Uncemented Custom-Made Femoral Components

2002 ◽  
Vol 12 (4) ◽  
pp. 365-370 ◽  
Author(s):  
B. Mohan ◽  
J.R. Nixon ◽  
E. Doran
Keyword(s):  
Titanium Alloy ◽  
Aseptic Loosening ◽  
Failure Rate ◽  
Hip Replacement ◽  
Average Duration ◽  
Femoral Prosthesis ◽  
Younger Patients ◽  
Custom Made ◽  
Fit And Fill

We present our experience of total hip replacement (THR) in younger patients using a custom-made smooth titanium alloy femoral prosthesis. Measurements made from pre-operative marker radiographs allowed creation of templates and subsequent computer analysis to mill the stem prior to surgery. Fifty-one such cementless implants were carried out in 43 patients between January 1993 and June 1996 with follow-up to an average of 47 months. Sixteen hips have required revision to date; 13 of these operations were for aseptic loosening. Two more were awaiting revision, giving an overall failure rate of 35.3 %. The average duration from primary operation to revision was 47 months. Thus, even though the concept of an uncemented custom-made femoral component is attractive, the failure rate was found to be unacceptably high. This device may achieve “fit and fill”, but adequate bone on- or in-growth was not achieved. On the basis of these data we have discontinued the use of this implant since 1996.

scholarly journals Is three-dimensional–printed custom-made ultra-short stem with a porous structure an acceptable reconstructive alternative in peri-knee metaphysis for the tumorous bone defect?

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jie Wang ◽  
Jingjing An ◽  
Minxun Lu ◽  
Yuqi Zhang ◽  
Jingqi Lin ◽  
...  
Keyword(s):  
Porous Structure ◽  
Aseptic Loosening ◽  
Bone Defect ◽  
Short Stem ◽  
Leg Length ◽  
Musculoskeletal Tumor Society ◽  
Custom Made ◽  
Orthopedic Oncology ◽  
3D Printed

Abstract Background Long-lasting reconstruction after extensive resection involving peri-knee metaphysis is a challenging problem in orthopedic oncology. Various reconstruction methods have been proposed, but they are characterized by a high complication rate. The purposes of this study were to (1) assess osseointegration at the bone implant interface and correlated incidence of aseptic loosening; (2) identify complications including infection, endoprosthesis fracture, periprosthetic fracture, leg length discrepancy, and wound healing problem in this case series; and (3) evaluate the short-term function of the patient who received this personalized reconstruction system. Methods Between September 2016 and June 2018, our center treated 15 patients with malignancies arising in the femur or tibia shaft using endoprosthesis with a 3D-printed custom-made stem. Osseointegration and aseptic loosening were assessed with digital tomosynthesis. Complications were recorded by reviewing the patients’ records. The function was evaluated with the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score at a median of 42 (range, 34 to 54) months after reconstruction. Results One patient who experienced early aseptic loosening was managed with immobilization and bisphosphonates infusion. All implants were well osseointegrated at the final follow-up examination. There are two periprosthetic fractures intraoperatively. The wire was applied to assist fixation, and the fracture healed at the latest follow-up. Two patients experienced significant leg length discrepancies. The median MSTS-93 score was 26 (range, 23 to 30). Conclusions A 3D-printed custom-made ultra-short stem with a porous structure provides acceptable early outcomes in patients who received peri-knee metaphyseal reconstruction. With detailed preoperative design and precise intraoperative techniques, the reasonable initial stability benefits osseointegration to osteoconductive porous titanium, and therefore ensures short- and possibly long-term durability. Personalized adaptive endoprosthesis, careful intraoperative operation, and strict follow-up management enable effective prevention and treatment of complications. The functional results in our series were acceptable thanks to reliable fixation in the bone-endoprosthesis interface and an individualized rehabilitation program. These positive results indicate this device series can be a feasible alternative for critical bone defect reconstruction. Nevertheless, longer follow-up is required to determine whether this technique is superior to other forms of fixation.

The Mayo Conservative hip: Experience from a District General Hospital

2009 ◽  
Vol 19 (3) ◽  
pp. 211-214 ◽  
Author(s):  
Rob E. Gilbert ◽  
Seema Salehi-Bird ◽  
Peter D. Gallacher ◽  
Phillip Shaylor
Keyword(s):  
Femoral Component ◽  
Hip Replacement ◽  
District General Hospital ◽  
Fracture Rate ◽  
Bone Stock ◽  
Femoral Prosthesis ◽  
Femoral Bone ◽  
Short Term ◽  
The Mean

The Mayo Conservative Hip femoral prosthesis has been designed to optimise proximal femoral loading as well as preserving proximal femoral bone stock. Between October 2003 and May 2006, 42 patients (49 hips) underwent total hip replacement (THR) using the Mayo Conservative Hip femoral component. The mean age at operation was 57.8 years (range 44 to 74) and the mean clinical follow up was 3.1 years (range 2.3 to 4.7 years). The aim of our study was to review the short term results of this unorthodox femoral component. We found that 18%° of stems were malaligned ≥ 5° and the prevalence of intra-operative femoral fracture was 4%. We feel this prosthesis is difficult to implant and has an unacceptable fracture rate.

