The Effect of Preoperative Planning and Impaction Grafting Surgical Technique on Intraoperative and Postoperative Complication Rate for Femoral Revision Patients with Moderate to Severe Bone Loss (original) (raw)
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Femoral Impaction Allografting for Significant Bone Loss in Revision Hip Arthroplasty
HIP International, 2017
IntroductionFemoral impaction bone allografting in revision hip arthroplasty facilitates physiological reconstruction with restoration of bone stock, allowing implantation of a standard cemented femoral component. The purpose of this study was to report our experience in femoral component revision arthroplasty with impaction morsellised cancellous bone allograft using custom impactors and a cemented triple-taper polished stem.MethodsRetrospective analysis of all cases of femoral component revision hip arthroplasty with impaction bone grafting undertaken by a single surgeon from 2005 to 2011. Outcome measures included radiographic analysis of stem subsidence over time, graft remodelling and incorporation, and clinical progress.ResultsWe reviewed 47 consecutive hips in 44 patients, mean age 62 years (37-88). Femoral impaction with allograft was performed as either single stage (41 cases) or 2-stage (6 cases) procedures. All patients received a cemented C-stem prosthesis. The mean foll...
The Journal of Bone and Joint Surgery, 2002
I mpacted morcellised bone allograft and a Charnley stem was used to revise 59 loose femoral components in 57 consecutive patients. Femoral bone loss was rated as Endo-Klinik grade 2 in nine patients, grade 3 in 41, and grade 4 in nine. The immediate postoperative radiographs and those taken at the most recent follow-up were compared for radiolucencies, subsidence and incorporation of the graft. One patient was lost to follow-up and two were not available for radiological analysis. The mean clinical follow-up in 58 procedures was 56.7 months (24 to 144) and the mean radiological review of 56 reconstructions was 54.4 months (24 to 144). An intraoperative femoral fracture occurred in one patient (1.7%) and was successfully treated by strut grafting and cerclage wiring. Extrusion of cement through perforations or incomplete hoop fractures was detected in the postoperative radiographs of ten procedures (17%); none of these patients sustained a complete fracture. Three patients had dislocations (5%) and two (3.5%) developed painful subsidence of the stem which required a further revision. The latest follow-up radiographs in 56 reconstructions showed a well fixed stem and radiological healing of the graft in 52 (93%), and definite loosening in four (7%). Of these four, two were revised again and two were asymptomatic after a follow-up of 120 months each. The mean subsidence in the 52 successful revisions was 0.38 mm (0 to 4). Impaction allografting with a Charnley stem restored bone stock and provided adequate fixation of the stem in 93% of the hips. There was a low rate of rerevision (3.5%) and a low incidence of intraoperative and postoperative complications.
Reconstruction of bone defects with impacted allograft in femoral stem revision surgery
International …, 2007
A retrospective clinical review was done on 54 revision hip patients. Radiological analysis examined the Gross and AAOS classifications, stem position, cement mantles, allograft and evolution (subsidence, resorption and remodelling). The Harris Hip score was used for clinical assessment. We used bone bank allograft and a polished noncollared stem LD. The follow-up period was 60.5 months (19.4-152.4), and the average age 68.5 (range: 22-85). There were 21 females and 33 males. The surgical approach was: lateral (5.56%) posterior (91.4%); trochanteric osteotomy: 25.9%; associated acetabular revision: 59.3%; previous operations: 1.9. The preoperative Harris score was 35 (28-40) and rose to 81 (50-99) postoperatively. The stem alignment was neutral (44.44%), varus (38.89%) and valgus (16.67%). The femur/stem diameter relationship was 1.8 (1.2-2.7). There were no changes in stem alignment in 94.4%. An adequate cement mantle was: proximal zone (61.1%), medium zone (27.8%) and distal zone (16.7%). The rate of any subsidence was 38.9% (progressive: 12.96%). The rate of complications was 40.7% and included periprosthetic fracture: 14.
HIP International, 2009
Massive bone loss is a problem frequently encountered during revision hip surgery. Several ways of addressing the bone loss in proximal femur have been described with varying results. We present our results with the use of a radial impaction grafting technique and a collared textured component. 107 consecutive cases of Revision Total Hip Arthroplasty, who underwent radial impaction grafting and had a textured collared implant inserted for femoral deficiencies were assessed. The average follow up was seven years and four months (3 to 11 years). All the patients experienced a significant improvement in the clinical scores. Oxford Hip scores improved from an average of 41.2 (30 - 56) to 19.3 (12 - 32). Harris Hip scores improved from an average of 40.8 (28 - 65) to 83.4 (60 -99). There were no cases of subsidence at follow up. Using revision for any cause as the end point the survivorship at an average of 88.8 months was 93.8%. Three revisions were performed for deep infection within t...
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.
Conservative Femoral Stem Revision
The Journal of Arthroplasty, 2009
A conservative approach to femoral revision is assessed. We report on 41 femoral revisions using an extensively coated hydroxyapatite primary femoral stem. Clinical, operative, and radiological data were gathered. Harris hip scores increased from 65/100 to 90/100 at the minimal follow-up of 1 year (P b .05). All stems showed signs of osseous integration. No significant migration was measured. No patient had to be reoperated because of problems related to the stem. Good results are reported for femoral revision with Paprosky type I and II bone defects with no significant difference between the 2 subgroups, hereby proving that conservative femoral revision is a reasonable treatment alternative. Reproducible results with such a technique may bring surgeons to be more aggressive when noticing early signs of femoral loosening. Key words: revision hip arthroplasty, femoral stem revision, primary intention stem, metaphyseal fixation, hydroxyapatite coating, bone loss.
A Contemporary Classification System of Femoral Bone Loss in Revision Total Hip Arthroplasty
Arthroplasty Today, 2021
Background: Current femoral bone loss classification systems in revision total hip arthroplasty were created at a time when the predominant reconstructive methods used cylindrical porous-coated cobaltchrome stems. As these stems have largely been replaced by fluted-tapered titanium stems, the ability of these classification systems to help guide implant selection is limited. The purpose of this study was to describe a novel classification system based on contemporary reconstructive techniques. Methods: We reviewed the charts of all patients who underwent femoral component revision at our institution from 2007 through 2019. Preoperative images were reviewed, and FBL was rated according to the Paprosky classification and compared to ratings using our institution's NCS. Rates of reoperation at the time of most recent follow-up were determined and compared. Results: Four-hundred and forty-two femoral revisions in 330 patients with a mean follow-up duration of 2.7 years were identified. Femoral type according to Paprosky and NCS were Paprosky I (36, 8.1%), II (61, 13.8%), IIIA (180, 40.7%), IIIB (116, 26.2%), and IV (49 11.1%) and NCS 1 (35, 7.9%), 2 (364, 82.4%), 3 (8, 1.8%), 4 (27, 6.1%), and 5 (8, 1.8%). Of the 353 nonstaged rTHAs, there were 42 cases requiring unplanned reoperation (11.9%), including infection (18, 5.1%), instability (10, 2.8%), femoral loosening (5, 1.4%), and various other causes (9, 2.5%). The NCS was more predictive of reoperation than the Paprosky classification (Fisher's exact test, P ¼ .008 vs P ¼ ns, respectively). Conclusion: We present a novel femoral classification system that can help guide contemporary implant selection.