Femoral defects in revision hip arthroplasty: a therapy-oriented classification

Abstract Introduction The complex field of femoral defects in revision hip arthroplasty displays a lack of standardized, intuitive pre- and intraoperative assessment. To address this issue, the femoral defect classification (FDC) is introduced to offer a reliable, reproducible and an intuitive classification system with a clear therapeutic guideline. Materials and methods The FDC is based on the integrity of the main femoral segments which determine function and structural support. It focuses on the femoral neck, the metaphysis consisting of the greater and lesser trochanter, and the femoral diaphysis. The four main categories determine the location of the defect while subcategories a, b and c are being used to classify the extent of damage in each location. In total, 218 preoperative radiographs were retrospectively graded according to FDC and compared to intraoperatively encountered bone defects. To account for inter-rater and intra-rater agreement, 5 different observers evaluated 80 randomized cases at different points in time. Results A Cohens kappa of 0.832 ± 0.028 could be evaluated, accounting for excellent agreement between preoperative radiographs and intraoperative findings. To account for inter-rater reliability, 80 patients have been evaluated by 5 different observers. Testing for inter-rater reliability, a Fleiss Kappa of 0.688 could be evaluated falling into the good agreement range. When testing for intra-rater reliability, Cohens Kappa of each of the 5 raters has been analyzed and the mean was evaluated at 0.856 accounting for excellent agreement. Conclusion The FDC is a reliable and reproducible classification system. It combines intuitive use and structured design and allows for consistent preoperative planning and intraoperative guidance. A therapeutic algorithm has been created according to current literature and expert opinion. Due to the combination of the FDC with the recently introduced Acetabular Defect Classification (ADC) a structured approach to the entire field of hip revision arthroplasty is now available.

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Total Hip Arthroplasty with Tantalum Constructions

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201219124-29 ◽

2012 ◽

Vol 19 (1) ◽

pp. 24-29

Author(s):

V Yu Murylev ◽

Dmitriy Igorevich Terent'ev ◽

P M Elizarov ◽

Ya A Rukin ◽

G M Kazaryan ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Arthroplasty ◽

Acetabular Reconstruction ◽

Defect Classification ◽

Common Complication ◽

Total Hip ◽

Primary Arthroplasty ◽

Selection Of ◽

Primary Total Hip Arthroplasty

Results of acetabular reconstruction with tantalum constructions were analyzed for 56 patients (25 men and 31 women) aged 35 to 70 years. Primary arthroplasty was performed in 30 and revision intervention in 26 patients. In case of primary total hip arthroplasty the following etiologic factors were considered: posttraumatic acetabulum deformity (21 patients), deficit of acetabular walls resulted from dysplasia (4), femoral head protrusion (5). Evaluation of the defect and selection of tantalum construction were made using defect classification by W.G. Paprosky. Results were assessed by Harris scale at terms 3,6 and 12 months after operation and every year thereafter. Excellent, good and satisfactory results were achieved in 96.8% of cases. The most common complication was the dislocation of hip implant head. It developed in 2 patients after revision arthroplasty and in 1 patient after primary total hip arthroplasty.

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Revision Hip Arthroplasty: Epidemiology, Causes, Risk Factors (foreign literature review)

N N Priorov Journal of Traumatology and Orthopedics ◽

10.32414/0869-8678-2015-2-83-89 ◽

2015 ◽

pp. 83-89 ◽

Cited By ~ 1

Author(s):

A. V. Kaminskiy ◽

L. O. Marchenkova ◽

A. V. Pozdnyakov

Keyword(s):

Risk Factors ◽

Literature Review ◽

Hip Arthroplasty ◽

Significant Risk ◽

Revision Arthroplasty ◽

Revision Hip Arthroplasty ◽

Foreign Literature ◽

Primary Hip Arthroplasty

Publications related to revision hip arthroplasty were analyzed. Data of National Registers from different countries were presented, problems of epidemiology and prognostication of need in revision arthroplasty were highlighted, the causes (demographic, clinical, surgical, rehabilitation) and the most significant risk factors that conditioned the failure of primary hip arthroplasty were described.