TREATMENT OF CHRONIC MALLET FRACTURES USING EXTENSION-BLOCK KIRSCHNER WIRE

Hand Surgery ◽  
2014 ◽  
Vol 19 (03) ◽  
pp. 399-403 ◽  
Author(s):  
Kenichi Asano ◽  
Goro Inoue ◽  
Masaki Shin
Keyword(s):  
Operative Treatment ◽  
Average Duration ◽  
Kirschner Wire ◽  
Bone Union ◽  
Younger Patients

Eleven patients with chronic mallet fractures that were seen later than four weeks after injury were treated by extension-block Kirschner wire technique. The average duration from injury to operative treatment was 56 days (range, 28–111). The follow-up evaluations took place after a mean of eight months. The radiographic bone union was obtained in all patients. The average extension loss of the DIP joint was 4 degree (range, 0–15) and the average flexion was 68 degree (range, 43–90). The results according to Crawford's criteria were six excellent, two good, two fair, and one poor. We would say that the technique we treated is effective method of treatment for younger patients with chronic mallet fractures.

The Cemented Custom Femoral Stem - a 10 Year Review

2007 ◽  
Vol 17 (4) ◽  
pp. 194-204 ◽  
Author(s):  
S. O'brien ◽  
R.K. Wilson ◽  
B.M. Hanratty ◽  
N.W. Thompson ◽  
M.E. Wallace ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Median Survival ◽  
Revision Surgery ◽  
Hip Replacement ◽  
Femoral Stem ◽  
Kaplan Meier ◽  
Custom Made ◽  
Titanium Stem

We report a series of 706 patients (759 hip implants) with an average follow up of 10.5 years (range, 10 - 11 years) following total hip replacement (THR) using a cemented custom-made femoral stem and a cemented HDP acetabular component. The fate of every implant is known. One hundred and seventy-four patients (23%) were deceased at the time of their 10-year review - all died with a functioning THR in situ. Four hundred and sixty-two patients (61%) were subsequently reviewed. One hundred and twenty three patients (16%) were assessed by telephone review, as they were too ill or unwilling to attend. Kaplan-Meier survival analysis (all components) demonstrated a median survival at 10 years of 96.05% or 95% Confidence Intervals (CI) for median survival of (94.41% to 97.22%). Revision surgery occurred in 30 cases (3.9%). Seventeen had full revisions (2.2%) and 13 (1.7%) socket revisions only. Twenty-one out of 30 revisions were for infection or dislocation. There were 2 cases (0.3%) of revision for aseptic loosening of the stem. The 10-year results of the custom femoral titanium stem are encouraging and compare well with other cemented systems.

A MODERN CONSTRAINED ACETABULAR COMPONENT FOR THE MANAGEMENT OF HIP INSTABILITY

2016 ◽  
Vol 19 (01) ◽  
pp. 1650002 ◽  
Author(s):  
Dror Maor ◽  
Jie Xu ◽  
Kulvir S Mudhar ◽  
Piers J Yates
Keyword(s):  
High Risk ◽  
Aseptic Loosening ◽  
Hip Replacement ◽  
Recurrent Dislocation ◽  
Deep Infection ◽  
Radiological Findings ◽  
Hip Instability ◽  
Constrained Liner ◽  
Constrained Acetabular Component

The incidence of dislocation after primary THR has been quoted up to 2.25%, and between 2% and 20% for revision THR. We report clinical and radiological findings in 76 patients treated with a constrained liner for those considered at high-risk for dislocation, intraoperative instability or recurrent dislocations. Mean follow up was 12 months. Post operatively there were two cases of recurrent dislocation, one aseptic loosening and nine cases of deep infection. These results support that these liners have been used to treat, or in some cases prevent, instability after total hip replacement.

