Results of Impaction Grafting in Revision Hip Arthroplasty at Two to Seven Years using Fresh and Irradiated Allograft Bone

The 2- to 7-year follow-up on 41 revision femoral arthroplasties performed using the impaction grafting technique and a collarless, polished, tapered stem is reported. Average age at surgery was 70 years (range 35 - 85) and femoral bone loss was Endoklinik grade 1 in 13.5%, grade 2 in 43.3%, grade 3 in 29.7% and grade 4 in 13.5%. Four patients died during the study period, three with well functioning implants and one with deep infection. Another implant had failed by 1 year with progressive subsidence and periprosthetic fracture and has been revised. Cumulative survival of femoral stems was 92% at 5 years. There were no dislocations. At latest follow-up (average 4 years) 86% of patients were satisfied and greatly improved with surgery (mean Harris hip score 75.1). Favourable radiological features of graft incorporation were observed in 77.5%. Although the follow-up period for the group receiving irradiated bone was slightly shorter, there was no significant difference in clinical or radiological outcomes between 20 patients who received fresh frozen allograft bone and 18 patients who received frozen irradiated allograft bone.

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Locally administered bisphosphonate in hip stem revisions using the bone impaction grafting technique: a randomised, placebo-controlled study with DXA and five-year RSA follow-up

Hip International ◽

10.1177/1120700018781809 ◽

2018 ◽

Vol 29 (1) ◽

pp. 26-34

Author(s):

Ola Belfrage ◽

Magnus Tägil ◽

Martin Sundberg ◽

Uldis Kesteris ◽

Gunnar Flivik

Keyword(s):

Bone Density ◽

Femoral Stem ◽

Controlled Study ◽

First Year ◽

Allograft Bone ◽

Impaction Grafting ◽

Hip Revision ◽

Grafting Technique ◽

Bone Impaction Grafting

Background: Bisphosphonates have previously been shown to increase the density of impacted graft bone. In the present study we hypothesise that bisphosphonates also reduce early stem subsidence. We examined the effect of locally applied bisphosphonate to allografts on prosthetic micromotion and bone density in femoral stem revision with impaction grafting. Methods: 37 patients were randomised to either clodronate or saline as local adjunct to the morsellised allograft bone. 24 patients were finally analysed per protocol and evaluated by dual-energy x-ray absorptiometry (DXA) during the first year and with radiostereometric analysis (RSA) for 5 years. Results: There were no significant differences neither in bone density, nor in migratory behaviour between the groups. The femoral stems had subsided 3.6 mm in both groups (p = 0.99) at 5 years and there was no difference as measured over time with mixed models analysis. The clinical outcome was good in both groups. Conclusion: Clodronate as a local addendum to allograft bone in hip revision did not increase bone density or reduce micromotion of the implant.

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Medium Term Results of Revision Total Hip Replacement Using Radial Impaction Grafting and a Collared Textured Stem

Hip International ◽

10.1177/112070000901900307 ◽

2009 ◽

Vol 19 (3) ◽

pp. 227-233 ◽

Cited By ~ 3

Author(s):

Rajesh G. Kakwani ◽

Mohammed Saquib ◽

Shankar Kashyap

Keyword(s):

Bone Loss ◽

Deep Infection ◽

First Year ◽

Impaction Grafting ◽

Total Hip ◽

Grafting Technique ◽

Revision Hip Surgery ◽

Revision Total Hip Replacement ◽

Massive Bone

Massive bone loss is a problem frequently encountered during revision hip surgery. Several ways of addressing the bone loss in proximal femur have been described with varying results. We present our results with the use of a radial impaction grafting technique and a collared textured component. 107 consecutive cases of Revision Total Hip Arthroplasty, who underwent radial impaction grafting and had a textured collared implant inserted for femoral deficiencies were assessed. The average follow up was seven years and four months (3 to 11 years). All the patients experienced a significant improvement in the clinical scores. Oxford Hip scores improved from an average of 41.2 (30 - 56) to 19.3 (12 - 32). Harris Hip scores improved from an average of 40.8 (28 - 65) to 83.4 (60 -99). There were no cases of subsidence at follow up. Using revision for any cause as the end point the survivorship at an average of 88.8 months was 93.8%. Three revisions were performed for deep infection within the first year. There were three cases of peri-prosthetic fractures distal to the tip of standard length stems at an average of 8.4 months after surgery. We recommend the use of morsellised allografts with radial impaction grafting and textured, collared stems for selected cases with paprosky type ii and type iii femoral defects. We also recommend use of long stems bypassing the tip of the previous implant with impaction grafting to avoid peri-prosthetic fractures.

