Extensively hydroxyapatite-coated long femoral stem revision hip arthroplasty: Clinical outcome and survivorship in 11 to 17.5 years follow up

Extensively coated long femoral stem revision hip arthroplasty is based on the principle of distal fixation at diaphyseal region, which can overcome the problem of proximal femoral bone stock deficiencies causing inadequate support and unstable fixation when using conventional length femoral stem. We performed a retrospective cohort analysis of 43 cases of revision hip arthroplasties using extensively hydroxyapatite-coated long femoral stem performed in our department from Jan 1998 to Dec 2005. Patients’ background demographic data, operative details and clinical outcome were analyzed. The mean age at revision surgery was 63.7 (32–84). The mean follow-up period was of 13.8 years (11–17.5 years). In the latest follow up, all patients reported either no or mild hip or thigh pain. 29.2% of patients were able to walk unaided, 25.0% were able to walk with stick, and 33.3% were able to walk with quadripod. The average Harris hip score measured in the latest follow up was 78.8 (55–100). 4.7% were complicated with implant loosening requiring re-revision and 4.7% were complicated with implant infection requiring implant removal. The survival rate was 89.9% at 17.5 years. The femoral stem without femoral fixation augmentation had better survivorship as compared with those with augmentation (p = 0.038). Extensively hydroxyapatite-coated long femoral stem is a good option for revision hip arthroplasty with good clinical outcome and high survival rate.

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

Journal of Orthopaedic Surgery ◽

10.1177/2309499018812241 ◽

2018 ◽

Vol 26 (3) ◽

pp. 230949901881224 ◽

Cited By ~ 1

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.

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Distal Femoral Cortical Hypertrophy after Hip Arthroplasty Using a Cementless Double-Tapered Femoral Stem

Journal of Orthopaedic Surgery ◽

10.1177/1602400309 ◽

2016 ◽

Vol 24 (3) ◽

pp. 317-322 ◽

Cited By ~ 9

Author(s):

Yoon Je Cho ◽

Young Soo Chun ◽

Kee Hyung Rhyu ◽

Jong Hun Baek ◽

Hu Liang

Keyword(s):

Clinical Outcome ◽

Hip Arthroplasty ◽

Stress Shielding ◽

Femoral Stem ◽

Visual Analogue Score ◽

Thigh Pain ◽

Harris Hip Score ◽

Cortical Hypertrophy ◽

Flare Index ◽

The Mean

Purpose To review 437 hips in 404 patients who underwent total hip arthroplasty (THA) or hemiarthroplasty using the Accolade TMZF stem to determine the incidence and risk factors of distal femoral cortical hypertrophy (DFCH). Methods Records of 437 hips in 169 men and 235 women aged 26 to 100 (mean, 65.7) years who underwent THA (n=293) or hemiarthroplasty (n=144) using the Accolade TMZF femoral stem by 2 senior surgeons and were followed up for a mean of 54.7 months were reviewed. Clinical outcome was assessed using the modified Harris Hip Score and visual analogue score for pain. Proximal femoral geometry and canal flare index were assessed on preoperative radiographs, and DFCH, stem position, subsidence, loosening, and stress shielding were assessed on postoperative radiographs according to the Gruen zone. Results Of 437 hips, 27 (6.2%) developed DFCH and 410 did not. Hips with DFCH had a higher incidence of thigh pain (18.5% vs. 2.2%, p<0.001) and earlier onset of thigh pain (12.3 vs. 20.8 months, p=0.015), compared with those without. Nonetheless, all femoral stems were well-fixed, and no osteolysis or loosening was detected. The 2 groups achieved comparable clinical outcome in terms of Harris Hip Score and pain. The mean canal flare index was higher in hips with than without DFCH (3.706 vs. 3.294, p=0.002). The mean vertical subsidence of the femoral stem was lower in hips with than without DFCH (1.5 vs. 3.4 mm p<0.001). Subsidence negatively correlated with the canal flare index (correlation coefficient= −0.110, p=0.022). The incidence of the DFCH increased with each unit of increment in canal flare index (odds ratio [OR]=1.828, p=0.043) and each year younger in age (OR=0.968, p=0.015). Conclusion The incidence of DFCH in hips with the Accolade TMZF stem was 6.2%. Patients with a higher canal flare index and younger age had a higher incidence of DFCH. Nonetheless, DFCH did not affect clinical outcome or femoral stem stability.

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

BioMed Research International ◽

10.1155/2015/345475 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 4

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.

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

10.21203/rs.3.rs-149542/v1 ◽

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.

