scholarly journals Revision hip arthroplasty using a porous tantalum acetabular component

2020 ◽  
pp. 112070002091329
Author(s):  
Hannu JA Miettinen ◽  
Simo SA Miettinen ◽  
Jukka S Kettunen ◽  
Jussi Jalkanen ◽  
Heikki Kröger
Keyword(s):  
Survival Analysis ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
University Hospital ◽  
Revision Hip Arthroplasty ◽  
Cumulative Proportion ◽  
Kaplan Meier ◽  
The Mean

Introduction: Reconstruction of acetabulum in case of bone defects can be challenging. The aim of this retrospective study was to investigate the 10-year survival of trabecular tantalum metal (TM) acetabulum component in revision hip arthroplasty operations and to evaluate complications. Methods: A total of 100 consecutive acetabulum revision hip arthroplasties (100 patients) were operated on between May 2004 and October 2006 at Kuopio University Hospital. The mean follow-up time was 9.4 years and the median was 11.5 years (SD 4.118; range 0.1–13.4 years). Kaplan-Meier survival analysis was performed to study the survival of patients to re-revision surgery. Intra- and postoperative complications and reasons for re-revision were evaluated. Results: The Kaplan-Meier analysis showed a cumulative proportion of revision hip survivorship of 66% at 13.4 years (SE 0.403, 95% CI, 10.886–12.466) based on the need for further re-revision surgery for any major reason. The Kaplan-Meier survival analysis of time to re-revision surgery due acetabular component loosening showed a cumulative proportion of survivorship of 98.9% at 13.4 years (SE 0.136; 95% CI, 12.998–13.529). There were a total of 41/100 complications and the most common complication was dislocation (24/100). Re-revision for any major reason was performed on 18/100 of the revision arthroplasties. The mean time to re-revision was 4.9 years (SD 5.247; range 0.1–13.2 years). Discussion: The trabecular TM acetabular component gives excellent outcomes regarding stability and fixation to the acetabulum in acetabulum revision hip arthroplasty at a minimum of ten years of follow-up. However, acetabular component malposition and the small head size (28 mm) are risk factors for dislocation.

scholarly journals Medium Term Outcome of Lancaster Cortical Window Technique For Extraction of Femoral Stem in Revision Hip Arthroplasty

2021 ◽  
Author(s):  
Amit Singh ◽  
Sunirmal Mukherjee ◽  
Kuntal Patel ◽  
Deepak Herlekar ◽  
Srikant Gandavaram ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Femoral Stem ◽  
Revision Hip Arthroplasty ◽  
Medium Term ◽  
Term Outcome ◽  
Window Technique ◽  
Femoral Stems ◽  
The Mean

Abstract Background The extraction of a femoral stem during the revision hip arthroplasty can be a daunting task and can lead to catastrophic complications for the patient. A sound technique employed intraoperatively helps in speedy recovery of the patient and reduces the risk of future surgical interventions. In this study, we present a medium-term outcome of our novel Lancaster Cortical Window technique which can be used for removal of cemented or uncemented femoral stems. Methodology The study was conducted at a specialist centre in the North-West of the UK from January 2014 to May 2019. This is a retrospective case series where patients were treated surgically using Lancaster Cortical Window technique for removal of femoral implant during a revision hip arthroplasty. Patient’s electronic notes and the radiographs were used to evaluate the functional and radiological outcome. Results In this study, 18 patients were managed surgically using Novel Lancaster Window technique. The mean age of the all the patients was 81.5 years and the male to female ratio was 10:8. Fifteen patients underwent revision surgery for aseptic loosening of the femoral and acetabular component. Rest of the three patients had revision surgery for a broken femoral stem, intraoperative femoral canal perforation while implanting a total hip replacement femoral stem and infection. Twelve femurs were replanted with uncemented long femoral stems and six with long cemented stems. The cortical window osteotomy united in all the patients in 4.2 months (mean). The mean follow up of these patients is 20.9 months, and none of them had any implant subsidence or loosening at the time of their last follow up. Conclusion We believe Lancaster cortical window technique can be safely used for removal of cemented stems during revision hip arthroplasty without the need for expensive equipment’s.

scholarly journals Medium term outcome of Lancaster cortical window technique for extraction of femoral stem in revision hip arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Amit Singh ◽  
Sunirmal Mukherjee ◽  
Kuntal Patel ◽  
Deepak Herlekar ◽  
Srikant Gandavaram ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Femoral Stem ◽  
Revision Hip Arthroplasty ◽  
Medium Term ◽  
Term Outcome ◽  
Window Technique ◽  
Femoral Stems ◽  
The Mean

