An Uncemented Spreading Stem for the Fixation in the Metaphyseal Femur: A Preliminary Report

Surgical treatment to restore full range of motion and full weight bearing after extensive femoral bone resection in patients with primary or metastatic femoral tumours is individually challenging. Especially when the remaining distal or proximal bone is very short, a rigid fixation of an implant is difficult to achieve due to the reverse funnel shape of the metaphysis. Herein, we present a novel implant design using a spreading mechanism in the distal part of the prosthesis for rigid, uncemented fixation in the remaining femoral bone after extensive tumour resection of the femur. We present the outcome of 5 female patients who underwent implantation of this spreading stem after extensive proximal or distal femoral bone resection. There was no radiological or clinical loosening or implant-related revision surgery in our follow-up (mean 21.46 months, range 3.5–46 months). This uncemented spreading stem may therefore represent an alternative option for fixation of a prosthetic device in the remaining metaphyseal femur.

Download Full-text

Intercalary reconstruction of femur after tumour resection: is a vascularized fibular autograft plus allograft a long-lasting solution?

The Bone & Joint Journal ◽

10.1302/0301-620x.100b3.bjj-2017-0283.r2 ◽

2018 ◽

Vol 100-B (3) ◽

pp. 378-386 ◽

Cited By ~ 10

Author(s):

D. A. Campanacci ◽

F. Totti ◽

S. Puccini ◽

G. Beltrami ◽

G. Scoccianti ◽

...

Keyword(s):

Weight Bearing ◽

Young Patients ◽

Bone Tumour ◽

Full Weight Bearing ◽

Tumour Resection ◽

Fibular Graft ◽

Musculoskeletal Tumor Society ◽

Long Term Outcome ◽

The Mean

Aims After intercalary resection of a bone tumour from the femur, reconstruction with a vascularized fibular graft (VFG) and massive allograft is considered a reliable method of treatment. However, little is known about the long-term outcome of this procedure. The aims of this study were to determine whether the morbidity of this procedure was comparable to that of other reconstructive techniques, if it was possible to achieve a satisfactory functional result, and whether biological reconstruction with a VFG and massive allograft could achieve a durable, long-lasting reconstruction. Patients and Methods A total of 23 patients with a mean age of 16 years (five to 40) who had undergone resection of an intercalary bone tumour of the femur and reconstruction with a VFG and allograft were reviewed clinically and radiologically. The mean follow-up was 141 months (24 to 313). The mean length of the fibular graft was 18 cm (12 to 29). Full weight-bearing without a brace was allowed after a mean of 13 months (seven to 26). Results At final follow-up, the mean Musculoskeletal Tumor Society Score of 22 evaluable patients was 94% (73 to 100). Eight major complications, five fractures (21.7%), and three nonunions (13%) were seen in seven patients (30.4%). Revision-free survival was 72.3% at five, ten, and 15 years, with fracture and nonunion needing surgery as failure endpoints. Overall survival, with removal of allograft or amputation as failure endpoints, was 94.4% at five, ten, and 15 years. Discussion There were no complications needing surgical revision after five years had elapsed from surgery, suggesting that the mechanical strength of the implant improves with time, thereby decreasing the risk of complications. In young patients with an intercalary bone tumour of the femur, combining a VFG and massive allograft may result in a reconstruction that lasts a lifetime. Cite this article: Bone Joint J 2018;100-B:378–86.

Download Full-text

An innovate strategy to treat large metaphyseal segmental femoral bone defect using customized design and 3D printed micro-porous prosthesis: a prospective clinical study

10.21203/rs.2.24245/v1 ◽

2020 ◽

Author(s):

Guojin Hou ◽

Bingchuan Liu ◽

Yun Tian ◽

Zhongjun Liu ◽

Fang Zhou ◽

...