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Traditional versus mirror three-dimensional printing technology for isolated acetabular fractures: a retrospective study with a median follow-up of 25 months

Journal of International Medical Research ◽

10.1177/03000605211028554 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110285

Author(s):

Kai Xiao ◽

Bo Xu ◽

Lin Ding ◽

Weiguang Yu ◽

Lei Bao ◽

...

Keyword(s):

3D Printing ◽

Three Dimensional ◽

Operation Time ◽

Harris Hip Score ◽

Acetabular Fractures ◽

Printing Technology ◽

Three Dimensional Printing ◽

3D Printing Technology ◽

Significant Difference

Objective To assess the outcomes of traditional three-dimensional (3D) printing technology (TPT) versus mirror 3D printing technology (MTT) in treating isolated acetabular fractures (IAFs). Methods Consecutive patients with an IAF treated by either TPT or MTT at our tertiary medical centre from 2012 to 2018 were retrospectively reviewed. Follow-up was performed 1, 3, 6, and 12 months postoperatively and annually thereafter. The primary outcome was the Harris hip score (HHS), and the secondary outcomes were major intraoperative variables and key orthopaedic complications. Results One hundred fourteen eligible patients (114 hips) with an IAF (TPT, n = 56; MTT, n = 58) were evaluated. The median follow-up was 25 months (range, 21–28 months). At the last follow-up, the mean HHS was 82.46 ±14.70 for TPT and 86.30 ± 13.26 for MTT with a statistically significant difference. Significant differences were also detected in the major intraoperative variables (operation time, intraoperative blood loss, number of fluoroscopic screenings, and anatomical reduction number) and the major orthopaedic complications (loosening, implant failure, and heterotopic ossification). Conclusion Compared with TPT, MTT tends to produce accurate IAF reduction and may result in better intraoperative variables and a lower rate of major orthopaedic complications.

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Slowly resorbable biosynthetic mesh: 2-year results in VHWG grade 3 hernia repair

Hernia ◽

10.1007/s10029-021-02453-1 ◽

2021 ◽

Author(s):

M. M. J. Van Rooijen ◽

T. Tollens ◽

L. N. Jørgensen ◽

T. S. de Vries Reilingh ◽

G. Piessen ◽

...

Keyword(s):

Quality Of Life ◽

Hernia Repair ◽

Hernia Recurrence ◽

Recurrence Rates ◽

Elective Repair ◽

Significant Difference ◽

Grade 3

Abstract Introduction Information on the long-term performance of biosynthetic meshes is scarce. This study analyses the performance of biosynthetic mesh (Phasix™) over 24 months. Methods A prospective, international European multi-center trial is described. Adult patients with a Ventral Hernia Working Group (VHWG) grade 3 incisional hernia larger than 10 cm2, scheduled for elective repair, were included. Biosynthetic mesh was placed in sublay position. Short-term outcomes included 3-month surgical site occurrences (SSO), and long-term outcomes comprised hernia recurrence, reoperation, and quality of life assessments until 24 months. Results Eighty-four patients were treated with biosynthetic mesh. Twenty-two patients (26.2%) developed 34 SSOs, of which 32 occurred within 3 months (primary endpoint). Eight patients (11.0%) developed a hernia recurrence. In 13 patients (15.5%), 14 reoperations took place, of which 6 were performed for hernia recurrence (42.9%), 3 for mesh infection (21.4%), and in 7 of which the mesh was explanted (50%). Compared to baseline, quality of life outcomes showed no significant difference after 24 months. Despite theoretical resorption, 10.7% of patients reported presence of mesh sensation in daily life 24 months after surgery. Conclusion After 2 years of follow-up, hernia repair with biosynthetic mesh shows manageable SSO rates and favorable recurrence rates in VHWG grade 3 patients. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report lasting presence of mesh sensation. Results of biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations. Trial registration Registered on clinicaltrials.gov (NCT02720042), March 25, 2016.