Abstract Background The extraction of a femoral stem during the revision hip arthroplasty can be a daunting task and can lead to catastrophic complications for the patient. A sound technique employed intraoperatively helps in the speedy recovery of the patient and reduces the risk of future surgical interventions. In this study, we present a medium-term outcome of our novel Lancaster cortical window technique which can be used for the removal of cemented or uncemented femoral stems. Methods The study was conducted at a specialist centre in the north-west of the UK from January 2014 to May 2019. This is a retrospective case series where patients were treated surgically using the Lancaster cortical window technique for removal of the femoral implant during a revision hip arthroplasty. Patient’s electronic notes and radiographs were used to evaluate the functional and radiological outcome. Results In this study, 18 patients were managed surgically using the novel Lancaster window technique. The mean age of all the patients was 81.5 years, and the male to female ratio was 10:8. Fifteen patients underwent revision surgery for aseptic loosening of the femoral and acetabular components. The rest of the three patients had revision surgery for a broken femoral stem, intraoperative femoral canal perforation while implanting a total hip replacement femoral stem and infection. Twelve femurs were replanted with uncemented long femoral stems and six with long cemented stems. The cortical window osteotomy united in all the patients in 4.2 months (mean). The mean follow-up of these patients is 20.9 months, and none of them had any implant subsidence or loosening at the time of their last follow-up. Conclusion We believe Lancaster cortical window technique can be safely used for the removal of cemented stems during revision hip arthroplasty without the need for expensive equipment.

Radiolucent lines do not affect the longevity of highly cross-linked polyethylene cemented components in total hip arthroplasty

2021 ◽  
Vol 103-B (10) ◽  
pp. 1604-1610
Author(s):  
Yusuke Takaoka ◽  
Koji Goto ◽  
Jiro Tamura ◽  
Yaichiro Okuzu ◽  
Toshiyuki Kawai ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Long Term Outcome ◽  
Total Hip ◽  
Radiolucent Lines ◽  
Kaplan Meier ◽  
Acetabular Components

Aims We aimed to evaluate the long-term outcome of highly cross-linked polyethylene (HXLPE) cemented acetabular components and assess whether any radiolucent lines (RLLs) which arose were progressive. Methods We retrospectively reviewed 170 patients who underwent 187 total hip arthroplasties at two hospitals with a minimum follow-up of ten years. All interventions were performed using the same combination of HXLPE cemented acetabular components with femoral stems made of titanium alloy. Kaplan-Meier survival analysis was performed for the primary endpoint of acetabular component revision surgery for any reason and secondary endpoint of the appearance of RLLs. RLLs that had appeared once were observed over time. We statistically assessed potential relationships between RLLs and a number of factors, including the technique of femoral head autografting and the Japanese Orthopaedic Association score. Results The mean follow-up period was 13.0 years (10.0 to 16.3). Femoral head autografting was performed on 135 hips (72.2%). One acetabular component was retrieved because of deep infection. No revision was performed for the aseptic acetabular loosening. The Kaplan-Meier survival curve for the primary and secondary endpoints were 98.2% (95% confidence interval (CI) 88.6% to 99.8%) and 79.3% (95% CI 72.8% to 84.6%), respectively. RLLs were detected in 38 hips (21.2%), at a mean of 1.7 years (1 month to 6 years) postoperatively. None of the RLLs were progressive, and the presence of RLLs did not show a significant association with the survival and clinical score. RLLs were more frequently observed in hips without femoral head autografts than in those with autografts. Conclusion The use of HXLPE cemented acetabular components in total hip arthroplasty demonstrated excellent clinical outcomes after ten years, and no RLLs were progressive, and their presence did not affect the outcome. Femoral head autografting did not negatively impact the acetabular component survival or the appearance of RLLs. Cite this article: Bone Joint J 2021;103-B(10):1604–1610.