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EVALUATION OF THE RESULTS OF CEMENTLESS TOTAL HIP ARTHROPLASTY IN PATIENTS WITH STAGES IV, V AND VI OSTEONECROSIS OF THE FEMORAL HEAD

Tạp chí Y học Cộng đồng ◽

10.52163/jcm.v62i1.6 ◽

2020 ◽

Vol 62 (1) ◽

Author(s):

Đắc Việt Mai ◽

Thu Thủy Nguyễn

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Bone Ingrowth ◽

Femoral Stem ◽

Stage Iv ◽

Harris Hip Score ◽

Total Hip ◽

The Mean

This study aimed to report the outcome of total hip arthroplasty (THA) with an extensive hydroxyapatite (HA) coating for the fixation of a tapered femoral stem (Corail) in patients aged 60 or younger than sixty years with stage IV, V và VI osteonecrosis of femoral head. Subject and method: Descriptive prospective research of ninety osteonecrotic hips in ninety patients were available for clinical and radiographic analyses at minimum follow-up of 5 years. Results and Conclusion: The mean Harris hip score improved from 43.74 ± 9,25points preoperatively to 96.67 ± 3.82points at final follow-up. Seventy-four (100%) hips demonstrated stable bone ingrowth. No hips showed acetabular or femoral osteolysis radiolucency and loosening, or required revision for aseptic loosening. We believe that cementless THA with a Corail stem is a promising procedure for patients with osteonecrosis of the femoral head.

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The Corail Stem as a Reverse Hybrid – Survivorship and X-Ray Analysis at 10 Years

Hip International ◽

10.5301/hipint.5000477 ◽

2017 ◽

Vol 27 (4) ◽

pp. 354-360 ◽

Cited By ~ 5

Author(s):

Helge Wangen ◽

Lars Nordsletten ◽

Jens G. Boldt ◽

Anne M. Fenstad ◽

David E. Beverland

Keyword(s):

Clinical Outcome ◽

Femoral Stem ◽

Successful Outcome ◽

Harris Hip Score ◽

Heterotopic Bone ◽

Heterotopic Bone Formation ◽

X Rays ◽

The Mean ◽

Cemented Cup

Background The use of a cemented cup together with an uncemented stem in total hip arthroplasty (THA) has become popular in Norway and Sweden during the last decade. The results of this prosthetic concept, reverse hybrid THA have been sparsely described. We report our experience of reverse hybrid THA, using the Elite plus polyethylene cemented cup together with the Corail fully hydroxyapatite-coated uncemented stem and a 28-mm alumina ceramic head. Patients and methods 132 consecutive reverse hybrid hip arthroplasties were performed from January 2000 to December 2003 in 126 patients with a mean age of 54.3 years (28-65). All patients were routinely reviewed at 3 months, 1, 5, 7 and 10 years postoperatively. At each follow-up patients were seen either by a consultant orthopaedic surgeon or a senior trainee. Anteroposterior pelvic and lateral x-rays of the hip were taken at each visit. To estimate the survival of the THAs we used the Kaplan-Meier method with 95% confidence interval (CI). Logistic regression analysis was performed to determine which factors affected the presence of radiolucency around the femoral stem. Results The mean follow-up was 11.1 years (9.0-14.2). 1 patient was lost to follow-up, and 7 patients were deceased at the time of 10-year follow up. At 10 years 7 patients have had further surgery. 5 for infection, 1 periprosthetic femoral fracture and 1 heterotopic bone formation. All stems were classified as well fixed. 2 cups were defined as loose at 10 years. 1 patient is scheduled for revision the other refused revision. The clinical outcome and radiological findings were assessed in 123 hips. The mean Harris Hip Score was 94 (35-100) at 10 years and the mean WOMAC score was 89 (30.2-100). Conclusions We report good results with respect to clinical outcome and survival of the reverse hybrid concept in patients younger than 65. A successful outcome depends on meticulous preoperative planning, use of modern cementing techniques in the acetabulum and experience in implanting an uncemented stem.

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

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02458-7 ◽

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.

