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.

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.

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.

Good implant survival after acetabular revision with extensive impaction bone grafting and uncemented components

2020 ◽  
Vol 102-B (2) ◽  
pp. 198-204
Author(s):  
Rico Perlbach ◽  
Lars Palm ◽  
Maziar Mohaddes ◽  
Ingemar Ivarsson ◽  
Jörg Schilcher
Keyword(s):  
Acetabular Revision ◽  
Impaction Grafting ◽  
Implant Survival ◽  
Bone Contact ◽  
Term Survival ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Bone Impaction Grafting

Aims This single-centre observational study aimed to describe the results of extensive bone impaction grafting of the whole acetabular cavity in combination with an uncemented component in acetabular revisions performed in a standardized manner since 1993. Methods Between 1993 and 2013, 370 patients with a median age of 72 years (interquartile range (IQR) 63 to 79 years) underwent acetabular revision surgery. Of these, 229 were more than ten years following surgery and 137 were more than 15 years. All revisions were performed with extensive use of morcellized allograft firmly impacted into the entire acetabular cavity, followed by insertion of an uncemented component with supplementary screw fixation. All types of reoperation were captured using review of radiographs and medical charts, combined with data from the local surgical register and the Swedish Hip Arthroplasty Register. Results Among patients with possible follow-up of ten and 15 years, 152 and 72 patients remained alive without revision of the acetabular component. The number of deaths was 61 and 50, respectively. Of those who died, six patients in each group had a reoperation performed before death. The number of patients with a reoperation was 22 for those with ten-year follow-up and 21 for those with 15 years of follow-up. The Kaplan-Meier implant survival rate for aseptic loosening among all 370 patients in the cohort was 96.3% (95% confidence interval (CI) 94.1 to 98.5) after ten years and 92.8% (95% CI 89.2 to 96.6) after 15 years. Conclusion Extensive bone impaction grafting combined with uncemented revision components appears to be a reliable method with favourable long-term survival. This technique offers the advantage of bone stock restoration and disputes the long-standing perception that uncemented components require > 50% of host bone contact for successful implant survival. Cite this article: Bone Joint J 2020;102-B(2):198–204.

Telephone Management Program for Patients Discharged From an Emergency Department After a Suicide Attempt

Crisis ◽  
2015 ◽  
Vol 36 (5) ◽  
pp. 345-352 ◽  
Author(s):  
Ana Isabel Cebria ◽  
Iris Pérez-Bonaventura ◽  
Pim Cuijpers ◽  
Ad Kerkhof ◽  
Isabel Parra ◽  
...  
Keyword(s):  
Intervention Program ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Management Program ◽  
Controlled Study ◽  
Control Group ◽  
First Year ◽  
Telephone Intervention ◽  
Beneficial Effects

Abstract. Aim: In a previous controlled study, the authors reported on the significant beneficial effects of a telephone intervention program for prevention of suicide attempts by patients for up to 1 year. This study reports the 5-year follow-up data. Outcomes were number of recurrences and time to recurrence. Method: The intervention was carried out on patients discharged from the emergency room (ER) following attempted suicide (Sabadell). It consisted of a systematic, 1-year telephone follow-up program: after 1 week, and thereafter at 1-, 3-, 6-, 9-, and 12-month intervals to assess the risk of suicide and encourage adherence to treatment. The population in the control group (Terrassa) received treatment as usual after discharge, without additional telephone contact. Results: The effect of reattempt prevention observed in the first year was not maintained over the long term. Conclusion: A telephone management program for patients discharged from an ER after attempted suicide could be considered a useful strategy in delaying further suicide attempts and reducing the rate of reattempts in the first year. However, results showed that the beneficial effects were not maintained at the 5-year follow-up.

