Revision Surgery After Fractures of Ceramic Components

2018 ◽  
pp. 115-124
Author(s):  
Luigi Zagra ◽  
Enrico Gallazzi
Keyword(s):  
Revision Surgery ◽  
Ceramic Components

scholarly journals Chromium-Cobalt Intoxication with Intense Systemic Complications following Total Hip Revision after Per-Operative Ceramic Fracture

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Paul Lecoanet ◽  
Mathias Blangis ◽  
Matthieu Garcia ◽  
Yohan Legallois ◽  
Thierry Fabre
Keyword(s):  
Heavy Metal ◽  
Case Report ◽  
Revision Surgery ◽  
Hip Revision ◽  
Systemic Complications ◽  
Ceramic Fracture ◽  
Ceramic Components ◽  
Systemic Symptoms ◽  
Heavy Metal Intoxication ◽  
Rapid Regression

Introduction. Heavy metal intoxication after arthroplasty is extremely rare but could be lethal. Case Report. We report the case of a 69-year-old woman, who presented intense systemic symptoms of chromium-cobalt intoxication after revision of per-operative fractured ceramic components with metal-on-polyethylene. Systemic toxicity occurred a year after surgery and expressed brutally with mostly central neurological symptoms. Chelation associated with revision surgery allowed rapid regression of all symptoms. Conclusion. Revision of fractured ceramic, even per-operatively, should not be done with metal-on-polyethylene components, in order to avoid potentially lethal metal intoxication.

scholarly journals Ceramic bearings fracture: a literature review on risk factors, diagnosis, and treatment

2020 ◽  
pp. 1-7 ◽  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Young Patients ◽  
Revision Arthroplasty ◽  
Ceramic Component ◽  
Total Hip ◽  
Ceramic Bearing ◽  
Ceramic Components

Ceramic surfaces are commonly used in total hip arthroplasty (THA) in young patients due to their good tribological properties. Nonetheless, the fracture of ceramic components is among the most demanding complications of total hip arthroplasty. Ceramic failure is a matter of emergency and needs urgent revision arthroplasty. In this regard, the present study aimed to better understand how to diagnose a ceramic component fracture, identify the major risk factors for the fracture of ceramic components, and analyze the different techniques used in revision arthroplasty for ceramic bearing failure. The literature search was performed on PubMed, MEDLINE-Ovid, and Cochrane Reviews. The search keywords included ceramic fracture, ceramic failure, and ceramic arthroplasty revision surgery. A number of 47 articles were selected out of 126 articles found in the initial research. X-ray and computed tomography (CT) scan must be utilized on suspicion of ceramic component fracture. The most relevant risk factor for head fracture is short neck and 28-mm head combination. Moreover, acetabular cup malpositioning and liner misalignment during insertion are the two major risk factors for liner fracture. There is no consensus on the best revision treatment strategy. Nonetheless, it is necessary to perform a complete synovectomy and an accurate cleaning of the hip joint before the implant of the new components. Stability, integrity, and positioning of both femoral and acetabular components must be evaluated during surgery. If damaged, even well-fixed components should be removed. New ceramic bearing surface is the best option, whereas metal is not recommended for revision surgery.

scholarly journals Fracture of Ceramic Bearing Surfaces following Total Hip Replacement: A Systematic Review

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Francesco Traina ◽  
Marcello De Fine ◽  
Alberto Di Martino ◽  
Cesare Faldini
Keyword(s):  
Systematic Review ◽  
Early Diagnosis ◽  
Total Hip Replacement ◽  
Revision Surgery ◽  
Hip Replacement ◽  
Ceramic Component ◽  
Component Failure ◽  
Total Hip ◽  
Ceramic Bearing ◽  
Ceramic Components

Ceramic bearing surfaces are increasingly used for total hip replacement, notwithstanding that concern is still related to ceramic brittleness and its possible mechanical failure. The aim of this systematic review is to answer three questions: (1) Are there risk factors for ceramic component fracture following total hip replacement? (2) Is it possible to perform an early diagnosis of ceramic component failure before catastrophic fracture occurs? (3) Is it possible to draw guidelines for revision surgery after ceramic components failure? A PubMed and Google Scholar search was performed and reference citations from publications identified in the literature search were reviewed. The use of 28 mm short-neck femoral head carries an increased risk of fracture. Acetabular component malposition might increase the risk of ceramic liner fractures. Synovial fluid microanalysis and CT scan are promising in early diagnosis of ceramic head and liner failure. Early revision is suggested in case of component failure; no consensus exists about the better coupling for revision surgery. Ceramic brittleness remains a major concern. Due to the increased number of ceramic on ceramic implants, more revision surgeries and reports on ceramic components failure are expected in the future. An algorithm of diagnosis and treatment for ceramic hip failure is proposed.

