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

2009 ◽  
Vol 19 (3) ◽  
pp. 227-233 ◽  
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.

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

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.

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

2003 ◽  
Vol 13 (1) ◽  
pp. 1-11 ◽  
Author(s):  
M.J.K. Bankes ◽  
P.W. Allen ◽  
C.H. Aldam
Keyword(s):  
Deep Infection ◽  
Harris Hip Score ◽  
Allograft Bone ◽  
Impaction Grafting ◽  
Grafting Technique ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Grade 3 ◽  
Irradiated Allograft

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.

Mid- to long-term outcomes of cementless modular, fluted, tapered stem for massive femoral bone loss in revision total hip arthroplasty

2020 ◽  
Author(s):  
Kai Zheng ◽  
Ning Li ◽  
Weicheng Zhang ◽  
Jun Zhou ◽  
Yaozeng Xu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Loss ◽  
Hip Arthroplasty ◽  
Long Term Results ◽  
Revision Total Hip Arthroplasty ◽  
Femoral Bone ◽  
Total Hip ◽  
Tapered Stem

Abstract Background: Revision total hip arthroplasty is frequently accompanied by bone loss. The purpose of this study is to evaluate mid- to long-term results of revision total hip arthroplasty for massive femoral bone loss using cementless modular, fluted, tapered stems.Methods: During the period of 2007 to 2015 at a single hospital, 34 hips (33 patients) underwent primary revision surgery with cementless modular, fluted, tapered stems due to massive bone loss, and patients with prosthetic joint infection (PJI) or tumours were excluded. The hips were revised with the LINK MP (Waldemar Link, Hamburg, Germany) prosthesis. Bone loss was categorized by the Paprosky classification for prosthesis loosening and Vancouver classification for peri-prosthetic fracture. All revision bearing surfaces were ceramic-on-ceramic (CoC). Clinical outcomes, radiographic outcomes and survivorship were evaluated.Results: The mean follow-up was 9.1±2.5 years (range, 5-13 years). The Harris hip score was 43.6±11.5 preoperatively and maintained at 86.5±6.6 at the time of latest follow-up (p<0. 05). The X-ray showed bone ingrowth fixation in 30 hips (88%), fibrous stable fixation in 3 hips (9%) and instability in 1 hip (3%). The average stem subsidence was 3.9±2.2 mm (range, 1 to 10 mm). The survivorship of prostheses with re-revision for any reason was 95% (95% CI, 12.0 to 13.0) at the 10-year follow-up. Three (9%) re-revisions were needed, including 1 for aseptic loosening, 1 for dislocation and 1 for infection.Conclusions: The mid- to long-term results of revision total hip arthroplasty with the cementless modular, fluted, tapered stem (LINK MP stem) are encouraging for massive femoral bone loss.

Guidelines for the follow-up of total hip arthroplasty

2019 ◽  
Vol 101-B (5) ◽  
pp. 536-539 ◽  
Author(s):  
R. S. Cassidy ◽  
S. O hEireamhoin ◽  
D. E. Beverland
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Primary Outcome Measure ◽  
First Year ◽  
Total Hip ◽  
Retrospective Audit ◽  
Asymptomatic Patients ◽  
Subsequent Revision ◽  
Evaluation Panel

AimsThe aim of this retrospective audit was to determine the route of referral or presentation of patients requiring revision following primary total hip arthroplasty (THA).Patients and MethodsA total of 4802 patients were implanted with an Orthopaedic Data Evaluation Panel (ODEP) 10A* cementless implant (Corail/Pinnacle) between 2005 and 2015; 80 patients with a mean age of 67.8 years (sd 10.8) underwent a subsequent revision. The primary outcome measure was route of referral for revision.ResultsOf the 80 revisions, 31 (38.8%) took place within the first year and 69 (86.3%) took place within six years. Only two of the 80 patients were picked up at a routine review clinic, one for infection and the other for liner dissociation. A total of 36 revised patients (45.0%) were reviewed following self-referral. Of the remaining 44 revised patients (55.0%), 15 (18.8%) were General Practitioner referrals, 13 (16.3%) were other hospital referrals, six (7.5%) were inpatients, six (7.5%) were Emergency Department referrals, and two (2.5%) were readmitted from their homes. No revisions were carried out on asymptomatic patients.ConclusionOur experience suggests that if there is a robust system in place for self-referral, patients with an ODEP 10A* hip implant can, if asymptomatic, be safely discharged at the time of their first postoperative review. Cite this article: Bone Joint J 2019;101-B:536–539.