Long-term follow-up of custom cross-pin fixation of 56 tumour endoprosthesis stems

2019 ◽  
Vol 101-B (6) ◽  
pp. 724-731 ◽  
Author(s):  
N. M. Bernthal ◽  
A. Upfill-Brown ◽  
Z. D. C. Burke ◽  
C. R. Ishmael ◽  
P. Hsiue ◽  
...  
Keyword(s):  
Aseptic Loosening ◽  
Failure Rate ◽  
Tumour Progression ◽  
Mechanical Failure ◽  
Term Survival ◽  
Modes Of Failure ◽  
Pin Fixation ◽  
Compressive Osseointegration

Aims Aseptic loosening is a major cause of failure in cemented endoprosthetic reconstructions. This paper presents the long-term outcomes of a custom-designed cross-pin fixation construct designed to minimize rotational stress and subsequent aseptic loosening in selected patients. The paper will also examine the long-term survivorship and modes of failure when using this technique. Patients and Methods A review of 658 consecutive, prospectively collected cemented endoprosthetic reconstructions for oncological diagnoses at a single centre between 1980 and 2017 was performed. A total of 51 patients were identified with 56 endoprosthetic implants with cross-pin fixation, 21 of which were implanted following primary resection of tumour. Locations included distal femoral (n = 36), proximal femoral (n = 7), intercalary (n = 6), proximal humeral (n = 3), proximal tibial (n = 3), and distal humeral (n = 1). Results The median follow-up was 132 months (interquartile range (IQR) 44 to 189). In all, 20 stems required revision: eight for infection, five for structural failure, five for aseptic loosening, and two for tumour progression. Mechanical survivorship at five, ten, and 15 years was 84%, 78%, and 78%, respectively. Mechanical failure rate varied by location, with no mechanical failures of proximal femoral constructs and distal femoral survivorship of 82%, 77%, and 77% at five, ten, and 15 years. The survivorship of primary constructs at five years was 74%, with no failure after 40 months, while the survivorship for revision constructs was 89%, 80%, and 80% at five, ten, and 15 years. Conclusion The rate of mechanical survivorship in our series is similar to those reported for other methods of reconstruction for short diaphyseal segments, such as compressive osseointegration. The mechanical failure rate differed by location, while there was no substantial difference in long-term survival between primary and revision reconstructions. Overall, custom cross-pin fixation is a viable option for endoprosthetic reconstruction of short metaphyseal segments with an acceptable rate of mechanical failure. Cite this article: Bone Joint J 2019;101-B:724–731.

Aseptic Loosening of Boneloc Cemented Exeter Total Hip Replacement. A 5 Year Follow-Up of the First 100 Hips

2000 ◽  
Vol 10 (2) ◽  
pp. 102-107 ◽  
Author(s):  
P.B. Thomsen ◽  
S. Bøvling ◽  
B. Jacoby ◽  
T.B. Hansen
Keyword(s):  
Aseptic Loosening ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Total Hip

scholarly journals Three-dimensional-printed custom-made hemipelvic endoprosthesis for the revision of the aseptic loosening and fracture of modular hemipelvic endoprosthesis: a pilot study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jie Wang ◽  
Li Min ◽  
Minxun Lu ◽  
Yuqi Zhang ◽  
Jingqi Lin ◽  
...  
Keyword(s):  
Pilot Study ◽  
Aseptic Loosening ◽  
Pelvic Ring ◽  
The Body ◽  
Harris Hip Score ◽  
Short Term ◽  
Musculoskeletal Tumor Society ◽  
Custom Made ◽  
3D Printed

Abstract Background The aims of this pilot study were (1) to assess the efficacy of 3D-printed custom-made hemipelvic endoprosthesis in restoring the natural location of acetabulum for normal bodyweight transmission; (2) to evaluate the short-term function of the revision with this endoprosthesis and (3) to identify short-term complications associated with the use of this endoprosthesis. Methods Between February 2017 and December 2017, seven patients received revision with 3D-printed custom-made hemipelvic endoprosthesis. The body weight moment arm (BWMA) and cup height discrepancy (CHD) after primary and revisional surgery were analyzed to assess acetabulum location with plain radiography. After a median follow-up duration of 29 months (range 24–34), the function was evaluated with the Musculoskeletal Tumor Society (MSTS-93) score and Harris hip score (HHS). Complications were recorded by chart review. Results The acetabulum locations were deemed reasonable, as evaluated by median BWMA (primary vs. revision, 10 cm vs. 10 cm) and median CHD (primary vs. revision, 10 mm vs. 8 mm). The median MSTS-93 score and HHS score were 21 (range 18–23) and 78 (range 75–82) after the revision. No short or mid-term complication was observed in the follow-up of this series. Conclusions Revision with 3D-printed custom-made hemipelvic endoprostheses benefited in reconstructing stable pelvic ring and natural bodyweight transmission for patients encountering the aseptic loosening and fracture of modular hemipelvic endoprosthesis. The revision surgery and appropriate rehabilitation program improved patients’ function to a median MSTS score of 22 and pain-free ambulation. The incidence of the complications was low via this individualized workflow.

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