Proximal Femoral Reconstruction for Revision Hip Arthroplasty with Severe Bone Loss: A New Technique Using Autologous Bone Graft and a Proximally Loading Femoral Component

1997 ◽  
Vol 7 (1) ◽  
pp. 3-10 ◽  
Author(s):  
J. Alfaro Adrian ◽  
M. Emerton ◽  
D.W. Murray ◽  
P. Mclardy-Smith
Keyword(s):  
Bone Loss ◽  
Bone Graft ◽  
Hip Arthroplasty ◽  
Autologous Bone Graft ◽  
Revision Hip Arthroplasty ◽  
Severe Bone Loss ◽  
Successful Technique ◽  
A New Technique ◽  
Proximal Femoral Reconstruction

We report the results of a new method of reconstructing the femur in 22 patients with severe bone loss having revision hip arthroplasty. The calcar and metaphysis were reconstructed with cortico-cancellous autograft around a new modular hip replacement. The metaphyseal portion of the implant is free to slide on the stem and therefore loads the graft and, we believe, encourages bone graft incorporation. The stem gains cementless fixation distal to the area of bone loss, thus preventing fractures and allowing the areas of bone loss to heal. At the time of review at a mean of 3 years follow-up there had been no revisions (since then there has been one re-revision due to recurrence of infection). The modified D'Aubigné and Postel hip score improved from 7.3 to 15. In 17 patients the graft has incorporated, in 5 it has partially resorbed but the prosthesis remains secure. We conclude that this is a relatively simple and successful technique for overcoming the problem of major femoral bone loss.

Proximal Cementing for Revision Hip Arthroplasty

1998 ◽  
Vol 8 (2) ◽  
pp. 62-69 ◽  
Author(s):  
J. Alfaro-Adrian ◽  
R.W. Crawford ◽  
A. Wulke ◽  
D.W. Murray ◽  
P. Mclardy-Smith
Keyword(s):  
Bone Loss ◽  
Hip Arthroplasty ◽  
High Rate ◽  
Revision Hip Arthroplasty ◽  
Hip Revision ◽  
Risk Of Fracture ◽  
Slight Pain ◽  
Continued Use ◽  
A New Technique

We report the results of a new technique of proximal cement fixation in 41 patients having revision hip arthroplasty using the Oxford modular femoral component. This consists of two parts, a metaphised wedge and a stem. The metaphyseal wedge is cemented and applies the load proximally to encourage bone healing. The wedge is free to slide on an uncemented stem that gains fixation distal to areas of bone loss, with the intention of reducing the risk of fracture. The clinical and radiographic follow-up ranged from a minimum of 3 years to 7 years. There have been no re-revisions. Ninety percent of the patients had pain or slight pain. Despite a relatively high rate of early subsidence, we feel that our results are encouraging, and justify the continued use of this component in hip revision surgery.

scholarly journals Allogenic bone graft for femoral defect augmentation in hip revision arthroplasty: A case series

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Nils Wirries ◽  
Michael Skutek ◽  
Marcus Örgel ◽  
Stefan Budde ◽  
Alexander Derksen ◽  
...  
Keyword(s):  
Bone Loss ◽  
Bone Graft ◽  
Cortical Bone ◽  
Hip Arthroplasty ◽  
Case Series ◽  
Revision Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Femoral Bone ◽  
Allogenic Bone

Cortical bone loss in revision hip arthroplasty requires an adequate stabilization to achieve a durable implant fixation. This case series shall illustrate possible indications for the use of allogenic grafts in revision hip arthroplasty. Twelve patients with femoral bone loss were treated with allografts. In addition to established clinical scores, the radiological follow-ups were analyzed for hints of implants loosening and the osteointegration of the allografts. After a mean follow-up of 3.0 years the mHHS was 61.3 points and the UCLA 3.8. One patient showed a non-progressive radiolucency around the hip implant. The osteointegration of all allogenic grafts happened on time. Up to the last follow-up no revision surgery of the hip implants and the associated femoral bone graft was observed. Allogenic bone grafts present a method for biological stabilization in situations of large femoral cortical bone defects in revision hip arthroplasty.

Femoral Impaction Allografting for Significant Bone Loss in Revision Hip Arthroplasty

2017 ◽  
Vol 27 (3) ◽  
pp. 281-285 ◽  
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.