The Wagner SL-Revision Stem for Aseptic Loosening: Clinical and Radiological Results 5 to 7 Years after Femoral Revision

2003 ◽  
Vol 13 (2) ◽  
pp. 94-100
Author(s):  
M.J.F. Diks ◽  
M. Spruit ◽  
J.J. Reimering ◽  
F. Den Boer ◽  
P.G. Anderson
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Loss ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Primary Stability ◽  
Harris Hip Score ◽  
Radiological Evaluation ◽  
Total Hip ◽  
Revision Stem

Aseptic loosening in total hip arthroplasty can lead to proximal femoral periprosthetic bone loss. The non-cemented Wagner revision stem achieves primary fixation in the diaphysis. The purpose of this study is to evaluate the results after medium- to long-term follow-up of the Wagner prosthesis for revision of the femoral component for aseptic loosening in total hip arthroplasty with proximal femoral bone loss. We performed 53 femoral revisions for aseptic loosening with the non-cemented Wagner revision stem. Clinical assessment included a modified Harris Hip Score and a radiological evaluation. The mean follow-up was 65 months. The Harris Hip Score improved significantly (42.9 to 72.3). Radiological evaluation revealed 24.5% subsidence (>5 mm) in our population. Nine re-revisions were done, eight in the first post-operative year. The re-revisions were performed for progressive subsidence (five), recurrent dislocations (one), subsidence with low-grade infection (one), false route (one), and aseptic loosening after 75 months (one). The cumulative survival rate of the Wagner stem after 12 months was 85% and 76% after 75 months. A relatively high re-revision rate was observed during the first post-operative year. Analysis of these failures has shown that subsidence may be the result of insufficient primary stability. Adequate pre-operative planning and intra-operative radiological assistance is necessary for perfect primary stability and fixation of the Wagner stem. The re-revision incidence after the first 12 months is 0.45 per 100 implants per year. The prosthesis has good survival potential after proper introduction.

scholarly journals Peri-Implant Tissue Behaviour Next to Different Titanium Surfaces: 16-Year Post-Trial Follow-Up

2021 ◽  
Vol 11 (20) ◽  
pp. 9625
Author(s):  
Francesca Delucchi ◽  
Enrico Pozzetti ◽  
Francesco Bagnasco ◽  
Paolo Pesce ◽  
Domenico Baldi ◽  
...  
Keyword(s):  
Bone Loss ◽  
Titanium Implants ◽  
First Year ◽  
Bone Maintenance ◽  
Probing Depth ◽  
Bone Level ◽  
Titanium Surfaces ◽  
Post Trial ◽  
And Control

The present post-trial follow-up investigated the influence of titanium implants with different surface treatments on clinical behavior of soft and hard peri-implant tissues. Each of the 18 included patients received at least two adjacent implants: one control implant with a dual acid-etched (DAE) surface in their apical portion and a machined coronal part, and one test implant with a DAE surface up to its coronal portion. Peri-implant bone level change (BLC), probing depth (PD), bleeding on probing (BOP) and plaque index (PI) were recorded. A total of 42 implants was inserted. The mean follow-up period was 9.3 years (range: 5–16 years) and there were six dropouts. No implant failed. Moderate crestal bone remodeling occurred during the first year after implant insertion, with lower bone loss next to test implants compared to control ones (0.80 vs. 1.39 mm; p = 0.002). This difference was also detected at the 5- (p = 0.011), 6- (p = 0.008) and 7-year follow-up appointment (p = 0.027). No statistically significant differences were found in bone resorption between implants rehabilitated with ceramic vs. composite resin veneering material. No statistically significant differences were detected between test and control implants for BOP, PI, and PD at any time point. The results of the present study suggest that DAE surfaces reduce peri-implant bone loss in the initial phase of healing compared to machined surfaces, while they do not significantly affect soft peri-implant tissue and bone maintenance in the long-term. In conclusion, the minimally rough surfaces favour peri-implant bone maintenance and their effect is greater in the first year post implant insertion.