Keyword(s):

Bone Defect ◽

Weight Bearing ◽

Fibrous Tissue ◽

Radiographic Evaluation ◽

Full Weight Bearing ◽

Prospective Clinical Study ◽

Femoral Bone ◽

3D Printed ◽

Partial Weight

Abstract Background Large segmental bone defect at the metaphyseal area is still difficult to treat, nowadays, there is a tremendous level of interest in uses of 3D printing technology in orthopaedic surgery. This study was introduced to prospectively confirm the safety and effectiveness of 3D printed micro-porous prosthesis in clinical bone defect reconstruction application. Methods Patients with segmental irregular-shaped bone defect of the femur were recruited from 2017.12 to 2018.11. The first stage of the treatment involves radical debridement of all infected or non-viable bone and interposed fibrous tissue, and temporary fixation. Once the culture and biopsy results were negative, the PMMA spacer should remain in the defect approximately 6-8 weeks. This period is for the membrane formation, virtual surgery (computed tomography (CT) scan of the lesion area and the contra-lateral parts of the femur, and then design of the implant). The second stage involves reconstruction the defects with the 3D printed micro-porous prosthesis combined with intra-medullar nailwithout bone graft.Routine clinical follow-up and radiographic evaluation were done to assess bone incorporation and complications of internal fixation. The weight-bearing time and the joint function were recorded. Result 5 consecutive patients were included in the study. They were followed up for an average of 16.4 months. The average length of bone defect and the distal residual bone was 12 cm and 6.5 cm. The average time of partial weight-bearing and full weight-bearing was 12.7 days and 2.6 months. X-ray demonstrated good osseous integration of the implant/bone interface. No complications occurred such as implant loosening, subsidence, loss of correctionand infection. At the last follow-up, Harris score of hip joint was excellent in 2 cases, good in 2 cases, fair in 1 case; HSS score of knee joint was good in 4 cases, middle in 1 case. Conclusion Meticulous customized design 3D printed micro-porous prosthesis combined with intramedullary fixation may be a cost-effective and an alternative strategy to treat metaphyseal segmental irregular-shaped femoral bone defect without bone graft, especially for cases with massive juxta-articular bone loss.

Download Full-text

Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03913-0 ◽

2021 ◽

Author(s):

Franziska Leiss ◽

Julia Sabrina Götz ◽

Matthias Meyer ◽

Günther Maderbacher ◽

Jan Reinhard ◽

...

Keyword(s):

Risk Factors ◽

Enhanced Recovery ◽

Weight Bearing ◽

Femoral Stem ◽

Full Weight Bearing ◽

Partial Weight Bearing ◽

Fill Ratio ◽

Stem Subsidence ◽

Partial Weight

Abstract Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

Download Full-text

SIMULTANEOUS INSUFFICIENCY FRACTURE OF BILATERAL NECK OF FEMUR WITH COXA VARA

10.36106/ijsr/3801776 ◽

2020 ◽

pp. 41-42

Author(s):

Rishabh Surana ◽

Saurabh Singh ◽

Alok Rai

Keyword(s):

Weight Bearing ◽

Insufficiency Fracture ◽

Young Female ◽

Full Weight Bearing ◽

Coxa Vara ◽

Neck Of Femur ◽

Femur Neck ◽

Femur Neck Fracture ◽

Neck Fracture

Simultaneous insufficiency fracture of bilateral neck of femur with displacement and coxa vara is very uncommon , and very challenging. Osteomalacia is a known cause of insufficiency fracture. We present a case of a young female with non traumatic simultaneous bilateral femur neck fracture. On radiological and laboratory investigation fracture was diagnosed as insufficiency fracture due to osteomalacia with coxa vara. Treatment was done by intertrochanteric valgus osteotomy and fixation by dynamic condylar screw with a prebend plate along with oral and parentral vitamin D therapy. On six month follow up both side fractures were well united and patient was able to walk without pain with full weight bearing and with normal gait .Her lab investigations also returned to normal during follow up.

Download Full-text

Is cemented revision total hip arthroplasty a reasonable treatment option in an elderly population?