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Long-term results of acetabular reconstruction using irradiated allograft bone

The Bone & Joint Journal ◽

10.1302/0301-620x.100b11.bjj-2018-0478.r2 ◽

2018 ◽

Vol 100-B (11) ◽

pp. 1449-1454 ◽

Cited By ~ 3

Author(s):

C. M. Green ◽

S. C. Buckley ◽

A. J. Hamer ◽

R. M. Kerry ◽

T. P. Harrison

Keyword(s):

At Risk ◽

Aseptic Loosening ◽

Acetabular Component ◽

Long Term Results ◽

Acetabular Reconstruction ◽

Allograft Bone ◽

Patients At Risk ◽

Irradiated Allograft

Aims The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction. Patients and Methods Between 1990 and 2000, 123 hips in 110 patients underwent acetabular reconstruction for aseptic loosening, using impaction bone grafting with frozen, irradiated, and morsellized femoral heads and a cemented acetabular component. A total of 55 men and 55 women with a mean age of 64.3 years (26 to 97) at the time of revision surgery are included in this study. Results At a mean follow-up of 16.9 years, there had been 23 revisions (18.7%), including ten for infection, eight for aseptic loosening, and three for dislocation. Of the 66 surviving hips (58 patients) that could be reassessed, 50 hips (42 patients; 75.6%) were still functioning satisfactorily. Union of the graft had occurred in all hips with a surviving implant. Survival analysis for all indications was 80.6% at 15 years (55 patients at risk, 95% confidence interval (CI) 71.1 to 87.2) and 73.7% at 20 years (eight patients at risk, 95% CI 61.6 to 82.5). Conclusion Acetabular reconstruction using frozen, irradiated, and morsellized allograft bone and a cemented acetabular component is an effective method of treatment. It gives satisfactory long-term results and is comparable to other types of reconstruction. Cite this article: Bone Joint J 2018;100-B:1449–54.

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Comparison of the Effects of Two Different Hollow Nails in the Treatment of the Young Pauwels Type Ⅲ Femoral Neck Fractures

10.21203/rs.3.rs-592204/v1 ◽

2021 ◽

Author(s):

WENJING CHENG ◽

GUOZHENG - DING

Keyword(s):

Femoral Neck ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Avascular Osteonecrosis ◽

Significant Difference ◽

Group A ◽

Random Number Table ◽

Screw Withdrawal ◽

Group B

Abstract Background: At present, there is a higher complication rate after treatment of femoral neck fractures with three parallel hollow nails (PHN) in the young Pauwels type Ⅲ femoral neck fractures.For better effect,F-shape hollow nails(FHN) is used to treat femoral neck fractures.The purpose of this study is to compare the clinical efficacy of FHN and PHN and provide reference for clinical application.Methods: Thirty-eight consecutive patients admitted from January 2017 to January 2020 were selected for the study. According to random number table method, the patients were divided into two groups:group A (FHN) and group B (PHN). The gender, age, BMI, comorbidities, time from injury to operation and other general preoperative demographics were not statistically different (P>0.05). The data of the two groups can be comparable.The occurrence of avascular osteonecrosis of the femoral head (AVN), femoral neck shortening, hollow screw withdrawal was recorded in follow-up.Then, Harris hip score (HHS), pain visual analog score (VAS) of two group were obtained at the last follow-up. Results: The mean follow-up period after surgery was 21.4±10.1 (range, 14–29) months. There were 18 cases(mean age, 47.5±9.6) in group A, 20 cases (mean age, 48.6±10.1) in group B. There was no significant difference between the two groups in AVN, femoral neck shortening (P>0.05), the two groups had statistically significant differences in screw withdrawal (F=4.416, P<0.05). There was no significant difference in HHS and VAS between the two groups at the last follow-up (P>0.05).Conclusion: Three parallel hollow nails (PHN) and F-shape hollow nails (FHN) have similar short-term effects in the young Pauwels type Ⅲ femoral neck fractures, but the nail withdrawal rate of FNH is lower.