The migration pattern and initial stability of the Optimys short stem in total hip arthroplasty: a prospective 2-year follow-up study of 33 patients with RSA

2020 ◽  
pp. 112070002090184 ◽  
Author(s):  
Sheryl de Waard ◽  
Inger N Sierevelt ◽  
Renee Jonker ◽  
Daniel Hoornenborg ◽  
Harm M van der Vis ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Deep Infection ◽  
Migration Pattern ◽  
Short Stem ◽  
Leg Length ◽  
Total Hip ◽  
Initial Stability ◽  
Short Stems

Background and purpose: The consensus that bone stock preservation and optimal restoration of offset and leg length is important in total hip arthroplasty is now widespread, especially for young and active patients. Short stems seem promising in this aspect, though implant stability is still of concern. This study looked at the migration pattern of the Optimys short stem through RSA analysis. Patients and methods: 40 patients were included. RSA images were made directly postoperatively (within 5 days), at 6 weeks and at 3, 6, 12 and 24 months. Double examinations were made for precision measurement. HOOS and pain scores were obtained preoperatively and at 2 years. 4 patients were excluded due to protocol violation and 1 patient was excluded for RSA analysis with a CN number >110. 2 patients were lost to follow-up after 3 and 6 months ( n  = 1 lost, n  = 1 deep infection, respectively). Results: Mean age was 60 years with a mean BMI of 27. RSA analysis of 34 patients showed a significant initial median proximodistal translation (subsidence) of 0.21 mm (IQR 0.64–0.06) and anteversion-retroversion rotation of 0.59° (IQR 0.01–1.34) at 6 weeks, after which the stem stabilises and showed no further significant movement. Median migration in other directions was small. 4 patients had an initial subsidence of >2 mm, all showed secondary stabilisation. HOOS outcomes were satisfactory, with the domain symptoms and pain showing a median score of 95/100 at 2 years. Conclusions: After initial migration the Optimys achieves secondary stabilisation, suggesting low risk on long-term aseptic loosening. Clinical trials registration: NL47055.048.13.

Impacted Bone Allografts and a Cemented Stem after Failure of an Uncemented Stem: Preliminary Results

2009 ◽  
Vol 19 (3) ◽  
pp. 221-226 ◽  
Author(s):  
Martin A. Buttaro ◽  
Lucas Marcos ◽  
German Farfalli ◽  
Fernando Comba ◽  
Francisco Piccaluga
Keyword(s):  
Clinical Evidence ◽  
Radiolucent Line ◽  
Deep Infection ◽  
Gruen Zone ◽  
Bone Allografts ◽  
Grafting Technique ◽  
Cemented Stem ◽  
Improved Function ◽  
Rate Of Success

We reviewed the results of impaction bone grafting technique and a cemented stem in 27 consecutive patients with a failed uncemented femoral component. At an average follow-up of 55 months (25 to 94) none of the femoral components were removed or revised because of aseptic loosening or deep infection. In one hip a non progressive radiolucent line was observed in Gruen zone 5 with no clinical evidence of failure. The average postoperative Merle d'Aubigné and Postel Hip Score was 5.8 points for pain, 5.5 points for mobility and 5.4 points for gait. Revision of a failed uncemented stem with impaction grafting technique provided pain relief and improved function. The rate of success and restoration of bone stock were encouraging at mid-term follow-up.

scholarly journals Bone disease after transplantation: osteoporosis and fractures risk

2014 ◽  
Vol 58 (5) ◽  
pp. 484-492 ◽  
Author(s):  
Carolina A. M. Kulak ◽  
Victoria Z. C. Borba ◽  
Jaime Kulak Júnior ◽  
Melani Ribeiro Custódio
Keyword(s):  
Bone Loss ◽  
Organ Transplantation ◽  
Bone Disease ◽  
Immunosuppressive Agents ◽  
Fragility Fractures ◽  
First Year ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
End Stage

Organ transplantation is the gold standard therapy for several end-stage diseases. Bone loss is a common complication that occurs in transplant recipients. Osteoporosis and fragility fractures are serious complication, mainly in the first year post transplantation. Many factors contribute to the pathogenesis of bone disease following organ transplantation. This review address the mechanisms of bone loss including the contribution of the immunosuppressive agents as well as the specific features to bone loss after kidney, lung, liver, cardiac and bone marrow transplantation. Prevention and management of bone loss in the transplant recipient should be included in their post transplant follow-up in order to prevent fractures.

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