Transfemoral implantation of the Wagner SL stem (original) (raw)
Related papers
The Effect of Prophylactic Cerclage Wires in Primary Total Hip Arthroplasty: A Biomechanical Study
Journal of Arthroplasty, 2017
Background: Despite literature to support the use of various cerclage techniques to address intraoperative femoral fractures in total hip arthroplasty, there are limited data to support prophylactic cerclage wiring of the femur during cementless implant placement. This study aims to evaluate the effect of prophylactic calcar cerclage wires on the biomechanical parameters required to produce periprosthetic femoral fractures and on the morphology of these fracture patterns in stable cementless femoral implants. Methods: Ten pairs of matched fresh frozen cadaveric femurs were implanted with anatomic tapered cementless implants with or without the addition of 2 monofilament calcar wires. Specimens were axially loaded and externally rotated to failure. Initial torsional stiffness, rotation and energy to failure, and torque at failure were measured. Statistical significance was set at P < .05. Fracture patterns were classified according to a well-known classification system. Results: Wired specimens required significantly more rotation (P ¼ .039) and energy to failure (P ¼ .048). No significant difference was detected in initial torsional stiffness (P ¼ .63) or torque at failure (P ¼ .10). All unwired samples developed a Vancouver B2 fracture pattern. Seven of the 8 wired specimens also developed a Vancouver B2 fracture pattern, while the eighth wired specimen developed a Vancouver B1 fracture pattern. Conclusion: Prophylactic cerclage wire placement increases the rotation and energy to failure in wellfixed press-fit femoral implants. The increase in torsional energy needed for failure may reduce the risk of early periprosthetic fracture. Further studies are needed to evaluate cost vs benefit and long-term outcomes of prophylactic wiring. Based on the results of our study, consideration of prophylactic wiring should be addressed on a case-to-case basis.
Technical Note for Transfemoral Implantation of Tapered Revision Stems. The Advantage to Stay Short
Arthroplasty Today, 2021
Background: The aim was to test the hypothesis that during transfemoral implantation of a conical revision stem, the fixation of the stem at the distal tip leads to a low rate of periprosthetic fractures. Material and Methods: Two hundred eighty-two stem revisions by a transfemoral approach in cases of Paprosky Type II and IIIA-defects (with a sufficient isthmus) were carried out and analyzed during and radiographically after the surgery for unintentional periprosthetic fractures below the osteotomy. Results: In all cases, fixation was always achieved at the tip of the distal component in the isthmus of the femur. No periprosthetic fractures were observed. Conclusions: When the isthmus of the femur is intact, a transfemoral implantation of a tapered revision stem at the distal end reduces the risk of periprosthetic fractures by preventing bypassing the isthmus with the stem. Knowing the difference between the nominal diameter and the diameter at the distal start of the conical zone can help to create this fixation technique resulting in short revision stems.
Results of extensively coated femoral stem in revision hip replacement
International Journal of Orthopaedics Sciences
Introduction: Revision hip replacement following failed previous hip arthroplasty or internal fixation (dynamic hip screw for intertrochanteric fractures) presents a major surgical challenge. Proximal fitting revision stems do not achieve adequate fixation. Distal fixation with long-stemmed extensively coated cementless implants (like the Solution™ system) affords a suitable alternative. We present our results of 25 patients treated with extensively coated cementless revision stems. Materials and Methods: Twenty five patients with severely compromised proximal femora following either failed hip arthroplasty or failed internal fixation (dynamic hip screw fixation for intertrochanteric fractures) were operated by the senior author over a two-year period. six patients had aseptic loosening of their femoral stems following cemented hip replacements, with severe thinning of their proximal cortices and impending stress fractures. Ten patients had secondary hip arthritis following failure of implants for comminuted intertrochanteric or subtrochanteric femoral fractures. Nine patients had peri-implant fracture following previous primary hip replacement. All patients were treated by removal of implant (cemented or uncemented stems/DHS implants) and insertion of long-stemmed extensively coated cementless revision ('Solution™ DePuy, Warsaw (IN), US') stems along with press-fit acetabular component (Duraloc Cup, DePuy, Warsaw (IN), US). Nine patient with peri-implant fracture and five having compromised proximal femora after inter trochanteric fracture needed osteotomy and undergone encerclage wiring. One patient had protrusion of acetabular cup with deficient acetabular wall in which anti protrusion cage was used. Results: All patients were primarily kept in bed on physiotherapy for six weeks and then gradually progressed to weight-bearing walking over the next six to eight weeks. The Harris Hip Scores and patient satisfaction were used for final evaluation. We achieved good results in the two years duration of study. Out of 25 patients, cerclage wiring was done for peri-implant fractures and osteotomy in 14 patients. One patient had a intraoperative fracture extending into subtrochantric area while hammering in the stem. Post cerclage wiring, she was put on a long knee brace and her mobilization was delayed to 12 weeks. Conclusions: The extensively coated cementless ('Solution™') femoral stem provides a reasonable 'solution' to the deficient femur in hip revision. The proximal femoral deficiences can be relatively easily adressed and distal fixation can be achieved with this stem. Extreme care needs to be taken to avoid fractures and penetration of the femoral shaft, which can, however, be managed by cerclage wiring. successful outcome can be assured by preservation of the functional continuity of the abduction apparatus, care to recognize and prevent distal extension of fracture while inserting the stem and supervised gradual rehabilitation post operatively.
