Femoral Revision with Impaction Allografting and an Uncemented Femoral Component

A technique for uncemented revision of the femoral component which combines impaction allografting and the use of a long-stemmed proximally coated titanium prostheses (Bimetric®, Biomet Inc.) is described. The results after a mean follow-up of 112 months are reported. From 1991 to 1995 femoral component revision for aseptic loosening was performed on 100 hips. In 14 cases (14%) an intraoperative fracture occurred and 7 patients (7%) had other postoperative complications. Seventeen patients (17%) required further revision, 10 because of aseptic loosening. Of 50 surviving patients with retained implants 88% had no pain, 10% had slight pain and only 2% had severe pain. Thirty-eight patients had radiographic signs of remodelling of the graft and/or cortical repair. In cases with a successful outcome, the results have been encouraging in relation to clinical performance, regeneration of bone and implant survival.

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Femoral Impaction Allografting for Significant Bone Loss in Revision Hip Arthroplasty

Hip International ◽

10.5301/hipint.5000438 ◽

2017 ◽

Vol 27 (3) ◽

pp. 281-285 ◽

Cited By ~ 1

Author(s):

Thomas A.J. Goff ◽

Peter Bobak

Keyword(s):

Bone Loss ◽

Femoral Component ◽

Hip Arthroplasty ◽

Revision Arthroplasty ◽

Bone Allograft ◽

Revision Hip Arthroplasty ◽

Stem Subsidence ◽

Impaction Allografting ◽

Component Revision

Introduction Femoral impaction bone allografting in revision hip arthroplasty facilitates physiological reconstruction with restoration of bone stock, allowing implantation of a standard cemented femoral component. The purpose of this study was to report our experience in femoral component revision arthroplasty with impaction morsellised cancellous bone allograft using custom impactors and a cemented triple-taper polished stem. Methods Retrospective analysis of all cases of femoral component revision hip arthroplasty with impaction bone grafting undertaken by a single surgeon from 2005 to 2011. Outcome measures included radiographic analysis of stem subsidence over time, graft remodelling and incorporation, and clinical progress. Results We reviewed 47 consecutive hips in 44 patients, mean age 62 years (37-88). Femoral impaction with allograft was performed as either single stage (41 cases) or 2-stage (6 cases) procedures. All patients received a cemented C-stem prosthesis. The mean follow-up period was 5.1 (1.3-9.4) years. The median pre-operative bone defect score was 3 (interquartile range [IQR] 2-3) using the Endo-Klinik classification. Radiological evidence of graft incorporation was observed in 89% (281 of 315 zones) with additional remodelling observed in 33% (103 of 315 zones). The median stem subsidence at 1-year follow-up was 1.1 mm (standard deviation [SD] 1.24 mm, range 0-6 mm). The median Oxford Hip Score at the most recent follow-up was 36.5. To date no femoral component has undergone further revision. Conclusions Encouraging results have been obtained with this technique for the treatment of significant bone loss in revision hip arthroplasty, allowing implantation of a standard prosthesis.

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Cement-in-cement femoral component revision

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-1953.r2 ◽

2021 ◽

Vol 103-B (7) ◽

pp. 1215-1221

Author(s):

John W. Kennedy ◽

Nigel Y. B. Ng ◽

David Young ◽

Nicholas Kane ◽

Andrew G. Marsh ◽

...

Keyword(s):

Femoral Component ◽

Short Form ◽

Demographic Data ◽

Senior Author ◽

Inclusion Criteria ◽

Reliable Technique ◽

Patient Demographic Data ◽

Oxford Hip Score ◽

Component Revision

Aims Cement-in-cement revision of the femoral component represents a widely practised technique for a variety of indications in revision total hip arthroplasty. In this study, we compare the clinical and radiological outcomes of two polished tapered femoral components. Methods From our prospectively collated database, we identified all patients undergoing cement-in-cement revision from January 2005 to January 2013 who had a minimum of two years' follow-up. All cases were performed by the senior author using either an Exeter short revision stem or the C-Stem AMT high offset No. 1 prosthesis. Patients were followed-up annually with clinical and radiological assessment. Results A total of 97 patients matched the inclusion criteria (50 Exeter and 47 C-Stem AMT components). There were no significant differences between the patient demographic data in either group. Mean follow-up was 9.7 years. A significant improvement in Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-item Short-Form Survey (SF-12) scores was observed in both cohorts. Leg lengths were significantly shorter in the Exeter group, with a mean of -4 mm in this cohort compared with 0 mm in the C-Stem AMT group. One patient in the Exeter group had early evidence of radiological loosening. In total, 16 patients (15%) underwent further revision of the femoral component (seven in the C-Stem AMT group and nine in the Exeter group). No femoral components were revised for aseptic loosening. There were two cases of femoral component fracture in the Exeter group. Conclusion Our series shows promising mid-term outcomes for the cement-in-cement revision technique using either the Exeter or C-Stem AMT components. These results demonstrate that cement-in-cement revision using a double or triple taper-slip design is a safe and reliable technique when used for the correct indications. Cite this article: Bone Joint J 2021;103-B(7):1215–1221.

