K-Wire Technique for the Removal of Uncemented Femoral Stem in Revision THA

This report reviews the findings of a massive pseudotumor detected pre-operatively in a 13-year-old revision total hip arthroplasty. The case is unique in that the bearing involved was a 28mm zirconia ceramic head on a polyethylene liner. We propose that the pseudotumor arose from ultrafine titanium particles liberated from the proximal porous coating of the femoral stem. We suspect that the osteolysis produced from polyethylene wear exposed the proximal porous coating and, via a process of mechanical abrasion with the surrounding soft tissues, liberated ultrafine titanium particles. We believe the pseudotumor formed because the patient was pre-sensitized to metal debris based upon a pre-operative lymphocyte T-cell proliferation test (LTT). Based upon this unique case, we feel that pseudotumors more likely form when there is a high rate of ultrafine metal particles generated in a pre-sensitized patient. Finally, we introduce what we believe are the main biologic wear responses in THA. Further research is needed to validate this proposed model.Keywords: pseudotumor, ceramic, polyethylene, osteolysis, THA, bearing wear eesponse, titanium debrisLevel of Evidence: AAOS Therapeutic Study Level IV

Download Full-text

Measurement of bone mineral density by dual-energy x-ray absorptiometry in patients with the Wisconsin hip, an uncemented femoral stem

The Journal of Arthroplasty ◽

10.1016/s0883-5403(05)80015-4 ◽

1996 ◽

Vol 11 (2) ◽

pp. 184-193 ◽

Cited By ~ 77

Author(s):

B. Jenny Kiratli ◽

Mary M. Checovich ◽

Andrew A. McBeath ◽

Michael A. Wilson ◽

John P. Heiner

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Femoral Stem ◽

Dual Energy ◽

Mineral Density ◽

X Ray ◽

Uncemented Femoral Stem

Download Full-text

Extended Trochanteric Osteotomy with Intermediate Resection Arthroplasty Is Safe for Use in Two-Stage Revision Total Hip Arthroplasty for Infection

Journal of Clinical Medicine ◽

10.3390/jcm11010036 ◽

2021 ◽

Vol 11 (1) ◽

pp. 36

Author(s):

Sebastian Hardt ◽

Vincent Justus Leopold ◽

Thilo Khakzad ◽

Matthias Pumberger ◽

Carsten Perka ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Femoral Fractures ◽

Revision Total Hip Arthroplasty ◽

Trochanteric Osteotomy ◽

Two Stage ◽

Total Hip ◽

Extended Trochanteric Osteotomy ◽

Revision Tha

Background: This study sought to compare the results of two-stage revision total hip arthroplasty (THA) for periprosthetic infection (PJI) in patients with and without the use of an extended trochanteric osteotomy (ETO) for removal of a well-fixed femoral stem or cement. Methods: Thirty-two patients who had undergone an ETO as part of a two-stage revision without spacer placement were matched 1:2 with a cohort of sixty-four patients of the same sex and age who had stem removal without any osteotomy. Clinical outcomes including interim revision, reinfection and aseptic failure rates were evaluated. Modified Harris hip scores (mHHS) were calculated. Minimum follow-up was two years. Results: Patients undergoing ETO had a significantly lower rate of interim re-debridement compared to non-ETO patients (0% vs. 14.1%, p = 0.026). Reinfection following reimplantation was similar in both groups (12.5% in ETO patients vs. 9.4% in non-ETO patients, p = 0.365). Revision for aseptic reason was necessary in 12.5% in the ETO group and 14.1% in the non-ETO group (p = 0.833). Periprosthetic femoral fractures were seen in three patients (3.1%), of which all occurred in non-ETO patients. Dislocation was the most common complication, which was equally distributed in both groups (12.5%). The mean mHHS was 37.7 in the ETO group and 37.3 in the non-ETO group, and these scores improved significantly in both groups following reimplantation (p < 0.01). Conclusion: ETO without the use of spacer is a safe and effective method to manage patients with well-fixed femoral stems and for thorough cement removal in two-stage revision THA for PJI. While it might reduce the rate of repeated debridement in the interim period, the use of ETO appears to lead to similar reinfection rates following reimplantation.

Download Full-text

Catastrophic Failure and Metallosis of the Acetabular Component in Total Hip Arthroplasty

10.21203/rs.3.rs-422921/v1 ◽

2021 ◽

Author(s):

FIRAT OZAN ◽

Murat Kahraman ◽

Ali Baktır ◽

Kürşat Gençer

Keyword(s):

Revision Arthroplasty ◽

Femoral Stem ◽

Harris Hip Score ◽

Catastrophic Failure ◽

Total Hip ◽

Catastrophic Failures ◽

Revision Tha ◽

The Mean ◽

Hip Arthroplasties

Abstract Background: To evaluate the clinical features and results of the revision total hip arthroplasties (THA) in patients with catastrophic failures and metallosis. Methods: Fifteen hips of 14 patients with catastrophic failure and metallosis in hip arthroplasties were evaluated. They were followed for at least 4.2 years after the revision THA. Clinical evaluation was performed using Harris hip score. Osteolysis, loosening or presence of metallosis was evaluated with standard radiographs. Metallosis was evaluated intraoperatively according to the metallosis severity classification. Results: The mean time from failure until revision surgery was 9.4 years. It was observed that in the primary THA, metal-on-ceramic (MoC), ceramic-on-ceramic (CoC) and metal-on-conventional polyethylene (MoCPE) bearings were used in 1, 3 and 11 hips, respectively. Grade III metallosis was observed in all patients during revision surgeries. The mean Harris hip score increased from 55 points before revision THA to 75 points at the final follow-up. In revision arthroplasty, MoCPE and CoC bearings were used in 13 and 2 hips, respectively. The femoral stem was replaced in 5 hips. All acetabular cups, except that of one hip, were revised. Conclusions: Revisions of THAs with catastrophic failures and metallosis are quite challenging. Routine follow-up of arthroplasty patients is beneficial to examine for osteolysis, loosening, and asymmetric wear.

Download Full-text