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Clinical outcomes of arthroscopic repair of acetabular labral tears

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2017-000328 ◽

2018 ◽

Vol 4 (1) ◽

pp. e000328 ◽

Cited By ~ 4

Author(s):

Carlos César Vassalo ◽

Antônio Augusto Guimarães Barros ◽

Lincoln Paiva Costa ◽

Euler de Carvalho Guedes ◽

Marco Antônio Percope de Andrade

Keyword(s):

Clinical Outcomes ◽

Arthroscopic Repair ◽

Final Evaluation ◽

Labral Repair ◽

Harris Hip Score ◽

Senior Surgeon ◽

Labral Tears ◽

Significant Difference ◽

The Mean

PurposeTo evaluate the primary clinical outcomes of arthroscopic labral repair.MethodsAll patients who underwent arthroscopic repair of the acetabular labrum performed by a senior surgeon between October 2010 and December 2013 were invited to participate in this prospective study. Patients included were those who had a preoperative diagnosis of labral tears, a lateral centre edge greater than 25° and a labral tear believed to be suturable during the intraoperative evaluation. Patients with Tönnis grade 2 or grade 3 hip osteoarthritis and those who had undergone a previous hip surgery were excluded. All patients were evaluated using the modified Harris Hip Score (mHHS) during the final appointment before surgery, 4 months after surgery and at the final evaluation. Interviews were conducted by the senior surgeon.ResultsEighty-four patients (90 hips) underwent arthroscopic repair. The mean age was 44.2 years and the mean follow-up period was 43.0 months (minimum of 25 months and maximum of 59 months). The mean mHHS was 80.4 preoperatively, 95.0 at 4 months postoperatively and 96.6 at final evaluation. A statistically significant difference existed among these scores (p<0.001).ConclusionArthroscopic labral repair was associated with a clinically significant improvement in mHHS after short-term (4 months) and medium-term (43 months) follow-up.Level of evidenceLevel IV, therapeutic case series.

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32-mm ceramic-on-ceramic total hip arthroplasty versus 28-mm ceramic bearings: 5- to 15-year follow-up study

Hip International ◽

10.1177/1120700018760971 ◽

2018 ◽

Vol 29 (1) ◽

pp. 65-71 ◽

Cited By ~ 3

Author(s):

Yoshitoshi Higuchi ◽

Taisuke Seki ◽

Yukiharu Hasegawa ◽

Yasuhiko Takegami ◽

Daigo Morita ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Total Hip ◽

Kaplan Meier ◽

Significant Difference ◽

Average Patient ◽

The Mean ◽

Ceramic On Ceramic

Introduction: This study aimed to compare the clinical and radiographic results of 28-mm ceramic-on-ceramic (CoC) total hip arthroplasty (THA) to those of 32-mm CoC during a 5- to 15-year follow-up period. Methods: 107 joints (95 women and 6 men) underwent 28-mm CoC, and 60 (49 women and 7 men) underwent 32-mm CoC. The average patient age at the time of surgery was 56.1 and 55.7 years in the 28-mm and 32-mm CoC groups, respectively. Clinical and radiologic measurements of all patients were analysed. Results: The mean preoperative Harris hip score (HHS) was similar in the 2 groups (28-mm, 58.9; and 32-mm, 58.5). However, at final follow-up, the mean HHS of the 32-mm CoC (91.8) was significantly better than that of the 28-mm CoC (88.2) ( p = 0.003), as were the ranges of motion (ROM) for flexion (98.3 ± 13.5° vs. 87.3 ± 19.3°, p < 0.001) and abduction (27.8 ± 14.9° vs. 22.1 ± 19.3°, p = 0.007). The mean wear rate was 0.0044 mm/year for the 28-mm CoC and 0.0044 mm/year for the 32-mm CoC. No ceramic fractures were found in the 2 groups. One joint in the 28-mm CoC (0.9%) required revision owing to progressive osteolysis. Kaplan-Meier survival at 10 years, with implant loosening or revision THA as the endpoint, was 98.3% for 28-mm CoC and 100% for 32-mm CoC ( p = 0.465). Conclusion: There was no significant difference in ceramic-related complications between the 2 groups. Our study demonstrated that the 32-mm and 28-mm CoC are safe and are associated with good clinical outcomes.