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Incidence and Causes of Tibial Component Loosening Based on Level of Obesity in a Large Consecutive Cohort of Cemented Primary TKAs without Stem Extensions

Proceedings of IMPRS ◽

10.18060/24699 ◽

2020 ◽

Vol 3 ◽

Author(s):

Lilly Longawa ◽

Leonard Buller ◽

Mary Ziemba-Davis ◽

R. Michael Meneghini

Keyword(s):

Aseptic Loosening ◽

Medical Records ◽

Tibial Component ◽

Low Viscosity ◽

Primary Tkas ◽

Total Knee ◽

Potential Impact ◽

Component Loosening ◽

Component Revision

Background and Hypothesis: Aseptic loosening is one of the most common failure mechanisms of total knee arthroplasty (TKA) requiring revision. The influence of obesity on tibial component aseptic loosening remains unknown. Some surgeons advocate the addition of a tibial stem extension to reduce the risk of loosening. The purpose of this study was to quantify the incidence and causes of revision for tibial component loosening in a large consecutive cohort of cemented primary TKAs without stem extensions based upon level of obesity. Experimental Design or Project Methods: 534 consecutive cemented primary TKAs performed between 2016 and 2018 by one surgeon were retrospectively reviewed. Procedures were performed using consistent surgical, perioperative medical, and pain-control protocols. All tibial implants were tapered thin keeled designs without stem extensions and implanted with low viscosity cement. Medical records were examined and all-cause revisions of the index surgery were documented. Results: After exclusions for confounds, 525 TKAs were analyzed. Mean age and BMI were 67.8 years and 33.9kg/m2 respectively and 72% were female. Mean follow-up was 19.1 (SD 10.5) months and 48% had minimum two-year follow-up. 41.3% of patients had a BMI greater than 35kg/m2 and 21.9% above 40kg/m2. There were 11 revisions in 10 patients, 1.9% out of all TKAs performed. Five TKAs required both-component revision and three involved the femoral component only. No tibial component revisions were performed for aseptic loosening. Conclusion and Potential Impact: None of the standard tibial implants with a keeled design without stem extensions failed in a patient population with greater than 40% obesity. Despite some suggesting tibial stem extensions should be used in obese TKA patients, these findings suggest that tibial component failure in obese patients may be design specific and routinely utilizing stem extensions may not be warranted and could result in deleterious bone loss at revision if required for reasons other than aseptic loosening.

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Charnley femoral cemented stem with a permeable and resorbable cement restrictor and low-viscosity cement

SICOT-J ◽

10.1051/sicotj/2019034 ◽

2019 ◽

Vol 5 ◽

pp. 39

Author(s):

Jean-Louis Prudhon ◽

Jacques H. Caton ◽

Thierry Aslanian

Keyword(s):

Survival Rate ◽

Femoral Component ◽

First Year ◽

Low Friction ◽

Low Viscosity ◽

Kaplan Meier ◽

Cemented Stem ◽

Component Revision ◽

Cement Restrictor

Introduction: In 1979, in his first book dealing with low-friction arthroplasty (LFA), Charnley highlighted the use of a cement restrictor. Breusch and Malchau described in 2005 the “second-generation cementing technique.” The main objective of this study was to report on the clinical survival of 100 cases of Charnley femoral component implanted in 2007 and 2008 using a permeable and resorbable cement restrictor and a low-viscosity antibiotic-loaded cement. The secondary objectives were to analyze the complications and side effects and the accuracy of the device positioning. Material and methods: This was a monocentric retrospective review of a prospectively compiled database. Diaphyseal restrictor was biodegradable and permeable to gas, blood, and fluids to avoid intramedullary over pression during cementation. The cement was a low-viscosity antibiotic-loaded cement. Among 3555 patients, we selected the first continuous 100 cases of patients where we implanted the device. Survival probability was computed according to Kaplan–Meier method. Results: Mean follow-up was 6.55 ± 2.6 (range 1–11). Considering femoral component revision as the endpoint, survival rate was 100%. No patients died intraoperatively, none in the first month and the first year after surgery. No early periprosthetic fractures have been reported. Discussion: As described initially by Charnley, the use of a cement restrictor was highly recommended through the different generations of cementing techniques. Hypotensive episodes and cardiac arrest have been reported during cement insertion. In our series, we did not deplore any adverse effect related to the cementation. Conclusion: Our study demonstrates a 100% survival rate of a cemented femoral component without adverse effects when using routinely a resorbable and permeable cement restrictor and a low-viscosity cement. Bone cement is still a fantastic ally for the surgeon and the patients.

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Early femoral component migration: comparing the anterior and posterior approach to the hip

Hip International ◽

10.1177/1120700019848103 ◽

2019 ◽

Vol 30 (2) ◽

pp. 160-166

Author(s):

Kathryn Culliton ◽

Hakim Louati ◽

Enrique Sandoval ◽

Wade Gofton ◽

Alexandre Pagé ◽

...