TCP-HA Granules and Impacted Morselized Cancellous Bone Graft Mixes for Acetabular Reconstruction with the Bone Impaction Grafting Technique. A Loaded and Critical Sized Defect Model in the Goat

2005 ◽  
Vol 284-286 ◽  
pp. 869-872
Author(s):  
J.J.C. Arts ◽  
J.W.M. Gardeniers ◽  
M.L.M Welten ◽  
N. Verdonschot ◽  
B.W. Schreurs ◽  
...  
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Bone Structure ◽  
Giant Cells ◽  
Point Of View ◽  
Acetabular Reconstruction ◽  
Graft Material ◽  
Impaction Grafting ◽  
Grafting Technique ◽  
Bone Impaction Grafting

With the bone impaction grafting technique, a 50/50 volume mix of morselized cancellous bone (MCB) with TCP-HA granules was used to reconstruct a critical sized acetabular defect in the goat. The biological activity of the MCB/TCP-HA mix was assessed after 15 weeks. Defects filled with 100% MCB, currently the gold standard for this technique, were used as controls. In the 100% MCB defects, a new trabecular bone structure was found in which scarce incorporated remnants of the original graft material were present. In the MCB/TCP-HA defects, MCB was also resorbed or incorporated into new bone. Deep in the MCB-TCP-HA defects, large TCP-HA granules were generally totally osseous-integrated with new bone. Superficially, more fragmented TCP-HA granules of various sizes were present in the medullar tissue or in the interface with the cement layer. Here, the crushed TCP-HA granules were generally surrounded by osteoclasts and giant cells. The soft tissue interface between the reconstruction and cement did not differ between both groups. In conclusion, from a biological point of view, this short-term follow-up study suggests that TCP-HA granules can be safely used in a mix with MCB as bone graft extender in acetabular revision surgery with the bone impaction grafting technique.

scholarly journals Predicting Cementless Stem Fixation in Total Hip Arthroplasty Using Radiodensity Mapping

10.29007/dv5n ◽  
2020 ◽  
Author(s):  
Teja Cherukuri ◽  
Chameka Madurawe ◽  
Jim Pierrepont ◽  
Jonathan Bare ◽  
Stephen McMahon ◽  
...  
Keyword(s):  
Bone Density ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
X Rays ◽  
Implant Fixation ◽  
X Ray ◽  
Total Hip ◽  
Stem Subsidence

Femoral component loosening due to poor fixation is a common failure mode in cementless total hip arthroplasty (THA). We sought to develop a technique to predicted femoral stem fixation using pre-operative CT.Forty-nine patients requiring THA received pre-operative CTs as part of Corin OPSTM 3D dynamic planning. All patients received a taper wedged blade stem (TriFitTM TS, Corin UK) implanted through a posterior approach. Post-operatively, patients received an immediate CT and AP x-ray and a 1-year follow-up x-ray. The distance between the most superior point of the greater trochanter and the shoulder of the stem was measured and scaled using the known cup diameter on both the immediate and 1- year follow-up x-rays. The difference was recorded as stem subsidence. Subsidence greater than 4mm was deemed clinically relevant. The precise placement of the stem determined by registering the known 3D implant geometry to the post-op CT was virtually implanted back into the pre-operative OPSTM planning software. A colour map of the bone density at the stem/bone interface using the Hounsfield Units (HU) of each CT pixel was generated. Blue represents low density bone transitioning through to green and then red.Mean stem subsidence was 1.8mm (0 to 11.1mm). Five patients had clinically relevant subsidence. Significant areas of blue and green around the proximal portion of the stem was observed in high subsidence stems when compared to the stems with minimal subsidence.Using the HU of the CT scan as an indicator for bone density, we were able to predict poor implant fixation and subsequent subsidence in a taper wedge stem.

High Proximal Migration in Cemented Acetabular Revisions Operated with Bone Impaction Grafting; 47 Revision Cups Followed with RSA for 17 Years

2016 ◽  
Vol 27 (3) ◽  
pp. 251-258 ◽  
Author(s):  
Maziar Mohaddes ◽  
Peter Herberts ◽  
Henrik Malchau ◽  
Per-Erik Johanson ◽  
Johan Kärrholm
Keyword(s):  
Demographic Data ◽  
Base Line ◽  
Impaction Grafting ◽  
Bone Implant ◽  
Proximal Migration ◽  
Early Migration ◽  
Bone Impaction Grafting ◽  
Acetabular Components ◽  
Acetabular Loosening