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Arthroscopic Debridement and Autologous Micronized Adipose Tissue Injection in the Treatment of Advanced-Stage Posttraumatic Osteoarthritis of the Ankle

Cartilage ◽

10.1177/1947603520946364 ◽

2020 ◽

pp. 194760352094636

Author(s):

Yoshiharu Shimozono ◽

John F. Dankert ◽

John G. Kennedy

Keyword(s):

Adipose Tissue ◽

Advanced Stage ◽

Arthroscopic Debridement ◽

Posttraumatic Osteoarthritis ◽

Significant Difference ◽

The Mean ◽

Grade 3

Objective To evaluate the effect of intra-articular injection of autologous micronized adipose tissue (MAT) with ankle arthroscopic debridement in patients with advanced-stage posttraumatic osteoarthritis (PTOA) of ankle. Design A retrospective cohort study investigating patients treated with arthroscopic debridement and autologous MAT injection for ankle PTOA was performed. Patients with Kellgren-Lawrence (KL) grade 3 to 4 were included. Visual analogue scale (VAS), Foot and Ankle Outcome Scores (FAOS), and patient satisfaction were evaluated. Results A total of 19 patients (19 ankles) were included (KL grade 3, 8 patients; grade 4, 11 patients). At a mean follow-up time of 14.3 months (range, 7-23 months), the mean FAOS subscales for pain and quality of life significantly increased from 48.8 and 20.1 preoperatively to 61.1 and 30.1 ( P = 0.029 and 0.048, respectively). The mean VAS score significantly improved from 6.1 to 3.8 (P = 0.003) at final follow-up. A total of 10.5% (2/19) of patients were very satisfied, 31.6% (6/19) satisfied, 26.3% (5/19) neutral, 21.1% (4/19) unsatisfied, and 10.5% (2/19) very unsatisfied with their outcomes. The overall FAOS score demonstrated a significant difference in pre- to postoperative change with 14.8 for KL grade 3 and 5.9 for KL grade 4 ( P = 0.048). Conclusions Autologous MAT injection is a safe and potentially beneficial procedure for advanced-stage ankle PTOA as an adjunct to arthroscopic debridement, although more than one-third of patients were unsatisfied with the procedure. This procedure may be more beneficial for KL grade 3 patients than grade 4 patients. However, future investigations are necessary to define the role of MAT for ankle PTOA.

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The use of an Ossis custom 3D-printed tri-flanged acetabular implant for major bone loss: minimum 2-year follow-up

Hip International ◽

10.1177/1120700018760817 ◽

2018 ◽

Vol 28 (6) ◽

pp. 668-674 ◽

Cited By ~ 15

Author(s):

David C Kieser ◽

Ramez Ailabouni ◽

Sandra C J Kieser ◽

Michael C Wyatt ◽

Paul C Armour ◽

...

Keyword(s):

New Technology ◽

Deep Infection ◽

Harris Hip Score ◽

Patient Specific ◽

Outcome Analysis ◽

Bone Contact ◽

Functional Scores ◽

3D Printed ◽

Acetabular Implant

Introduction: Custom 3D-printed acetabular implants are a new technology used in hip surgery with ever-increasing frequency. They offer patient-specific implants to optimise filling of bone defects and implant-bone contact, without the need for excessive bone resection. Methods: This is a retrospective cohort study of 46 consecutive patients who underwent an Ossis unilateral custom 3D-printed acetabular implant. Clinical (Oxford Hip Score OHS-60), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS) and radiological (restoration of biomechanical hip centre, osteointegration, wear, heterotrophic ossification) results were assessed. Results: Patient mean age was 68 years and follow-up was 38 months (minimum 24 months). 10 patients were excluded from the outcome analysis; 2 patients died, 1 required revision for deep infection and 7 were lost to follow-up. Of the 36 patients included, 21 had severe osteolysis. 7 were revised for infection, 3 for tumoural defects, 3 for metallosis, 1 for dysplasia and 1 for trauma (Paprosky 2a [n=6], 2b [n=2], 2c [n=5], 3a [n=6], 3b [n=11], pelvic dissociation [n=6]). OHS significantly improved postoperatively (16-8-48.4 p=0.027). Postoperative functional scores were good (WOMAC 98; HHS 79). The biomechanical hip centre was restored in all patients. 1 patient had early implant migration with subsequent stabilisation. 2 patients had radiographs concerning for failure of osteointegration. 1 patient had recurrent dislocations. Conclusions: The mid-term results of the Ossis custom 3D-printed tri-flanged acetabular implant for the management of severe acetabular defects are encouraging. The improvement in functional scores and radiographic outcomes are comparable to similar designs. In addition, no cases have required revision for aseptic loosening.

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