Keyword(s):

Aseptic Loosening ◽

Clinical Outcomes ◽

Femoral Component ◽

Posterior Approach ◽

Migration Rates ◽

Risk Of Failure ◽

Early Migration ◽

Component Migration ◽

Total Migration

Purpose: Early femoral component migration is a useful indicator for identifying implants at risk of failure due to aseptic loosening. The goal of this retrospective study was to identify if anterior approach (AA) treated hips are at a higher risk of failure due to aseptic loosening caused by early migration compared to hips operated on using the traditional posterior approach (PA). Methods: A total of 388 hips were included in this study, 139 AA and 249 PA treated hips. Femoral component migration was evaluated using EBRA-FCA and radiographs were assessed for radiolucency at latest follow-up. Preoperative and 2-year clinical outcomes were reported. Results: The 1- and 2-year migration rates (mm/year), and total migration (mm) at 2-year follow-up were comparable between AA and PA hips, respectively: 0.52 versus 0.41, 0.18 versus 0.19, and 0.64 versus 0.63 (all p > 0.05). Though not statistically significant, a higher percentage of AA hips passed 2-year total migration thresholds that have been associated with aseptic loosening compared to PA hips: 25.4% versus 16.5% for 1.5 mm threshold, and 11.3% versus 4.1% for the 2.7 mm threshold. Migration was not associated with the presence of radiolucent lines. All clinical outcomes improved significantly between preoperative and 2-year follow-up. Conclusions: There was no association between the AA and any significant increase in femoral component migration. A higher percentage of AA hips exceeded the migration thresholds associated aseptic loosening; however, these stems had no other indications of instability and therefore suggests that this may be a difference in migration pattern.

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Impaction Allografting for Femoral Component Revision

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-200403000-00022 ◽

2004 ◽

Vol 420 ◽

pp. 160-168 ◽

Cited By ~ 21

Author(s):

Hannah D Morgan ◽

Wren McCallister ◽

Mickey S Cho ◽

Michael T Casnellie ◽

Seth S Leopold

Keyword(s):

Femoral Component ◽

Impaction Allografting ◽

Component Revision

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Mid- and long-term results of femoral component revision using the cement-in-cement technique: Average 10.8-year follow-up study

Journal of Orthopaedic Science ◽

10.1016/j.jos.2016.03.013 ◽

2016 ◽

Vol 21 (6) ◽

pp. 810-814 ◽

Cited By ~ 5

Author(s):

Yaichiro Okuzu ◽

Koji Goto ◽

Kazutaka So ◽

Yutaka Kuroda ◽

Shuichi Matsuda

Keyword(s):

Femoral Component ◽

Long Term Results ◽

Follow Up Study ◽

Component Revision

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Second-generation uncemented total hip arthroplasty: a minimum 20-year follow-up

Bone & Joint Open ◽

10.1302/2633-1462.21.bjo-2020-0157.r1 ◽

2021 ◽

Vol 2 (1) ◽

pp. 33-39

Author(s):

Jeffrey R. McLaughlin ◽

Kyla R. Lee ◽

Mary Ann Johnson

Keyword(s):

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Femoral Component ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Second Generation ◽

Total Hip ◽

Uncemented Total Hip Arthroplasty ◽

Acetabular Components

Aims We present the clinical and radiological results at a minimum follow-up of 20 years using a second-generation uncemented total hip arthroplasty (THA). These results are compared to our previously published results using a first-generation hip arthroplasty followed for 20 years. Methods A total of 62 uncemented THAs in 60 patients were performed between 1993 and 1994. The titanium femoral component used in all cases was a Taperloc with a reduced distal stem. The acetabular component was a fully porous coated threaded hemispheric titanium shell (T-Tap ST). The outcome of every femoral and acetabular component with regard to retention or revision was determined for all 62 THAs. Complete clinical follow-up at a minimum of 20 years was obtained on every living patient. Radiological follow-up was obtained on all but one. Results Two femoral components (3.2%) required revision. One stem was revised secondary to a periprosthetic fracture one year postoperatively and one was revised for late sepsis. No femoral component was revised for aseptic loosening. Six acetabular components had required revision, five for aseptic loosening. One additional acetabular component was revised for sepsis. Radiologically, all femoral components remained well fixed. One acetabular was judged loose by radiological criteria. The mean Harris Hip Score improved from 46 points (30 to 67) preoperatively to 89 points (78 to 100) at final follow-up. With revision for aseptic loosening as the endpoint, survival of the acetabular component was 95% (95% confidence interval (CI) 90 to 98) at 25 years. Femoral component survival was 100%. Conclusion The most significant finding of this report was the low prevalence of aseptic loosening and revision of the femoral component at a mean follow-up of 22 years. A second important finding was the survival of over 90% of the hemispheric threaded ring acetabular components. While these shells remain controversial, in this series they performed well. Cite this article: Bone Jt Open 2021;2(1):33–39.

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