scholarly journals Anterolateral Bone Window for Revision Broken Cemented Stem of Unipolar Hemiarthroplasty

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Mohamed Mosa Mohamed Mahmoud ◽  
Bahaaeldin Ibrahim ◽  
Amr Abdelhalem Amr ◽  
Maysara Abdelhalem Bayoumy
Keyword(s):  
Hip Prosthesis ◽  
Femoral Stem ◽  
Functional Improvement ◽  
Bone Window ◽  
Cemented Stem ◽  
Long Stem ◽  
Revision Total Hip Replacement ◽  
Short Time ◽  
Hip Arthroplasties

Background. Fractured stem of the hip prosthesis is well documented in the literature. Although it is rare, it is considered as a challenging problem. Many techniques have been described to solve this problem. Purpose of the Study. Evaluation of the effect of anterolateral bone window for extraction of the cemented femoral stem of hemiarthroplasty in revision total hip replacement. Methods. The study included eight revision hip arthroplasties in eight patients, with a broken stem of cemented (Thompson) hemiarthroplasty, which has been revised by the anterolateral proximal femoral window. All cases received cemented cups and cement-in-cement stems, except one case who received cementless long stem. Clinical follow-up of cases by Harries hip score (HHS) and X-ray. Results. Functional improvement of HHS of all cases, with no signs of loosening, after a mean follow-up period of 1.5 years. Conclusion. Extraction of broken stem is a challenging procedure. Many techniques have been described for revision of cases with a fractured stem of hip prosthesis, but we think that the anterolateral femoral bone window is a reproducible technique due to the characteristics of simplicity, short-time procedure, less invasive, not requiring extra instruments, and can be successful for most patients.

scholarly journals The Olympia anatomic polished cemented stem is associated with a high survivorship, excellent hip-specific functional outcome, and high satisfaction levels: follow-up of 239 consecutive patients beyond 15 years

2021 ◽  
Author(s):  
Gareth S. Turnbull ◽  
Claire Marshall ◽  
Jamie A. Nicholson ◽  
Deborah J. MacDonald ◽  
Nicholas D. Clement ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Femoral Stem ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
High Satisfaction ◽  
Age At Surgery ◽  
Patient Reported ◽  
Cemented Stem ◽  
Oxford Hip Score

Abstract Introduction The Olympia femoral stem is a stainless steel, anatomically shaped, polished and three-dimensionally tapered implant designed for use in cemented total hip arthroplasty (THA). The primary aim of this study was to determine the long-term survivorship, radiographic outcome, and patient-reported outcome measures (PROMs) of the Olympia stem. Patients and methods Between May 2003 and December 2005, 239 patients (264 THAs) underwent a THA with an Olympia stem in our institution. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS), EuroQol-5 dimensions (EQ-5D) score, and patient satisfaction at mean 10 years following THA. Patient records and radiographs were then reviewed at a mean of 16.5 years (SD 0.7, 15.3–17.8) following THA to identify occurrence of complications or revision surgery for any cause following surgery. Radiographs were assessed for lucent lines and lysis according to Gruen’s zones Results Mean patient age at surgery was 68.0 years (SD 10.9, 31–93 years). There were 156 women (65%, 176 THAs). Osteoarthritis was the indication for THA in 204 patients (85%). All cause stem survivorship at 10 years was 99.2% (95% confidence interval [CI], 97.9%–100%) and at 15 years was 97.5% (94.6%–100%). The 15-year stem survival for aseptic loosening was 100%. Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (96.3%–100%) at 10 years and 95.9% (92.4%–99.4%) at 15 years. There were 9 THAs with non-progressive lucent lines in a single Gruen zone and 3 had lines in two zones, and no patient demonstrated signs for lysis. At a mean of 10-year (SD 0.8, 8.7–11.3) follow-up, mean OHS was 39 (SD 10.3, range 7–48) and 94% of patients reported being very satisfied or satisfied with their THA. Conclusions The Olympia stem demonstrated excellent 10-year PROMs and very high rates of stem survivorship at final follow-up beyond 15 years.

scholarly journals Outcome after Two Sequential Revision Hip Arthroplasties for CoC Bearing Fracture with 10 Years Follow-up: A Case Report