Resection and reconstruction of the proximal femur with revision stems: a cost-effective alternative
Annals of Joint
Background: Modular oncologic megaprosthesis is the standard method for reconstruction after resection of tumors of the proximal femur. These implants have been utilized for either primary tumors or metastatic disease of bone and multiple myeloma. Fixation is based on either cemented or cementless stems, and a collar supporting the body of the prosthesis. For those patients with advanced disease and/or limited life span, a judicious approach should balance the functional expectations, prognosis, and the issue of cost of the surgical procedure and the implant that is selected. Methods: Based on the principles of distal fixation of tapered stems, the authors have utilized implants originally designed for hip revision surgery to reconstruct the proximal femur in 19 patients, after resection because of metastases, multiple myeloma and some aggressive primary tumors. The essentials of the technique consist of distal fixation in the remaining isthmus of the femur by means of tapered stems, impacted in such a way to achieve solid primary fixation, balanced with accurate leg length restoration. Proximally, the implant remains devoid of bone coverage. Results: In this retrospective study, proper distal fixation, leaving the proximal part of the implant uncovered with bone, has resulted in good functional results in mid-term follow up of patients. Primary fixation has led to secondary bone ongrowth and remodeling, providing secondary fixation. Complications such as instability, loosening and infection are comparable with those associated to the traditional management with mega prosthesis. Conclusions: The utilization of tapered stems for distal fixation after proximal femoral resections has shown reliable results after mid-term follow up. The method might be considered as a cost-effective alternative for selected patients.
Extensively coated revision stems in proximally deficient femur: early results in 15 patients
Indian journal of orthopaedics, 2008
Hip replacement following failed internal fixation (dynamic hip screw for intertrochanteric fractures) or previous hip arthroplasty presents a major surgical challenge. Proximal fitting revision stems do not achieve adequate fixation. Distal fixation with long-stemmed extensively coated cementless implants (like the Solution system) affords a suitable solution. We present our early results of 15 patients treated with extensively coated cementless revision stems. Fifteen patients with severely compromised proximal femora following either failed hip arthroplasty or failed internal fixation (dynamic hip screw fixation for intertrochanteric fractures) were operated by the senior author over a two-year period. Eight patients had aseptic loosening of their femoral stems following cemented hip replacements, with severe thinning of their proximal cortices and impending stress fractures. Seven had secondary hip arthritis following failure of long implants for comminuted intertrochanteric or ...
The transfemoral approach for controlled removal of well-fixed femoral stems in hip revision surgery
Journal of Clinical Orthopaedics and Trauma, 2019
Background: For the removal of well fixed femoral stems, various standard and extended approaches are possible, all of which have their advantages and disadvantages. They should allow good visualization and avoid uncontrolled damage to the bone (especially devascularization and fractures) and to the musculature (especially the gluteus medius). As an extended approach we prefer the transfemoral approach in a modified Wagner technique. It is indicated for the controlled removal of broken endoprosthetic stems, a significantly thinned bone at risk of fracture, a stable cement mantle, a partially fixed cementless prosthetic stem with a coarse, rough surface, and infected, fixed total hip endoprostheses. In this review article we describe our experience with our technique of the transfemoral approach. Material and results: In 68 patients with hip revisions using the modified transfemoral approach, the Harris Hip Score increased continuously from 41.4 points preoperatively to 85.9 points 24 months postoperatively. The bony flap showed bone consolidation in 98.5% of cases. In 76 patients with transfemoral two-stage septic hip revisions, with closure of the flap around the interim prosthesis with cerclage wires and reopening of the flap during second stage revision, the Harris Hip Score was 62.2 ± 12.6 points before the replacement of the spacer and 86.6 ± 15.5 points two years after reimplantation. The healing rate of the bony flap after reimplantation was 98.7%, the absence of infection 93.4%, the rate of stem subsidence 6.6%, and the dislocation rate 6.6%; there was no aseptic loosening of the implants. Conclusion: The transfemoral approach allows a reliable protection of the gluteus medius and the vastogluteal sling, and enables reproducibly good clinical outcomes.