Orthopedic Reviews ◽

10.4081/or.2019.8263 ◽

2019 ◽

Vol 11 (3) ◽

Author(s):

Philipp Born ◽

Isabella Manzoni ◽

Thomas Ilchmann ◽

Martin Clauss

Keyword(s):

Aseptic Loosening ◽

Elderly Population ◽

Weight Bearing ◽

The Elderly ◽

Full Weight Bearing ◽

Septic Loosening ◽

Term Survival ◽

Press Fit ◽

Revision Tha

Revision THA is increasingly performed especially in the elderly population. The surgeon’s challenge is to provide a solution that supports immediate full weight-bearing, despite poor bone quality. Shape-closed revision stems facilitate that by combining cement fixation with additional press-fit anchoring. The design tolerates varying cement mantle thickness and inconsistent cancellous bone lining of the femoral canal. Following that philosophy, we present our mid-term results using a long version of a cemented Charnley- Kerboull type stem. From 2010 to 2017, 38 long Charnley-Kerboull revision stems (Centris®, Mathys European Orthopaedics, Bettlach, Switzerland) were implanted and followed prospectively. Surgery was performed via a Hardinge approach in supine position with a third generation cementing technique. Patients were mobilized using full-weight bearing as early as possible. Survival was determined for stem revision for aseptic loosening and stem and/or cup revision for any reason. 20 stems had a minimum follow-up (f/u) of 2 years and were included for further radiological analysis. Detailed subsidence analysis as an early predictor for later aseptic loosening was performed using EBRA-FCA software. Further, the presence of osteolysis and cement debonding was evaluated. Mean follow- up was 4 years. No patient was lost to f/u.18 died of causes unrelated to THA. Stem survival was 100%. Survival for any re-operation was 82.2% (two early infections, one soft-tissue debridement, one cup exchange for recurrent dislocations). None of the cases revised for septic loosening showed signs of persistent infection at final f/u. EBRA-FCA revealed two oligosymptomatic cases of subsidence of 5mm and 6mm over a course of 2 and 12 months, respectively, with stable implants thereafter. Neither required revision. There was no development of osteolysis or debonding. The stem provides a reliable early fullweight bearing solution for revision THA with excellent mid-term survival in an elderly population. Even in two cases where subsidence was present, mobility was not impaired and re-revision could be avoided.

Download Full-text

Screw osteosynthesis of transverse fracture of the patella in children

World Journal of Pediatric Surgery ◽

10.1136/wjps-2018-000014 ◽

2019 ◽

Vol 2 (2) ◽

pp. e000014

Author(s):

Simon Oksbjerre Mortensen ◽

Anne Mette Stausholm ◽

Rikke Thorninger

Keyword(s):

Screw Fixation ◽

Weight Bearing ◽

Full Range ◽

Surgical Techniques ◽

Full Weight Bearing ◽

Transverse Fracture ◽

Excellent Outcome ◽

Fractures In Children ◽

Patella Fractures ◽

Special Surgery

ObjectivePatella fractures in children are rare, with an incidence of less than 1% of all pediatric fractures. Literature describes different surgical techniques and outcomes, but there is not a specified superior technique for children. The aim of this study is to assess the functional outcome after screw fixation of transverse patella fractures in children.MethodsTwo boys at 11 years of age were presented with a transverse fracture of the patella within the same week. Open reduction and fixation of the fractured patella with periost sutures and a 4.0 mm titanium screw inserted from the distal fragment. Afterward, the quadriceps expansion was meticulously repaired with sutures.ResultsThe patients could fully weight bear immediately on a fully extended knee in an orthosis. After 4 weeks, radiological healing was obtained. At the 8-week and 6-month follow-up, the modified Hospital of Special Surgery knee score was 100 points in both patients.ConclusionSingle screw fixation provides an excellent outcome after 8 weeks with a full range of motion and full weight bearing, providing a faster recovery.