2021 ◽  
Vol 11 (7) ◽  
Author(s):  
Matevž Topolovec ◽  
Ingrid Milošev ◽  
Andrej Cör
Keyword(s):  
Case Report ◽  
Hip Prosthesis ◽  
Full Range ◽  
Revision Operation ◽  
Term Survival ◽  
Ceramic Liner ◽  
Bearing Couple ◽  
Hip Arthroplasties

Introduction: Revisions due to the fracture of ceramic-on-ceramic (CoC) bearing are rare, however when they occur, they represent a major challenge to an orthopedic surgeon for ensuring safe and long-term survival of the replaced bearing. Case Report: We present a case of fractured ceramic liner of total hip prosthesis that underwent revision to a metal-on-polyethylene (MoP) bearing couple, with consequent huge periprosthetic metallosis. Shortly after, the second revision operation followed using the third bearing couple of ceramic-on-polyethylene (CoP). At 10 years follow-up after the operation due to ceramic fracture, the patient is now pain free with full range of motion of the revised hip. Conclusion: Establishment of diagnostic routes and recommended protocols for CoC bearing fracture would allow easier recognition of potential fracture and diminish its consequences for the patients. Keywords: Tribology, Revision Hip Arthroplasty, Ceramic Bearing Fracture.

Cement within Cement Revision Hip Arthroplasty a Minimum 5 Year Follow-Up Study

1998 ◽  
Vol 8 (3) ◽  
pp. 129-137 ◽  
Author(s):  
J.P. Holland ◽  
F.A. Weber
Keyword(s):  
Femoral Stem ◽  
Femoral Shaft ◽  
Complete Removal ◽  
Senior Author ◽  
Long Term Results ◽  
Cemented Stem ◽  
Revision Hip Surgery

Complete removal of femoral shaft cement during revision hip surgery is a difficult task prone to complications. If the cement bone interface is intact however, is there a place for its preservation and re-use with a new cemented stem? The results are reported of 51 cement within cement femoral stem revisions carried out between 1984 and 1991 with a minimum of 5 years’ follow-up, and a mean of 7.8 years. Excluding patients lost or deceased, 39 hips in 38 patients were reviewed clinically and radiologically. Eighty-two percent of these were still functioning in situ, 72% were excellent or good using the HSS scoring system and 97% had no radiological evidence of loosening. Femoral stem failure due to aseptic loosening occurred in 4 cases (10%) between 4 and 12 years after revision. Comparing this series to a previous revision hip series by the senior author, there appears to be no deterioration in long term results using this technique, and a better long term radiological outcome.

The ESOP-HA modular cementless femoral stem: a study of the results of 165 hip arthroplasties with a minimum of 10-year follow-up

2005 ◽  
Vol 15 (4) ◽  
pp. 275-285 ◽  
Author(s):  
Michel P. Philippe ◽  
Elvira Martin ◽  
Jacques Hummer ◽  
Gérard Gacon ◽  
Alain Dambreville ◽  
...  
Keyword(s):  
Femoral Stem ◽  
Cementless Femoral Stem ◽  
Hip Arthroplasties

Hydroxyapatite-Coated Femoral Stem Survivorship at 10 Years

2005 ◽  
Vol 284-286 ◽  
pp. 1069-0 ◽  
Author(s):  
Gregory Y. Lee ◽  
Ajay Srivastava ◽  
Darryl D. D'Lima ◽  
Pam Pulido ◽  
Clifford W. Colwell
Keyword(s):  
Polyethylene Wear ◽  
Femoral Stem ◽  
Senior Author ◽  
Independent Observer ◽  
Long Term Follow Up ◽  
The Mean ◽  
Lost To Follow Up ◽  
Hip Arthroplasties