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

2018 ◽  
Vol 29 (1) ◽  
pp. 65-71 ◽  
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.

scholarly journals Salvaging Unstable or Recurrent Dislocating Total Hip Arthroplasty with the Constrained Acetabular Component

2002 ◽  
Vol 10 (2) ◽  
pp. 165-169 ◽  
Author(s):  
DA Stanton ◽  
WJ Bruce ◽  
JA Goldberg ◽  
W Walsh
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Recurrent Dislocation ◽  
Total Hip ◽  
Hip Replacements ◽  
The Mean ◽  
Acetabular Components ◽  
Constrained Acetabular Component

Purpose. To review cases of implantation of constraining acetabular components for unstable or recurrent dislocating total hip arthroplasty at the Department of Orthopaedics, Concord Hospital, Sydney. Methods. A retrospective analysis was performed on prospectively collected data of 13 consecutively enrolled patients. Results. From 1989 to 2000, 13 constraining acetabular components were implanted into 13 patients as a revision procedure. The surgical approach for the implantation of the constrained liner was posterolateral in 11 cases; a modified Hardinge approach was applied in 2 cases. The mean clinical follow-up duration was 43 months (range, 14–121 months) and the mean age at the time of surgery was 73 years (range, 52–84 years). No patients were lost to follow-up. Indications for using the constrained acetabular component were recurrent dislocation in revision hip replacements (n=8), and intra-operative instability (n=5). There were no episodes of dislocation of the constrained arthroplasty. In 7 cases, the constrained component was implanted into a previously well-fixed shell. Conclusion. We recommend the judicious use of the constrained component in cases of hip instability during or after total hip arthroplasty when other methods are not successful.

scholarly journals Two-Stage Revision Arthroplasty for Periprosthetic Hip Infection: Mean Follow-Up of Ten Years

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Szu-Yuan Chen ◽  
Chi-Chien Hu ◽  
Chun-Chieh Chen ◽  
Yu-Han Chang ◽  
Pang-Hsin Hsieh
Keyword(s):  
Hip Arthroplasty ◽  
Cox Regression ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Harris Hip Score ◽  
Two Stage ◽  
Eradication Of Infection ◽  
The Mean

Background. Two-stage revision hip arthroplasty is the gold standard for treatment of patients with chronic periprosthetic joint infection (PJI), but few studies have reported outcomes beyond short-term follow-up.Methods. A total of 155 patients who underwent two-stage revision arthroplasty for chronic PJI in 157 hips were retrospectively enrolled in this study between January 2001 and December 2010. The mean patient age was 57.5 years, the mean prosthetic age was 3.6 years, and the interim interval was 17.8 weeks. These patients were followed up for an average of 9.7 years.Results. At the latest follow-up, 91.7% of the patients were free of infection. The mean Harris hip score improved significantly from 28.3 points before operation to 85.7 points at the latest follow-up. Radiographically, there was aseptic loosening of the stem or acetabular components in 4 patients. In the multivariate survival analysis using a Cox regression model, repeated debridement before final reconstruction, an inadequate interim period, bacteriuria or pyuria, and cirrhosis were found to be the independent risk factors for treatment failure.Conclusion. Our data show that two-stage revision hip arthroplasty provides reliable eradication of infection and durable reconstruction of the joint in patients with PJI caused by a variety of pathogens.

scholarly journals Clinical outcomes and survival rate of cementless modular distal fixation femoral stem for revision hip arthroplasty: A minimum 6-year follow-up

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901881224 ◽  
Author(s):  
Joon Soon Kang ◽  
Yeop Na ◽  
Bong Seong Ko ◽  
Yoon Sang Jeon
Keyword(s):  
Survival Rate ◽  
Hip Arthroplasty ◽  
Periprosthetic Fracture ◽  
Femoral Stem ◽  
Revision Hip Arthroplasty ◽  
Harris Hip Score ◽  
The Mean ◽  
Distal Fixation

Purpose: Revision hip arthroplasty is a very challenging procedure. Use of a modular distal fixation stem is one of the available options for revision arthroplasty in patients with proximal femoral bone deficiency. The purpose of this study was to evaluate mid- to long-term outcomes of cementless modular distal fixation femoral stem implantation in revision hip surgery. Methods: Clinical and radiological findings, complications, and stem survival rate were analyzed for 46 patients (48 hips) who underwent revision hip arthroplasty using a cementless modular distal fixation femoral stem. The mean patient age was 58.8 years (range 31–82 years) and the mean follow-up period was 95 months (72–122 months). The preoperative diagnoses were aseptic loosening (36 hips), infection (4 hips), ceramic fracture (4 hips), and femoral periprosthetic fracture (4 hips). Results: The mean Harris hip score improved from 56.6 preoperatively to 88.2 postoperatively at the last follow-up. All hips showed stable osteointegration and firm fixation. Complications involved four hips (8.3%); there was one case each of periprosthetic fracture, delayed union of osteotomy site, femoral perforation, and infection. One stem re-revision was performed for deep infection of the femoral side. The Kaplan–Meier survival rate was 97.6% at the final follow-up. Conclusion: Revision hip arthroplasty using a cementless modular distal fixation femoral stem showed satisfactory initial firm fixation and mid- to long-term survival rate. Complications can be minimized by careful surgical planning and meticulous procedure.