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Cementless total hip arthroplasty after failed internal fixation of acetabular fractures: A single center experience of 25 consecutive patients

Journal of Orthopaedic Surgery ◽

10.1177/2309499020910666 ◽

2020 ◽

Vol 28 (2) ◽

pp. 230949902091066

Author(s):

Min Uk Do ◽

Won Chul Shin ◽

Nam Hoon Moon ◽

Suk-Woong Kang ◽

Kuen Tak Suh

Keyword(s):

Total Hip Arthroplasty ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Harris Hip Score ◽

Acetabular Fractures ◽

Walking Ability ◽

Total Hip ◽

The Mean

Purpose: Total hip arthroplasty (THA) is an available surgical option for failed acetabular fracture, previously managed by open reduction and internal fixation. This study aimed to report the postoperative outcomes of cementless THA in patients with this condition. Materials and Methods: Between November 2000 and September 2016, 25 consecutive cementless THAs for failed internal fixation after acetabular fractures with a minimum follow-up of 2 years were analyzed. The mean age at the time of surgery was 58 years (36–85 years), and the time elapsed between fracture and THA was 70 months (7–213 months). Clinical and radiologic evaluations were performed on all patients. Results: Clinically, the mean Harris hip score at the last follow-up was 88 points. Walking ability recovered to pre-injury status in 92% patients, and activities of daily living recovered in 96% patients. Radiographically, none of the acetabular cups showed evidence of migration and loosening during the mean follow-up of 50 months. All cases showed stable femoral stem fixation at the last follow-up. Dislocation occurred in three cases (12%). Conclusion: Outcomes of cementless THA after failed internal fixation for acetabular fractures were satisfactory. However, a relatively high incidence of postoperative dislocation is still a concern.

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Partial two-stage exchange: an alternative method for infected total hip arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04550-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Mumingjiang Yishake ◽

Lan Tang ◽

Xi Chen ◽

Yuejian Wang ◽

Rongxin He

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcomes ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Severe Trauma ◽

Harris Hip Score ◽

Two Stage ◽

Total Hip ◽

The Mean

Abstract Background Total two-stage exchange is commonly used in clinical practice as a treatment for infected total hip arthroplasty (THA); however, this approach involves considerable limitations, including significant bone loss and severe trauma. This retrospective cohort study was conducted to evaluate clinical outcomes following the use of partial two-stage exchange (PTE) for infected THA. Methods We performed a retrospective analysis of 28 patients with infected THA who were treated by PTE between September 2000 and June 2019. Eligibility for PTE was limited to patients with a well-fixed femoral stem prosthesis. In the first stage of the operation, the femoral stem prosthesis was preserved; subsequently, the acetabular prosthesis, liner, and head were replaced with an antibiotic-loaded spacer. The new prosthesis was then implanted into patients and monitored for at least 3 months to ensure freedom from infection. Results Patients were followed for an average of 4 years (range, 2–11 years), with an overall success rate of 85.7% (24/28). The mean Harris hip score at the final follow-up was 76.2 ± 11.7 points. Conclusions The findings of this study suggest that PTE could be an acceptable option for a subset of patients with infected THA, offering a satisfactory infection control rate and clinical outcomes comparable to those of total two-stage exchange, but with less harm.

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Long-term outcomes of cementless femoral stem revision with the Wagner cone prosthesis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02457-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Kyung-Soon Park ◽

Sheng-Yu Jin ◽

Jun-Hyuk Lim ◽

Taek-Rim Yoon

Keyword(s):

Revision Surgery ◽

Femoral Stem ◽

Harris Hip Score ◽

Long Term Outcomes ◽

Stem Revision ◽

Revision Tha ◽

Cementless Femoral Stem ◽

The Mean

Abstract Background The procedure of femoral stem revision is challenging, and bone conservation with less stress shielding is a mandatory effort in these cases. Although there are several reports of stem revision with stems designed for primary total hip arthroplasty (THA), there is no report on stem revision with the Wagner cone prosthesis. Methods Between 1996 and 2008, 41 hips of 41 consecutive patients were subjected to femoral revision THA using the Wagner cone prosthesis. The mean age during revision surgery was 56.1 years, and the mean follow-up period was 14.8 years. The clinical results were evaluated, and the femoral component was assessed radiologically. Results The results showed that the average period from the first operation to revision THA was 8.0 years. Additionally, the mean Harris hip score improved from 52 points preoperatively to 83 points at the final follow-up. All stems showed bone integration in the radiological evaluation. A subsidence of more than 5 mm was observed in 3 out of 28 (10.7%) femoral stems. Two patients needed an acetabular revision for acetabular cup loosening during the follow-up period. Furthermore, one patient had recurrent dislocation and had to undergo revision surgery for soft tissue augmentation. Conclusions We achieved favorable clinical and radiological long-term outcomes in femoral stem revision using the Wagner cone prosthesis. This cementless femoral stem could be an option for femoral stem revision in cases with relatively good bone stock.

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