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Two-Stage Revision Arthroplasty for Periprosthetic Hip Infection: Mean Follow-Up of Ten Years

BioMed Research International ◽

10.1155/2015/345475 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Szu-Yuan Chen ◽

Chi-Chien Hu ◽

Chun-Chieh Chen ◽

Yu-Han Chang ◽

Pang-Hsin Hsieh

Keyword(s):

Hip Arthroplasty ◽

Cox Regression ◽

Joint Infection ◽

Revision Arthroplasty ◽

Revision Hip Arthroplasty ◽

Harris Hip Score ◽

Two Stage ◽

Eradication Of Infection ◽

The Mean

Background. Two-stage revision hip arthroplasty is the gold standard for treatment of patients with chronic periprosthetic joint infection (PJI), but few studies have reported outcomes beyond short-term follow-up.Methods. A total of 155 patients who underwent two-stage revision arthroplasty for chronic PJI in 157 hips were retrospectively enrolled in this study between January 2001 and December 2010. The mean patient age was 57.5 years, the mean prosthetic age was 3.6 years, and the interim interval was 17.8 weeks. These patients were followed up for an average of 9.7 years.Results. At the latest follow-up, 91.7% of the patients were free of infection. The mean Harris hip score improved significantly from 28.3 points before operation to 85.7 points at the latest follow-up. Radiographically, there was aseptic loosening of the stem or acetabular components in 4 patients. In the multivariate survival analysis using a Cox regression model, repeated debridement before final reconstruction, an inadequate interim period, bacteriuria or pyuria, and cirrhosis were found to be the independent risk factors for treatment failure.Conclusion. Our data show that two-stage revision hip arthroplasty provides reliable eradication of infection and durable reconstruction of the joint in patients with PJI caused by a variety of pathogens.

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Conversion of a Long Distally Fixed Uncemented Revision Femoral Stem to a Proximally Fixed Implant following Fatigue Fracture

Hip International ◽

10.5301/hip.2011.8859 ◽

2011 ◽

Vol 21 (6) ◽

pp. 766-769 ◽

Cited By ~ 4

Author(s):

Peter S. Young ◽

Rory G. Middleton ◽

Ian D. Learmonth ◽

Tahawwar Hasnat A. Minhas

Keyword(s):

Fatigue Fracture ◽

Hip Arthroplasty ◽

Revision Surgery ◽

Revision Arthroplasty ◽

Femoral Stem ◽

Revision Hip Arthroplasty ◽

Hip Revision ◽

Clear Cut ◽

Younger Patient ◽

Primary Hip Arthroplasty

There has been increasing focus on bone conservation through proximal fixation in primary hip arthroplasty. However, the debate regarding fixation in revision arthroplasty and which factors influence implant choice remains less clear-cut. We report a case involving fatigue fracture of a long, distally well-fixed, uncemented revision stem. This was revised to a proximally fixed implant. This case highlights a number of issues when considering the choice of implant in hip revision surgery and raises the issue of bone conservation in revision surgery. We would suggest that in both primary and revision hip arthroplasty meticulous pre-operative consideration of the choice of implant should be undertaken, especially in the younger patient with higher expectations and functional demands.