Revision Hip Arthroplasty Using a Modular Revision Hip System in Cases of Severe Bone Loss

2014 ◽  
Vol 29 (8) ◽  
pp. 1594-1597 ◽  
Author(s):  
Ivan Dzaja ◽  
Matt C. Lyons ◽  
Richard W. McCalden ◽  
Douglas D.D. Naudie ◽  
James L. Howard
Keyword(s):  
Bone Loss ◽  
Hip Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Severe Bone Loss

scholarly journals The mid-long term results of reconstructional cage and morselized allografts combined application for the Paprosky type III acetabular bone defects in revision hip arthroplasty

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Qiang Xiao ◽  
Haoyang Wang ◽  
Kai Zhou ◽  
Duan Wang ◽  
Tingxian Ling ◽  
...  
Keyword(s):  
Bone Graft ◽  
Hip Arthroplasty ◽  
Bone Defects ◽  
Revision Hip Arthroplasty ◽  
Cancellous Bone Graft ◽  
Acetabular Bone ◽  
Type Iii ◽  
Acetabular Bone Defects

Abstract Background Severe acetabular bone defects is a complex problem in revision hip arthroplasty, cage is one of the reconstruction options. The purpose of this study is to report the mid-long term clinical and radiographic results of Paprosky type III acetabular bone defects revised with reconstructional cage and morselized allogeneic cancellous bone graft without impaction. Methods We retrospectively analyzed 28 patients who underwent revision hip arthroplasty with reconstructional cage and allogeneic cancellous bone graft between January 2007 and January 2016. There were 13 Paprosky type IIIA bone defect patients and 15 Paprosky type IIIB bone defect patients and 4 patients of the 15 were also with pelvic discontinuity. Clinical assessment included Harris Hip Score (HHS) and Short Form-12 (SF-12). Radiographic assessment included center of rotation, cage migration, and bone graft incorporation. Results All patients were followed up with a mean follow-up of 79.5 months (range 38–141), HHS improved from 31.4 (13–43) points preoperatively to 84.6 (55–94) points at last follow-up and SF-12 also improved significantly. There was 1 re-revision for the cage loosening and screw breakage at 61 months after surgery, and 2 patients had nonprogressive radiolucency in zone III and the junction of zone II and zone III at the bone implant interface. Conclusion The reconstructional cage combining with morselized allografts without impaction achieves a good result with a high complete allograft incorporation rate in Paprosky type III acetabular bone defects.

Extensively Hydroxyapatite-Coated Stems in Revision Hip Arthroplasty: A Radiological Mid-Term follow-up Study

2005 ◽  
Vol 15 (1) ◽  
pp. 38-45
Author(s):  
D. Hernández-Vaquero ◽  
A. Suarez-Vazquez ◽  
M. Cima-Suarez ◽  
M. A. Garcia-Sandoval ◽  
R. Gava
Keyword(s):  
Hip Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Follow Up Study

Reconstruction of the glenoid using autologous bone-graft and the SMR Axioma TT metal-backed prosthesis

2018 ◽  
Vol 100-B (12) ◽  
pp. 1609-1617 ◽  
Author(s):  
A. M. Malhas ◽  
J. Granville-Chapman ◽  
P. M. Robinson ◽  
S. Brookes-Fazakerley ◽  
M. Walton ◽  
...  
Keyword(s):  
Bone Graft ◽  
Reliable Method ◽  
Titanium Surface ◽  
Bone Defects ◽  
Autologous Bone Graft ◽  
Short Term ◽  
Bone Deficiency ◽  
Autologous Bone ◽  
Shoulder Arthroplasties

Aims We present our experience of using a metal-backed prosthesis and autologous bone graft to treat gross glenoid bone deficiency. Patients and Methods A prospective cohort study of the first 45 shoulder arthroplasties using the SMR Axioma Trabecular Titanium (TT) metal-backed glenoid with autologous bone graft. Between May 2013 and December 2014, 45 shoulder arthroplasties were carried out in 44 patients with a mean age of 64 years (35 to 89). The indications were 23 complex primary arthroplasties, 12 to revise a hemiarthroplasty or resurfacing, five for aseptic loosening of the glenoid, and five for infection. Results Of the 45 patients, 16 had anatomical shoulder arthroplasties (ASA) and 29 had reverse shoulder arthroplasties (RSA). Postoperatively, 43/45 patients had a CT scan. In 41 of 43 patients (95%), the glenoid peg achieved > 50% integration. In 40 of 43 cases (93%), the graft was fully or partially integrated. There were seven revisions (16%) but only four (9%) required a change of baseplate. Four (25%) of the 16 ASAs were revised for instability or cuff failure. At two-year radiological follow-up, five of the 41 cases (11%) showed some evidence of lucent lines. Conclusion The use of a metal baseplate with a trabecular titanium surface in conjunction with autologous bone graft is a reliable method of addressing glenoid bone defects in primary and revision RSA setting in the short term. ASAs have a higher rate of complications with this technique.

The minimalinvasive direct anterior approach in aseptic cup revision hip arthroplasty: a mid-term follow-up

2018 ◽  
Vol 139 (1) ◽  
pp. 121-126 ◽  
Author(s):  
Marc Dominique Horsthemke ◽  
Christoph Koenig ◽  
Georg Gosheger ◽  
Jendrik Hardes ◽  
Steffen Hoell
Keyword(s):  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Revision Hip Arthroplasty ◽  
Cup Revision

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.

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