Revision Surgery for the Mastoid Cavity

1974 ◽  
Vol 7 (1) ◽  
pp. 41-56
Author(s):  
Edward C. Brandów
Keyword(s):  
Revision Surgery ◽  
Mastoid Cavity

Mid-term results of a cementless primary press-fit cup in acetabular revision surgery

2020 ◽  
Author(s):  
N Kolbe ◽  
B Zimmer ◽  
P Matheis ◽  
M Streit ◽  
T Gotterbarm ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Acetabular Revision ◽  
Press Fit ◽  
Mid Term Results

The impact of increasing interbody fusion levels at the fractional curve on lordosis, curve correction, and complications in adult patients with scoliosis

2020 ◽  
pp. 1-10
Author(s):  
Dominic Amara ◽  
Praveen V. Mummaneni ◽  
Shane Burch ◽  
Vedat Deviren ◽  
Christopher P. Ames ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Revision Surgery ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Pelvic Incidence ◽  
Secondary Analysis ◽  
Lumbar Interbody Fusion ◽  
Curve Correction ◽  
Surgery Rates

OBJECTIVERadiculopathy from the fractional curve, usually from L3 to S1, can create severe disability. However, treatment methods of the curve vary. The authors evaluated the effect of adding more levels of interbody fusion during treatment of the fractional curve.METHODSA single-institution retrospective review of adult patients treated for scoliosis between 2006 and 2016 was performed. Inclusion criteria were as follows: fractional curves from L3 to S1 > 10°, ipsilateral radicular symptoms concordant on the fractional curve concavity side, patients who underwent at least 1 interbody fusion at the level of the fractional curve, and a minimum 1-year follow-up. Primary outcomes included changes in fractional curve correction, lumbar lordosis change, pelvic incidence − lumbar lordosis mismatch change, scoliosis major curve correction, and rates of revision surgery and postoperative complications. Secondary analysis compared the same outcomes among patients undergoing posterior, anterior, and lateral approaches for their interbody fusion.RESULTSA total of 78 patients were included. There were no significant differences in age, sex, BMI, prior surgery, fractional curve degree, pelvic tilt, pelvic incidence, pelvic incidence − lumbar lordosis mismatch, sagittal vertical axis, coronal balance, scoliotic curve magnitude, proportion of patients undergoing an osteotomy, or average number of levels fused among the groups. The mean follow-up was 35.8 months (range 12–150 months). Patients undergoing more levels of interbody fusion had more fractional curve correction (7.4° vs 12.3° vs 12.1° for 1, 2, and 3 levels; p = 0.009); greater increase in lumbar lordosis (−1.8° vs 6.2° vs 13.7°, p = 0.003); and more scoliosis major curve correction (13.0° vs 13.7° vs 24.4°, p = 0.01). There were no statistically significant differences among the groups with regard to postoperative complications (overall rate 47.4%, p = 0.85) or need for revision surgery (overall rate 30.7%, p = 0.25). In the secondary analysis, patients undergoing anterior lumbar interbody fusion (ALIF) had a greater increase in lumbar lordosis (9.1° vs −0.87° for ALIF vs transforaminal lumbar interbody fusion [TLIF], p = 0.028), but also higher revision surgery rates unrelated to adjacent-segment pathology (25% vs 4.3%, p = 0.046). Higher ALIF revision surgery rates were driven by rod fracture in the majority (55%) of cases.CONCLUSIONSMore levels of interbody fusion resulted in increased lordosis, scoliosis curve correction, and fractional curve correction. However, additional levels of interbody fusion up to 3 levels did not result in more postoperative complications or morbidity. ALIF resulted in a greater lumbar lordosis increase than TLIF, but ALIF had higher revision surgery rates.

Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

2020 ◽  
Vol 49 (3) ◽  
pp. E11 ◽  
Author(s):  
Yoshifumi Kudo ◽  
Ichiro Okano ◽  
Tomoaki Toyone ◽  
Akira Matsuoka ◽  
Hiroshi Maruyama ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Spinal Canal ◽  
Interbody Fusion ◽  
Decompression Surgery ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Posterior Decompression ◽  
Lateral Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Dural Tears

OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

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