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Femoral Impaction Allografting for Significant Bone Loss in Revision Hip Arthroplasty

Hip International ◽

10.5301/hipint.5000438 ◽

2017 ◽

Vol 27 (3) ◽

pp. 281-285 ◽

Cited By ~ 1

Author(s):

Thomas A.J. Goff ◽

Peter Bobak

Keyword(s):

Bone Loss ◽

Femoral Component ◽

Hip Arthroplasty ◽

Revision Arthroplasty ◽

Bone Allograft ◽

Revision Hip Arthroplasty ◽

Stem Subsidence ◽

Impaction Allografting ◽

Component Revision

Introduction Femoral 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. Methods Retrospective 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. Results We 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 follow-up period was 5.1 (1.3-9.4) years. The median pre-operative bone defect score was 3 (interquartile range [IQR] 2-3) using the Endo-Klinik classification. Radiological evidence of graft incorporation was observed in 89% (281 of 315 zones) with additional remodelling observed in 33% (103 of 315 zones). The median stem subsidence at 1-year follow-up was 1.1 mm (standard deviation [SD] 1.24 mm, range 0-6 mm). The median Oxford Hip Score at the most recent follow-up was 36.5. To date no femoral component has undergone further revision. Conclusions Encouraging results have been obtained with this technique for the treatment of significant bone loss in revision hip arthroplasty, allowing implantation of a standard prosthesis.

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The short-term outcome of hip revision arthroplasty with Trabecular Metal™ components and augments

SA Orthopaedic Journal ◽

10.17159/2309-8309/2020/v19n3a6 ◽

2020 ◽

Vol 19 (3) ◽

Author(s):

L Noconjo ◽

MB Nortje

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Arthroplasty ◽

Revision Hip Arthroplasty ◽

Trabecular Metal ◽

Short Term ◽

Level Of Evidence ◽

Term Outcome ◽

Hip Revision ◽

Total Hip

ABSTRACT BACKGROUND: Highly porous Trabecular Metal™ acetabular components are increasingly being used in revision hip arthroplasty as they facilitate ingrowth, provide a useful mechanism to deal with bone loss and may decrease the risk of infection. The purpose of this audit was to describe: 1) the total number of hip arthroplasty surgeries over Ave years, the ratio of revision to primary hip arthroplasty and indications for revision; 2) the short-term outcomes of revision hip arthroplasty with Trabecular Metal™ components and augments METHODS: A retrospective folder and radiograph review of all patients who had revision total hip arthroplasty (THA) at a tertiary level hospital from February 2012 to February 2017 was done RESULTS: There were 979 THAs performed over the period - 863 (87%) primary THAs, and 116 (12%) hip revision cases performed in 107 patients. Of the 116 (107 patients) hip revisions, there were seven (6%) re-revisions in Ave patients. The indications for revision were aseptic loosening 67 (59%), septic loosening 11 (10%), liner wear 18 (16%), periprosthetic fracture Ave (4%), other 15 (13%). Trabecular Metal™ was used for revision in 16 hips (14 patients), which is 14% of the total 116 revisions. There were ten females and four males with an average age of 61 years. The average duration of follow-up in this group was 18.5 months (1.5-39.2). In these 16 Trabecular Metal™ hips, there were three (19%) early failures of fixation due to technical errors CONCLUSION: In our institution, 12% of the arthroplasty is revision surgery. The indications for revision are similar to published literature. Trabecular Metal™ revisions had a 19% early failure rate due to technical error Level of evidence: Level 4 Keywords: Trabecular Metal™, augments, total hip arthroplasty, revision hip arthroplasty

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Results of Bone Plasty with Allografts in Revision Hip Arthroplasty

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto20140233-39 ◽

2014 ◽

Vol 21 (2) ◽

pp. 33-39

Author(s):

N. V Zagorodniy ◽

V. I Nuzhdin ◽

K. M Bukhtin ◽

S. V Kagramanov

Keyword(s):

Hip Arthroplasty ◽

Revision Arthroplasty ◽

Bone Defects ◽

Revision Hip Arthroplasty ◽

Treatment Results ◽

Group I ◽

Group Ii ◽

Distal Fixation ◽

Hip Arthroplasties

Results of 79 revision hip arthroplasties using bone defects plasty with allografts were analyzed. Plasty of defects in the zone of acetabulum was performed in 62 operations (group I), alloplasty of femoral defects - in 17 interventions (group II). Mean follow up period made up 5 (3-14) years. In group I excellent treatment results were recorded in 18 (29.03%) cases, good - in 23 (37.1%), satisfactory - in 15 (24.19%), poor - in 6 (9.68%) cases and in II group in 4 (23.53%), 6 (35.29%), 5 (29.41%) and 2 (11.76%) cases, respectively. It was shown that in revision arthroplasty application of allografts increased the risk of suppurative complication development while insertion of distal fixation revision stems enabled to avoid allograft application in femoral defects.

