest trough, 35.93 micrograms/mL), and the lowest tissue concentration (6.57 micrograms/mL in cancellous bone from the acetabulum) was still more than 3 times the MIC90. The mean tissue concentration was 15 times the MIC90.