Download Full-text

Surgical Repair of Open Achilles Tendon Injuries Using No.1 Prolene to Pull Down the Proximal Tendon: A Safe Technique

TAJ Journal of Teachers Association ◽

10.3329/taj.v21i2.3792 ◽

1970 ◽

Vol 21 (2) ◽

pp. 132-134

Author(s):

Sayed Ahmed ◽

Debashis Roy ◽

S Uddin Ahmed ◽

M Enamul Haque ◽

Moshidur Rahman

Keyword(s):

Suture Material ◽

Weight Bearing ◽

Full Range ◽

Neutral Position ◽

Partial Weight Bearing ◽

Active Flexion ◽

Safe Technique ◽

Partial Weight ◽

Distal Tendon

From July 1998 to October 2004 forty-seven patients with open tendo-Achilles injuries were treated pull down the proximal tendon with no.1 prolene. In this surgical method no.1 prolene was threaded through the proximal tendon and the same suture material passed through the distal tendon and its bilateral ends were tightened over the rubber button either under the heel or by the sides of the heel. Box sutures apposed cut ends of the tendon. The ankle was placed in the cast in near neutral position. At six weeks the cast was removed and active flexion program was started. Partial weight bearing was allowed at seven weeks and full bearing was allowed at ten weeks after surgery. The average follow up period is 1.8 years. All the patients exhibited full range of motion at the final follow-up. doi: 10.3329/taj.v21i2.3792 TAJ 2008; 21(2): 132-134

Download Full-text

Reconstruction with Custom Unicondylar Hemiarthroplasty following Tumor Resection: A Case Series and Review of the Literature

The Journal of Knee Surgery ◽

10.1055/s-0039-1688556 ◽

2019 ◽

Vol 33 (08) ◽

pp. 818-824

Author(s):

Joseph A. Ippolito ◽

Megan L. Campbell ◽

Brianna L. Siracuse ◽

Joseph Benevenia

Keyword(s):

Distal Femur ◽

Weight Bearing ◽

Tumor Resection ◽

Case Series ◽

Full Weight Bearing ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Optimal Function ◽

Tumor Involvement

AbstractFor patients with tumors of the distal femur, options for limb salvage include tumor resection followed by reconstruction. While reconstruction commonly involves a distal femoral replacement, careful selection of patients with tumor involvement limited to a single condyle may be candidates for reconstruction with distal femur hemiarthroplasty. In these procedures, resection spares considerably more native anatomy. Three consecutive patients who underwent resection and reconstruction at the distal femur with custom unicondylar hemiarthroplasty are presented in this case series at a mean follow-up of 45 months (range, 26–78). In two cases, prostheses were utilized as a secondary procedure after failure of initial reconstruction. In one case, the custom prosthesis was utilized as the primary method of reconstruction. Mean Musculoskeletal Tumor Society disease-specific scores were 26.7 (range, 25–28). All patients achieved a return to full weight bearing, activities of daily living, and functional range of motion. In appropriately selected patients with tumors of the distal femur, reconstruction with custom unicondylar hemiarthroplasty provides benefits including optimal function postoperatively via preservation of tumor-free bone and ligamentous structures. Additionally, maintenance of greater bone stock may confer benefits to patients with pathology at a high likelihood for recurrence and need for subsequent procedures.

Download Full-text

Synovial Lipomatosis (Lipoma Arborescens) of the Knee

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00263 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0026

Author(s):

Melih Malkoç ◽

Ozgur Korkmaz ◽

Ali Seker ◽

Mehmet Isyar ◽

Ismail Oltulu ◽

...