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Revision Hip Arthroplasty: Epidemiology, Causes, Risk Factors (foreign literature review)

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201522283-89 ◽

2015 ◽

Vol 22 (2) ◽

pp. 83-89

Author(s):

A. V Kaminskiy ◽

L. O Marchenkova ◽

A. V Pozdnyakov

Keyword(s):

Risk Factors ◽

Literature Review ◽

Hip Arthroplasty ◽

Significant Risk ◽

Revision Arthroplasty ◽

Revision Hip Arthroplasty ◽

Foreign Literature ◽

Primary Hip Arthroplasty

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Revision Hip Arthroplasty: A Histologic Review

International Journal of Surgical Pathology ◽

10.1177/106689699604030404 ◽

1996 ◽

Vol 3 (4) ◽

pp. 247-256 ◽

Cited By ~ 7

Author(s):

M. O. Shokeir ◽

C. P. Duncan ◽

J. X. O'Connell

Keyword(s):

Foreign Body ◽

Hip Arthroplasty ◽

Inflammatory Reaction ◽

Plasma Cells ◽

Revision Arthroplasty ◽

Revision Hip Arthroplasty ◽

Foreign Body Giant Cell ◽

Metal Debris ◽

Large Joint ◽

Joint Prostheses

Over 120,000 hip prostheses are implanted annually in North America. The rate of revision arthroplasty for loosened large joint prostheses is burgeoning because primary arthroplasties are now performed on younger and more physically active patients. Increasingly, pathologists are being confronted with specimens from these reoperations. The histologic descriptions of the inflammatory tissue that surrounds these loosened prostheses stress the histiocytic and foreign body giant cell reaction, the appearance of the wear debris, and the utility of stromal neutrophils in identifying infection. In fact, the morphologic range of this inflammatory reaction is wider than generally reported in the literature. To define better the histopathology of the tissue surrounding loosened large joint prostheses, 104 revision hip arthroplasty specimens (1,164 hematoxylin and eosin slides, mean 11.2 per case) were examined. Multiple intraoperative bacterial cultures were obtained in 82 cases, of which 8 were positive. Foreign body giant cells and foamy histiocytes were identified in 88 and 89% of cases, respectively. Polyethylene, methylmethacrylate, and metal debris were present in 74, 78, and 63% of cases, respectively. Elemental analysis, performed in selected cases, demonstrated the presence of chromium, cobalt, and titanium, confirming that the observed metal particles were derived from detrition of the femoral component of the implant. Extensive coagulative necrosis was displayed in 67% of the cases. A distinctive papillary fibrocartilaginous metaplasia of synovium was seen in 50% of cases. Superficial fibrinous exudates were present in 62% and active bone remodeling in 49% of cases. The reactive tissue in 8% focally resembled nodular and proliferative fasciitis. Stromal neutrophils, identified in 20% of cases, strongly correlated with positive cultures ( r = .5641, P < .0001, sensitivity = 88%, specificity = 88%). Perivascular plasma cell aggregates, present in 14% of cases, also correlated with positive cultures ( r = .3290, P = .0025, sensitivity 50%, specificity 91%). Superficial fibrin and neutrophils, scattered lymphocytes, and lymphoid aggregates were all poor and insignificant predictors of infection. This study demonstrates that the spectrum of the inflammatory reaction to loosened large joint prostheses is greater than previously appreciated. The value of stromal neutrophilia and perivascular plasma cells in identifying infection is highlighted.

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