The Omnifit-HA femoral stem component has shown excellent results in early clinical studies. This is an independent prospective study of the outcome of a ydroxyapatite-coated femoral component implanted by one surgeon with an intermediate-term follow up. The senior author performed 103 consecutive uncemented total hip arthroplasties in 96 patients from July 1991 to December 1996. The components implanted were the Omnifit-HA femoral stem and the Omnifit PSL porous-coated acetabular shell. The mean age at the time of the index procedure was 52 years old (range, 27–78) and male:female ratio was 54:42. Three patients were deceased and four patients were lost to follow-up. The mean follow up was 10.3 years (range, 7.3–12.7 years). Clinical and radiographic evaluations were performed by an independent observer. The average preoperative and postoperative Harris Hip Scores were 55 and 92, respectively. The overall survivorship of the Omnifit-HA stem was 100% with no femoral revisions. The survivorship of the Omnifit PSL cup was 89.7% with 4 acetabular revisions for aseptic loosening and 6 polyethelene liner exchanges for osteolysis or late instability. The mean polyethylene wear rate was 0.24 mm per year. This long-term follow up shows that the use of circumferentially coated hydroxyapatite stems can protect against the migration of wear debris along the femoral stem.

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

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.

Cementless Revision for Failed Cemented total Hip Arthroplasty

1996 ◽  
Vol 6 (2) ◽  
pp. 69-74 ◽  
Author(s):  
J.G. Hussell ◽  
E.J. Smith ◽  
I.D. Learmonth
Keyword(s):  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Late Dislocation ◽  
Hip Function ◽  
Long Stem ◽  
And Migration ◽  
Lost To Follow Up ◽  
Hip Arthroplasties ◽  
Cemented Total Hip Arthroplasty

Sixty-two consecutive revision hip arthroplasties were carried out in 57 patients between 1986 and 1990 using the long stem Porous Coated Anatomic (PCA) prosthesis. Fifty-two hips were available for clinical and radiological review. The remainder had either died or were lost to follow-up. The average follow-up was 4.8 years (range 3-7.8 years) and the mean age was 56 years (range 25-77 years). Using the Harris Hip Score, 38/53 (73%) were regarded as good/excellent, 6/52 (11.5%) as fair and 8/52 (15.5%) as poor. The incidence of femoral component subsidence (31/52 - 60%) was a cause of concern, and accounted for two cases of late dislocation. Of the remaining six hips regarded as failures, two had been revised for acetabular graft resorption and migration of the cup while four had moderate persistent pain despite fair hip function. The authors are unable to recommend the long stem PCA prosthesis for routine use in revision hip arthroplasty.

Clinical outcomes and dislocation rates after hip reconstruction using the Bioball system

2019 ◽  
Vol 30 (5) ◽  
pp. 609-616 ◽  
Author(s):  
John Dabis ◽  
Jonathan R Hutt ◽  
David Ward ◽  
Richard Field ◽  
Philip A Mitchell ◽  
...  
Keyword(s):  
Femoral Stem ◽  
Clinical Results ◽  
Femoral Anteversion ◽  
Functional Improvement ◽  
Leg Length ◽  
Neck Extension ◽  
Post Surgery ◽  
Iatrogenic Damage ◽  
The Uk

Introduction: Instability accounts for 1/3 of revision total hip arthroplasty (rTHA) performed in the UK. Removal of well-fixed femoral stems in rTHA is challenging with a risk of blood loss and iatrogenic damage to the femur. The Bioball universal adaptor (BUA), a modular head neck extension adaptor, provides a mechanism for optimisation of femoral offset, leg length and femoral anteversion. This can avoid the need for femoral stem revision in selected cases. The aim of this study is to present the clinical results and rate of instability following revision with this BUA at a minimum of 2 years follow-up. Patients and methods: A review of our prospectively collected database was performed. All patients treated with the Bioball device were included. Clinical and radiologic review were performed pre- and post-surgery. Specific enquiry for instability was made. The Oxford Hip Score (OHS), EuroQol (EQ-5D) score and WOMAC scores were calculated pre-and post-operatively. Complications were recorded. Results: 32 rTHA procedures were performed using the Bioball device between 2013 and 2016. 4 patients did not wish to complete post-operative questionnaires. 2 patients (2/28, 7%) complained of recurrent dislocations following their rTHA procedure. 1 patient complained of instability but no dislocation. The median pre-operative EQ-5D was 0.195 (range −0.07–0.85), OHS was 20 (range 5–43) and WOMAC was 29.8 (range 15.5–52.3). The median EQ-5D was 0.85 (range 0.59–1), OHS was 39 (range 21–48) and WOMAC was 91.1 (range 44.5–99.2) at final follow-up. There were significant improvements in the EQ-5D ( p = 0.0009), OHS ( p = 0.0004) and WOMAC ( p = 0.0001). Conclusion: The BUA is associated with significant functional improvement and relatively low dislocation rates in revision THA. It is a viable option for use in the revision setting.