Background Bone impaction grafting is a biologically and mechanically appealing option in acetabular revision surgery, allowing restitution of the bone stock and restoration of the biomechanics. We analysed differences in proximal migration of the revision acetabular components when bone impaction grafting is used together with a cemented or an uncemented cup. Patients and Methods 43 patients (47 hips), revised due to acetabular loosening and judged to have less than 50% host bone-implant contact were included. The hips were randomised to either an uncemented (n = 20) or a cemented (n = 27) revision cup. Radiostereometry and radiography was performed postoperatively, at 3 and 6 months, 1, 2, 3, 5, 7, 10 and 13 and 17 years postoperatively. Clinical follow-up was performed at 1, 2 and 5 years postoperatively and thereafter at the same interval as in the radiographic follow-up. Results here were no differences in the base line demographic data between the 2 groups. At the last follow-up (17 years) 14 hips (10 cemented, 4 uncemented) had been re-revised due to loosening. 3 additional cups (1 uncemented and 2 cemented) were radiographically loose. There was a higher early proximal migration in the cemented cups. Discussion Cups operated on with cement showed a higher early migration measured with RSA and also a higher number of late revisions. The reason for this is not known, but factors such as inclusion of cases with severe bone defects, use of smaller bone chips and issues related to the impaction technique might have had various degrees of influence.

scholarly journals Short Uncemented Femoral Component for Hip Revision: Prognosis and Risk Factors Associated With Failure

2020 ◽  
Author(s):  
Zeming Liu ◽  
Bo Liu ◽  
Bingshi Zhang ◽  
WenHui Ma ◽  
Tao Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Revision Surgery ◽  
Cox Regression ◽  
Femoral Stem ◽  
Periprosthetic Femoral Fracture ◽  
Hip Revision ◽  
Cox Regression Analysis ◽  
Bone Deficiency ◽  
The Mean

Abstract BackgroundThe application of short uncemented femoral stem is partially restricted in revision surgery. In some patients with mild to moderate bone deficiency, short uncemented stem is certainly a choice. This study will demonstrate the therapeutic effect and unsuitable situation for short uncemented stem revision.MethodsPatients who undergone hip revision from January 2005 to December 2015 were retrospectively analyzed in this study. Preoperative radiological images were evaluated to help estimating the bone deficiency around hip joint. Mann-Whitney U test was performed for comparison between continuous variables. Chi-square test was performed for comparison between categorical variables. Cox regression analysis was used to assess the association between potential risk factors and failure of revision surgery.ResultsA total of 381 patients were retrospectively reviewed. The mean follow-up time was 71.05±16.54 months. The mean time from primary revision surgery to secondary revision surgery was 16.41±17.47 months. According to the survival status of femoral component at final follow-up, patients were divided into two groups. Cox regression analysis revealed that the risk for revision failure approximately increased by 5.6% for every year of age increase (HR=1.056, 95%CI=1.012–1.102). Osteoporosis was another independent risk factor for revision failure (HR=2.802, 95%CI=1.097–7.157). The strongest risk factor was intraoperative periprosthetic femoral fracture during revision surgery in this study (HR=5.477, 95%CI=2.156–13.913).ConclusionThree risk factors for failure are identified, such as aging, osteoporosis and intraoperative periprosthetic femoral fracture during revision surgery. Therefore, short uncemented femoral stem should be implanted in these patients with additional caution.

scholarly journals Bone Impaction Grafting with Trabecular Metal Augments in Large Defects in Young Patients: Unravelling A New Perspective in Surgical Technique

2020 ◽  
Author(s):  
Basilio De la Torre-Escurero ◽  
Eva Gómez-González ◽  
Slavador Álvarez-Villar ◽  
Julia Bujan ◽  
Miguel A Ortega
Keyword(s):  
Surgical Technique ◽  
Young Patients ◽  
Case Series ◽  
Abduction Angle ◽  
Acetabular Reconstruction ◽  
Impaction Grafting ◽  
Trabecular Metal ◽  
Bone Impaction Grafting ◽  
Acetabular Defects

Abstract Background: Acetabular reconstruction with bone impaction grafting in large defects has yielded conflicting results. Methods: This was a retrospective study of a case series of five patients with a young age (≤50 years) at the time of surgery who had large acetabular defects reconstructed by bone impaction grafting and trabecular metal augments. The mean follow-up was 79 months. We describe the surgical technique in detail.Results: Improvement was significant on the WOMAC and SF-36 scales (p < 0.05). The radiographs taken at the last follow-up examination showed no migration of the polyethylene cup (p = 0.31) or differences in the abduction angle (p = 0.27) compared to the radiographs from the immediate postoperative period. One patient presented two dislocation episodes as a complication.Conclusion: The combination of trabecular metal augments with the bone impaction grafting technique in young patients with large acetabular defects provides satisfactory results in the long term and restores the bone stock.

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