Keyword(s):

Range Of Motion ◽

Knee Society Score ◽

Weight Bearing ◽

Full Range ◽

Daily Activities ◽

Full Weight Bearing ◽

Female Group ◽

Arthroscopic Synovectomy ◽

Significant Difference ◽

Synovial Lipomatosis

Objectives: The goals of this retrospective study are to emphasize that the patients who have non surgical treatments for several times due to the massive swelling in their knees should be considered the SL and this pathology is treatable by arthroscopic synovectomy Methods: Seventeen patients (four female and thirteen male), were evaluated retrospectively from May 2009 and April 2013. Mean age for female group was 34,75 (range between 32 to 41) and for male group was 34,23 (range between 26 to 46). Mean follow-up period was 14,76 months (range between 6 months and 38 months). Mean duration of compliance was 26,23 months (range between 9 to 96) months. All patients rated by Knee Society Score preoperatively and postoperatively arthroscopic synovectomy, performed by using radiofrequency ablation and arthroscopic shaver for treatment procedure. Patients were discharged at the end of the one day hospitalization. Postoperatively all patients were allowed to full range of motion and full weight-bearing within one day after surgery. Results: Patients were evaluated preoperatively and postoperatively using the Knee Society Score. The mean Knee Society Score was 67,82 preoperatively and 88,23 was postoperatively. There is significant difference between preoperative and postoperative Knee Society scores.(p <0.05) At the end of the three months, MRI studied and there was no clue of recurrence except two patients. All patients returned to their daily activities with full of range of motion and without swelling of the affected knee joints. At the microscopic histological studies were reported as synovial lipomatosis for all patients Conclusion: Arthroscopic synovectomy is the safe and dramatically effective method of treatment in synovial lipomatosis with less complication, curability and retrieving patients full range of motion with no limitation in their daily activities

Download Full-text

Nottingham Experience with The Fixed Bearing Infinity Total Ankle Replacement

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00424 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0042

Author(s):

Hatem Salem-Saqer ◽

Martin Raglan ◽

Sunil Dhar

Keyword(s):

Complication Rate ◽

Weight Bearing ◽

Total Ankle Replacement ◽

Total Ankle Arthroplasty ◽

Implant Design ◽

Fixed Bearing ◽

Ankle Arthroplasty ◽

Ankle Replacement ◽

End Stage

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is increasingly used for treatment of end stage arthritis of the ankle; improvements continue to evolve in implant design and instrumentation. We present our experience of the Infinity Total Ankle Arthroplasty (Wright Medical), a fixed bearing 4th generation implant with improved instrumentation Methods: This is a retrospective review of prospectively collected data. From October 2016 to July 2019, we identified 92 (52M/40F) who had the infinity Total Ankle Replacement. This review is of 70 patients with a minimum of 1 year follow up (33M,37F). The mean age was 67.5 years (33-87); 32 right side and 38 left no bilaterals. The indication for surgery was end stage Osteoarthritis in 52, post traumatic arthritis 12, inflammatory arthritis 4, conversion of fusion to TAR 2. The preoperative deformity was graded according to the COFAS classification. All patients had follow up at 6 weeks, 3,6 and 12 months and then annually, with MOXFQ questionnaire and weight bearing radiographs. Results: TAA was performed with the use of fluoroscopy. 77% (54/70) had concomitant procedures as listed in Table.5% (4/70) had complications consisting of, 1 DVT, 1 intra operative medial malleolus fracture, 1 EHL tendon laceration and 1 wound break down. There were no deep or superficial infections. Improvement in clinical outcome and PROMS data was noted on follow up. The MOXFQ for Pain improved from 72 pre-op to 25 at 1year (p<0.001). The outcome for Walking improved from 83 pre-op to 30 at one year (p<0.001). Radiological alignment was maintained asymptomatic posterior heterotopic ossification was noted in 23(16%) patients, lucent lines under the tibial implant were noted in 4 ankles and 1 fibula erosion. 2 TAA (3%) needed to be revised due to malpositioning. Conclusion: Our results show significant improvement in patient outcomes, a short recovery time and marked improvement in mobility post operatively with a very low complication rate, we had no deep infection to date. Two implants were revised which we attribute to the learning curve at the start of practice. This implant is fluoroscopically navigated allowing precise implantation with dedicated instrumentation and we feel this attributed to the low complication rate and good results in our short-term study [Table: see text]

Download Full-text