Cemented femoral stem fixation through the anterior approach has fewer early complications than cementless fixation

2021 ◽  
Vol 103-B (7 Supple B) ◽  
pp. 33-37 ◽  
Author(s):  
Kwame A. Ennin ◽  
Karim A. Elsharkawy ◽  
Shuvalaxmi Dasgupta ◽  
Roger H. Emerson
Keyword(s):  
Anterior Approach ◽  
Older Patients ◽  
Femoral Stem ◽  
Consecutive Series ◽  
Cementing Technique ◽  
Cementless Fixation ◽  
Early Complications ◽  
Surgical Complexity ◽  
Cemented Stem

Aims To achieve the functional benefits of the direct anterior (DA) approach and the fixation benefits of cemented replacement, this study combined the two techniques posing the following questions: does the limited access of the DA approach adversely affect the cement technique?; and does such a cementing technique reduce the incidence of cementless complications? Methods A consecutive series of 341 patients (360 hips) receiving the DA approach between 2016 and 2018 were reviewed. There were 203 cementless stems and 157 cemented stems. Mean age was 75 years (70 to 86) in the cementless group and 76 years (52 to 94) in the cemented group, with 239 (70%) females in the whole series. Femoral complications were compared between the two groups. Mean follow-up was 1.5 years (0.1 to 4.4) for patients in the cementless group and 1.3 years (0.0 to 3.9) for patients in the cemented group. Results The cementless group had a higher rate of femoral complications (8 vs 0; p = 0.011). There were two loose stems and six fractures, all requiring revision. Fractures occurred a mean 14.5 days (2 to 31) postoperatively and loosening at 189 days and 422 days postoperatively. Femoral cementing can be done using the DA approach safely and reduces the number of complications compared with a contemporary cementless series. Conclusion A higher rate of early fractures and loosening occurred with cementless stems. This was not observed in our cemented stem cohort and cementing was safely accomplished through the DA approach. The modern femoral cementing process with the DA approach does not add to surgical complexity or time, has fewer early complications, and is a safer option for older patients compared to cementless femoral arthroplasties. Cite this article: Bone Joint J 2021;103-B(7 Supple B):33–37.

scholarly journals A minimally invasive technique to remove broken cemented stems and its reconstruction with cement-in-cement

2018 ◽  
Vol 29 (1) ◽  
pp. NP1-NP5
Author(s):  
Federico J Burgo ◽  
Diego E Mengelle ◽  
Maecelo Feijoo ◽  
Carlos M Autorino
Keyword(s):  
Minimally Invasive ◽  
Low Cost ◽  
Femoral Stem ◽  
Invasive Procedure ◽  
Low Complexity ◽  
Invasive Technique ◽  
Reconstruction Technique ◽  
Bone Stock ◽  
Cemented Stem

Introduction: Historically the removal of fractured stems was associated with complex revision and loss of bone stock. This study describes a minimally invasive procedure for extraction of the distal part of a broken cemented stem that does not compromise the bone stock and results with the cement-in-cement reconstruction technique. Materials and method: 7 patients with an average age of 74 years who underwent total hip replacement (THR) revision for fracture of femoral stems were included. The average follow-up was 8.7 years. For the removal of the distal fragment of the broken stem, a set of instruments have been manufactured using a coupling through the wrought of a thread over the fractured face of the stem. 6 cases were reconstructed using a cement-in-cement technique. In 1 case an extended trochanteric osteotomy was required. Results: There were no complications associated with the surgical technique. Early rehabilitation and standing were achieved in all patients at 48 hours postoperatively. No patient required a blood transfusion. No clinical or radiological loosening was detected at final follow-up. Conclusions: Different methods have been described for the extraction of distal fragments of a broken femoral stem. The majority include the use of femoral osteotomies, bone windows and knee arthrotomies. These techniques are associated with bone loss and bleeding. The advantages of the method described are, its low complexity, low-cost, accelerated functional recovery and the preservation of bone stock with the possibility of performing cement-in-cement reconstruction techniques.

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