Impaction Grafting for Femoral Component Revision Using a Non-Polished Bead-Blasted Chrome Cobalt Stem—Average 8 1/2–Year Follow-Up

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.

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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

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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.

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Impaction Grafting for Femoral Component Revision in a Goat Model Using Washed Morselized Cancellous Allograft

Orthopedics ◽

10.3928/01477447-20110414-12 ◽

2011 ◽

Author(s):

Michael J. Voor ◽

Robin Madsen ◽

Arthur Malkani ◽

Daisuke Togawa ◽

Thomas W. Bauer

Keyword(s):

Femoral Component ◽

Impaction Grafting ◽

Component Revision ◽

Cancellous Allograft

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Mid- and long-term results of femoral component revision using the cement-in-cement technique: Average 10.8-year follow-up study

Journal of Orthopaedic Science ◽

10.1016/j.jos.2016.03.013 ◽

2016 ◽

Vol 21 (6) ◽

pp. 810-814 ◽

Cited By ~ 5

Author(s):

Yaichiro Okuzu ◽

Koji Goto ◽

Kazutaka So ◽

Yutaka Kuroda ◽

Shuichi Matsuda

Keyword(s):

Femoral Component ◽

Long Term Results ◽

Follow Up Study ◽

Component Revision

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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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Impaction Grafting for Femoral Component Revision in a Goat Model Using Washed Morselized Cancellous Allograft

Orthopedics ◽

10.3928/01477447-20080501-32 ◽

2008 ◽

Vol 31 (5) ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Michael J. Voor ◽

Robin Madsen ◽

Arthur Malkani ◽

Daisuke Togawa ◽

Thomas W. Bauer

Keyword(s):

Femoral Component ◽

Impaction Grafting ◽

Component Revision ◽

Cancellous Allograft

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Femoral Revision with Impaction Allografting and an Uncemented Femoral Component

Hip International ◽

10.1177/112070000801800403 ◽

2008 ◽

Vol 18 (4) ◽

pp. 278-285 ◽

Cited By ~ 6

Author(s):

T.N. Nickelsen ◽

M. Erenbjerg ◽

J.B. Retpen ◽

S. Solgaard

Keyword(s):

Aseptic Loosening ◽

Femoral Component ◽

Clinical Performance ◽

Successful Outcome ◽

Femoral Revision ◽

Slight Pain ◽

Impaction Allografting ◽

Component Revision ◽

Regeneration Of Bone

A technique for uncemented revision of the femoral component which combines impaction allografting and the use of a long-stemmed proximally coated titanium prostheses (Bimetric®, Biomet Inc.) is described. The results after a mean follow-up of 112 months are reported. From 1991 to 1995 femoral component revision for aseptic loosening was performed on 100 hips. In 14 cases (14%) an intraoperative fracture occurred and 7 patients (7%) had other postoperative complications. Seventeen patients (17%) required further revision, 10 because of aseptic loosening. Of 50 surviving patients with retained implants 88% had no pain, 10% had slight pain and only 2% had severe pain. Thirty-eight patients had radiographic signs of remodelling of the graft and/or cortical repair. In cases with a successful outcome, the results have been encouraging in relation to clinical performance, regeneration of bone and implant survival.

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Exeter Universal cemented femoral component

The Bone & Joint Journal ◽

10.1302/0301-620x.102b10.bjj-2019-1454.r1 ◽

2020 ◽

Vol 102-B (10) ◽

pp. 1319-1323

Author(s):

Fouzia Khatun ◽

Damien F. Gill ◽

Amit Atrey ◽

Matthew Porteous

Keyword(s):

