Notching of the Neck After Acetabular Constraint Necessitating Femoral Component Revision

AbstractIsolated polyethylene liner exchange (IPLE) is infrequently selected as a treatment approach for patients with primary total knee arthroplasty (TKA) prosthetic joint instability. Potential advantages of less immediate surgical morbidity, faster recovery, and lower procedural cost need to be measured against reoperation and re-revision risk. Few published studies have directly compared IPLE with combined tibial and femoral component revision to treat patients with primary TKA instability. After obtaining institutional review board (IRB) approval, we performed a retrospective comparison of 20 patients treated with IPLE and 126 patients treated with tibial and femoral component revisions at a single institution between 2011 and 2018. Patient demographic characteristics, medical comorbidities, time to initial revision TKA, and reoperation (90 days, <2 years, and >2 years) were assessed using paired Student's t-test or Fisher's exact test with a p-value <0.01 used to determine significance. Patients undergoing IPLE were more likely to undergo reoperation (60.0 vs. 17.5%, p = 0.001), component revision surgery (45.0 vs. 8.7%, p = 0.002), and component revision within 2 years (30.0 vs. 1.6%, p < 0.0001). Differences in 90-day reoperation (p = 0.14) and revision >2 years (p = 0.19) were not significant. Reoperation for instability (30.0 vs. 4.0%, p < 0.001) and infection (20.0 vs. 1.6%, p < 0.01) were both higher in the IPLE group. IPLE does not provide consistent benefits for patients undergoing TKA revision for instability. Considerations for lower immediate postoperative morbidity and cost need to be carefully measured against long-term consequences of reoperation, delayed component revision, and increased long-term costs of multiple surgical procedures. This is a level III, case–control study.

Download Full-text

Results of Isolated Femoral Component Revision With Well-Fixed Acetabular Implant Retention

The Journal of Arthroplasty ◽

10.1016/j.arth.2009.12.015 ◽

2010 ◽

Vol 25 (8) ◽

pp. 1188-1195 ◽

Cited By ~ 8

Author(s):

Kyung Soon Park ◽

Taek Rim Yoon ◽

Eun Kyoo Song ◽

Keun Bae Lee

Keyword(s):

Femoral Component ◽

Implant Retention ◽

Component Revision ◽

Acetabular Implant

Download Full-text

Cement-in-cement femoral component revision

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-1953.r2 ◽

2021 ◽

Vol 103-B (7) ◽

pp. 1215-1221

Author(s):

John W. Kennedy ◽

Nigel Y. B. Ng ◽

David Young ◽

Nicholas Kane ◽

Andrew G. Marsh ◽

...

Keyword(s):

Femoral Component ◽

Short Form ◽

Demographic Data ◽

Senior Author ◽

Inclusion Criteria ◽

Reliable Technique ◽

Patient Demographic Data ◽

Oxford Hip Score ◽

Component Revision

Aims Cement-in-cement revision of the femoral component represents a widely practised technique for a variety of indications in revision total hip arthroplasty. In this study, we compare the clinical and radiological outcomes of two polished tapered femoral components. Methods From our prospectively collated database, we identified all patients undergoing cement-in-cement revision from January 2005 to January 2013 who had a minimum of two years' follow-up. All cases were performed by the senior author using either an Exeter short revision stem or the C-Stem AMT high offset No. 1 prosthesis. Patients were followed-up annually with clinical and radiological assessment. Results A total of 97 patients matched the inclusion criteria (50 Exeter and 47 C-Stem AMT components). There were no significant differences between the patient demographic data in either group. Mean follow-up was 9.7 years. A significant improvement in Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-item Short-Form Survey (SF-12) scores was observed in both cohorts. Leg lengths were significantly shorter in the Exeter group, with a mean of -4 mm in this cohort compared with 0 mm in the C-Stem AMT group. One patient in the Exeter group had early evidence of radiological loosening. In total, 16 patients (15%) underwent further revision of the femoral component (seven in the C-Stem AMT group and nine in the Exeter group). No femoral components were revised for aseptic loosening. There were two cases of femoral component fracture in the Exeter group. Conclusion Our series shows promising mid-term outcomes for the cement-in-cement revision technique using either the Exeter or C-Stem AMT components. These results demonstrate that cement-in-cement revision using a double or triple taper-slip design is a safe and reliable technique when used for the correct indications. Cite this article: Bone Joint J 2021;103-B(7):1215–1221.

Download Full-text

Femoral Component Revision with Use of Impaction Bone-Grafting and a Cemented Polished Stem

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200605000-00037 ◽

2006 ◽

Vol 88 (5) ◽

pp. 1162 ◽

Cited By ~ 1

Author(s):

Timothy N. Board

Keyword(s):

Femoral Component ◽

Bone Grafting ◽

Impaction Bone Grafting ◽

Component Revision

Download Full-text

Histologic and Mechanical Evaluation of Impaction Grafting for Femoral Component Revision in a Goat Model

Orthopedics ◽

10.3928/0147-7447-20050101-14 ◽

2005 ◽

Vol 28 (1) ◽

pp. 49-58 ◽

Cited By ~ 6

Author(s):

Arthur L Malkani ◽

Michael J Voor ◽

Edward J Hellman ◽

Cyna Khalily ◽

William Capello ◽

...

Keyword(s):

Femoral Component ◽

Impaction Grafting ◽

Component Revision

Download Full-text

Charnley femoral cemented stem with a permeable and resorbable cement restrictor and low-viscosity cement

SICOT-J ◽

10.1051/sicotj/2019034 ◽

2019 ◽

Vol 5 ◽

pp. 39

Author(s):

Jean-Louis Prudhon ◽

Jacques H. Caton ◽

Thierry Aslanian

Keyword(s):

Survival Rate ◽

Femoral Component ◽

First Year ◽

Low Friction ◽

Low Viscosity ◽

Kaplan Meier ◽

Cemented Stem ◽

Component Revision ◽

Cement Restrictor

Introduction: In 1979, in his first book dealing with low-friction arthroplasty (LFA), Charnley highlighted the use of a cement restrictor. Breusch and Malchau described in 2005 the “second-generation cementing technique.” The main objective of this study was to report on the clinical survival of 100 cases of Charnley femoral component implanted in 2007 and 2008 using a permeable and resorbable cement restrictor and a low-viscosity antibiotic-loaded cement. The secondary objectives were to analyze the complications and side effects and the accuracy of the device positioning. Material and methods: This was a monocentric retrospective review of a prospectively compiled database. Diaphyseal restrictor was biodegradable and permeable to gas, blood, and fluids to avoid intramedullary over pression during cementation. The cement was a low-viscosity antibiotic-loaded cement. Among 3555 patients, we selected the first continuous 100 cases of patients where we implanted the device. Survival probability was computed according to Kaplan–Meier method. Results: Mean follow-up was 6.55 ± 2.6 (range 1–11). Considering femoral component revision as the endpoint, survival rate was 100%. No patients died intraoperatively, none in the first month and the first year after surgery. No early periprosthetic fractures have been reported. Discussion: As described initially by Charnley, the use of a cement restrictor was highly recommended through the different generations of cementing techniques. Hypotensive episodes and cardiac arrest have been reported during cement insertion. In our series, we did not deplore any adverse effect related to the cementation. Conclusion: Our study demonstrates a 100% survival rate of a cemented femoral component without adverse effects when using routinely a resorbable and permeable cement restrictor and a low-viscosity cement. Bone cement is still a fantastic ally for the surgeon and the patients.

Download Full-text