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.

scholarly journals Long-term results of cementless total hip arthroplasty for the treatment of ankylosed hip

2019 ◽  
Vol 27 (2) ◽  
pp. 230949901985803
Author(s):  
Goksel Dikmen ◽  
Vahit Emre Ozden ◽  
Fırat Gulagaci ◽  
I. Remzi Tozun
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Limb Length Discrepancy ◽  
Long Term Results ◽  
Cementless Fixation ◽  
Length Discrepancy ◽  
Kaplan Meier ◽  
The Mean

Purpose: The purpose of this study was to report the long-term results of total hip arthroplasty (THA) for the treatment of ankylosed hip. Methods: Twenty-nine consecutive THAs were performed in 26 patients. The mean age of the patients at the time of the operation was 43.3 years (range, 19–69 years). We used cementless fixation in all hips and the mean duration of follow-up was 10.1 years (range, 4.5–20 years). Radiological evaluation of components, osteolysis, radiolucent lines and loosening were assessed. The Harris Hip Score (HHS), range of motion (ROM), limb-length discrepancy and walking capacity with or without any support were used preoperatively and at final follow-up for clinical evaluation. Survivorship analysis was conducted using the Kaplan–Meier method using second revision for any reason as the endpoint. Results: The mean HHS was 85.6 (range, 55–98) points and mean ROM was 110.5° for flexion. The mean limb-length discrepancy improved from 4.1 cm to 1.1 cm. Positive Trendelenburg sign was recorded in 31% of the patients and 24% of patients needed any support for walking postoperatively. We observed surgical complications related to abductor arm in 25% of the patients. Radiolucency on the acetabular side was seen on one or more zones in 15 patients (16 hips). One aseptic acetabular component loosening was observed. On the femoral side, 11 patients demonstrated non-progressive radiolucent lines and osteolysis around the stem was seen in four hips but there was no aseptic stem loosening. The Kaplan–Meier survival rate considering revision for any reason as the endpoint was 81.5%, for aseptic loosening 91.3%, for a worst-case scenario of 66.4% at 10 years. Conclusion: Cementless fixation showed good to excellent results at 10 years. Preoperative and postoperative abductor status of the patient is critical for patient satisfaction.

scholarly journals Mid-term outcomes of tantalum cup– a single centre study

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Rajesh Bawale ◽  
Baseem Choudhry ◽  
Srinivasa Samsani
Keyword(s):  
Hip Arthroplasty ◽  
Deep Infection ◽  
Revision Hip Arthroplasty ◽  
Trabecular Metal ◽  
Level Of Evidence ◽  
Porous Tantalum ◽  
Midterm Outcome ◽  
Cementless Cup ◽  
The Mean

Abstract Introduction The cementless acetabular implants are commonly used in primary and revision hip arthroplasty. Reconstruction of acetabulum in case of bone defects can be challenging. The aims of this single center study are to review the mid-term outcomes of porous tantalum cups (TM) and evaluate complications. Methods The midterm outcome of a trabecular metal tantalum modular uncemented cup was evaluated in 59 hips in 58 patients. In our group, we had 23 males and 35 females. The mean age was 70.11 years (range, 30 to 87 years). Four patients were lost to follow-up and 13 died during the period without having further surgeries attributed to the hip arthroplasty. The remaining 41 patients (42 revision hip arthroplasties) had complete data available. Results The mean follow-up was 87 months, ranging from 24 to 144 months. Standard pelvic anteroposterior (AP) radiographs were used to assess and preoperatively classify acetabular defects as per Paprosky classification. The serial radiographs showed excellent stability, bone opposition and graft incorporation. Four patients had further surgeries. Two of these were due to infection (one superficial and one deep infection). One of the patients had washout and then removal of metal work, the other patient only had a washout and symptoms settled. One patient had vascular compromise and went for surgery to stem the bleeding. One patient had re-revision due to stem loosening and hence required surgery but the revision cup remained stable. We noted a 96% survival at an average of 7.2 years follow-up. Conclusion The mid-term results with the trabecular metal cementless cup appeared to be promising in both primary and revision hip arthroplasty, even in the presence of considerable bone loss which requires bone grafting and augments. Level of evidence IV.

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