Femoral Component ◽

Acetabular Component ◽

District General Hospital ◽

Long Term Results ◽

Case Scenario ◽

Worst Case ◽

Joint Registry ◽

Component Revision ◽

Lost To Follow Up

Aims We present the results, in terms of survival, clinical outcome, and radiological appearance at 20 years, in a cohort of 225 cemented Exeter Universal femoral components (Stryker, Newbury, UK) implanted in 207 patients, at a district general hospital. Methods All patients in this study had a total hip arthroplasty (THA) using an Exeter Universal femoral component with a cemented (n = 215) or cementless (n = 10) acetabular component. Clinical and radiological data were collected prospectively at one year, five years, and every five years thereafter. Patients lost to radiological and clinical follow-up (five) were cross-referenced with National Joint Registry (NJR) data and general practitioner (GP) records to assess whether they had undergone revision for any reason. Results During this period of study 144 patients (157 hips) died (69.78%). Two patients were lost to follow-up, leaving 61 patients (66 hips) available for review (29.33%). Of the 225 hips, three underwent revision for femoral failure with osteolysis. One underwent femoral component revision for treatment of a periprosthetic fracture. Eight underwent revision of the acetabular component only for loosening. Two hips had both components revised, when components were found to be loose at time of revision for acetabular loosening, though no radiological femoral osteolysis. Two patients underwent revision for infection. Using femoral loosening as an endpoint, the survival of the Exeter Universal femoral component was 98.7% (n = 220, 95% confidence interval (CI) 96.1% to 100%) at 20 to 22 years. Survival with an endpoint of revision for any reason was 92.6% (n = 209, 95% CI 89.4 to 95.55), with a ‘worst-case scenario’ (considering two patients lost to follow-up to have failed), the overall survival rate was 91.7% (n = 207, 95% CI 87.8 to 95.9) at 20 to 22 years. Conclusion Our results confirm excellent long-term results for the cemented Exeter Universal femoral componentimplanted outside of the originating centre. Cite this article: Bone Joint J 2020;102-B(10):1319–1323.

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Is a full component revision necessary for isolated tibial loosening?

The Bone & Joint Journal ◽

10.1302/0301-620x.102b6.bjj-2019-1401.r1 ◽

2020 ◽

Vol 102-B (6_Supple_A) ◽

pp. 123-128

Author(s):

J. Ryan Martin ◽

Michael B. Geary ◽

Michael Ransone ◽

David Macknet ◽

Keith Fehring ◽

...

Keyword(s):

Femoral Component ◽

Tibial Component ◽

Primary Total Knee Arthroplasty ◽

Flexion Contracture ◽

Management Options ◽

Patient Demographics ◽

Cause Of Failure ◽

Component Loosening ◽

Component Revision

Aims Aseptic loosening of the tibial component is a frequent cause of failure in primary total knee arthroplasty (TKA). Management options include an isolated tibial revision or full component revision. A full component revision is frequently selected by surgeons unfamiliar with the existing implant or who simply wish to “start again”. This option adds morbidity compared with an isolated tibial revision. While isolated tibial revision has a lower morbidity, it is technically more challenging due to difficulties with exposure and maintaining prosthetic stability. This study was designed to compare these two reconstructive options. Methods Patients undergoing revision TKA for isolated aseptic tibial loosening between 2012 and 2017 were identified. Those with revision implants or revised for infection, instability, osteolysis, or femoral component loosening were excluded. A total of 164 patients were included; 88 had an isolated tibial revision and 76 had revision of both components despite only having a loose tibial component. The demographics and clinical and radiological outcomes were recorded. Results The patient demographics were statistically similar in the two cohorts. The median follow-up was 3.5 years (interquartile range (IQR) 1 to 12.5). Supplementary femoral metaphyseal fixation was required in five patients in the full revision cohort. There was a higher incidence of radiological tibial loosening in the full component revision cohort at the final follow-up (8 (10.5%) vs 5 (5.7%); p = 0.269). Three patients in the full component revision cohort developed instability while only one in the isolated tibial cohort did. Three patients in the full revision cohort developed a flexion contracture greater than 5° while none in the isolated tibial cohort did. Conclusion Isolated tibial revision for aseptic tibial loosening has statistically similar clinical and radiological outcomes at a median follow-up of 3.5 years, when compared with full component revision. Substantial bone loss can occur when removing a well-fixed femoral component necessitating a cone or sleeve. Femoral component revision for isolated tibial loosening can frequently be avoided provided adequate ligamentous stability can be obtained. Cite this article: Bone Joint J 2020;102-B(6 Supple A):123–128.

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