Modular tapered conical revision stem in hip revision surgery: mid- term results
BMC Musculoskeletal Disorders, 2021
Background: The aim of this paper is to evaluate the clinical and radiological outcomes of a fluted tapered modular distal-fixation stem at medium to long-term follow-up. The hypothesis of this investigation was to verify if the use of this implant design may have provided potential advantages in femoral revisions and post-traumatic instances where the restoration of the anatomy was the prime concern. Methods: We retrospectively reviewed 62 cases of femoral revision surgeries, performed in Paprosky type IIIA and IIIB bone defects between January 2001 and December 2011 with a mean follow-up of 8.5 ± 1.5 years (range 5.1-15.9 years) where a modular fluted stem was used. The clinical assessment was performed with the Harris Hip Score (HHS), and the radiographic evaluation was carried in order to assess the stability of the femoral component. Intraoperative and postoperative complications were recorded, and the rates of complications and revisions for any cause were determined. Results: Mean HHS improved 35.4 points from the preoperative assessment. Radiographic evaluation showed a stable stem anchorage in 90.3% of the cases at the last follow-up. Five (8%) implants required additional surgery. Neither breakage of the stem nor loosening of the taper junction were recorded. Kaplan-Meier survivorship was 89.4% (CI: 88.8-90%) for any complication and 92.3% (CI: 91.8-92.7%) according to revision for any causes at 81 months follow-up. Conclusions: Our findings suggest that this stem design is a reliable option in cases of complex femoral bone defects, as well as in cases with high functional deficiencies, with promising survivorship.
The Journal of Bone and Joint Surgery. British volume, 2012
There are no recent studies comparing cable with wire for the fixation of osteotomies or fractures in total hip replacement (THR). Our objective was to evaluate the five-year clinical and radiological outcomes and complication rates of the two techniques. We undertook a review including all primary and revision THRs performed in one hospital between 1996 and 2005 using cable or wire fixation. Clinical and radiological evaluation was performed five years post-operatively. Cables were used in 51 THRs and wires in 126, and of these, 36 THRs with cable (71%) and 101 with wire (80%) were evaluated at follow-up. The five-year radiographs available for 33 cable and 91 wire THRs revealed rates of breakage of fixation of 12 of 33 (36%) and 42 of 91 (46%), respectively. With cable there was a significantly higher risk of metal debris (68% vs 9%; adjusted relative risk (RR) 6.6; 95% confidence interval (CI) 3.0 to 14.1), nonunion (36% vs 21%; adjusted RR 2.0; 95% CI 1.0 to 3.9) and osteolysis ...
Veterinary journal (London, England : 1997), 2016
Periprosthetic femoral fractures are a common complication associated with cementless press-fit total hip arthroplasty. The use of prophylactic cerclage wire fixation has been advocated to reduce this complication. The objective of this study was to evaluate whether a double loop cerclage wire, used as adjunctive fixation, increased the peak torsional load to failure in femora implanted with press-fit cementless stems. Peak torsional load to failure was compared between femora without adjunctive fixation and femora receiving a 1 mm double loop cerclage wire placed proximally to the lesser trochanter. Femora treated with adjunctive cerclage wire fixation failed at 20% greater peak torque (P = 0.0001). In conclusion, a double loop cerclage wire may aid in the prevention of periprosthetic fractures associated with press-fit cementless femoral stems.
Clinical Orthopaedics & Related Research, 2011
Background The transfemoral approach is an extensile surgical approach that is performed routinely to facilitate cement and implant removal and improve exposure for revision stem implantation. Previous studies have looked at clinical results of small patient groups. The factors associated with fixation failure of cementless revision stems when using this approach have not been examined. Questions/purposes We determined (1) the clinical results and (2) complications of the transfemoral approach and (3) factors associated with fixation failure of revision stems when using the transfemoral approach. Patients and Methods We retrospectively examined all our patients in whom femoral stem revision was performed through a transfemoral approach between December 1998 and April 2004 and for whom a minimal followup of 2 years was available. One hundred patients were available for this study. The mean (± SD) postoperative followup was 5 years (± 1.64 years). Results The average Harris hip score improved from 45.2 (± 14.02) preoperatively to 83.4 (± 11.86) at final followup. Complete radiographic bony consolidation of the osteotomy site was observed in 95% of patients. Dislocations occurred in 9% of patients. Four revision stem fixation failures were observed, all occurring in patients with primary three-point fixation. Three-point fixation was associated with short osteotomy flaps and long revision stems. Conclusions The transfemoral approach is associated with a high rate of osteotomy flap bony healing and good clinical results. When using the transfemoral approach, a long osteotomy flap should be performed and the shortest possible revision stem should be implanted. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at Polyclinique Sévigné.