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

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.

Results at 10–24 years after single-stage revision arthroplasty of infected total hip arthroplasty in patients under 45 years of age

2019 ◽  
pp. 112070001988887 ◽  
Author(s):  
Matthias Wolff ◽  
Christian Lausmann ◽  
Thorsten Gehrke ◽  
Akos Zahar ◽  
Malte Ohlmeier ◽  
...  
Keyword(s):  
Infection Control ◽  
Revision Surgery ◽  
Single Stage ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Study Cohort ◽  
One Stage ◽  
The Mean

Introduction: The management of periprosthetic joint infection (PJI) of the hip is a challenging procedure. One-stage exchange is carried out in specialist centres with comparable infection free survival rates. However, there is a paucity of long-term results of this approach in young patients. Methods: All patients undergoing one-stage exchange due to PJI with a known causative organism ⩽45 years of age with a minimum of 10-year follow-up (mean 15 years; range 10–24 years) were enrolled in this retrospective study. Patients older than 45 years of age or patients with a two-stage procedure were excluded from the study. The primary outcome measure was failure rate with special focus on reinfection at latest follow-up. Failure was defined as revision surgery for infection. Furthermore, functional outcome using the Harris Hip Score was determined initially and at latest follow-up. 26 patients fulfilled the inclusion criteria and were available for final follow-up. Results: The study cohort consists of 16 male and 10 female patients with a mean age of 36.8 years (range 20–45 years) and a mean BMI of 29.8 kg/m2 (range 20.7–40.6 kg/m2). Prior to the single-stage procedure, the patients underwent an average of 3.1 previous surgical interventions (range 1–9). The mean hospital stay after septic revision was 19.7 days (11–33 days). Most infections were caused by Staphylococcus epidermidis ( n = 8, 30.8%), followed by Staph. aureus ( n = 7, 26.9%) and Propionibacterium acnes ( n = 6, 23.1%). At latest follow-up, the overall survival rate was 76.9 %, while infection control could be achieved in 96.2%. At final examination, the mean Harris Hip Score improved from 46.2 to 78.9 (range 18.0–99; SD, 22.6). Conclusions: Single-stage revision surgery for the management of PJI in patients ⩽45 years is a successful treatment option with high infection control, even after long-term follow-up.

scholarly journals Catastrophic Failure and Metallosis of the Acetabular Component in Total Hip Arthroplasty

2021 ◽  
Author(s):  
FIRAT OZAN ◽  
Murat Kahraman ◽  
Ali Baktır ◽  
Kürşat Gençer
Keyword(s):  
Revision Arthroplasty ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Catastrophic Failure ◽  
Total Hip ◽  
Catastrophic Failures ◽  
Revision Tha ◽  
The Mean ◽  
Hip Arthroplasties

Abstract Background: To evaluate the clinical features and results of the revision total hip arthroplasties (THA) in patients with catastrophic failures and metallosis. Methods: Fifteen hips of 14 patients with catastrophic failure and metallosis in hip arthroplasties were evaluated. They were followed for at least 4.2 years after the revision THA. Clinical evaluation was performed using Harris hip score. Osteolysis, loosening or presence of metallosis was evaluated with standard radiographs. Metallosis was evaluated intraoperatively according to the metallosis severity classification. Results: The mean time from failure until revision surgery was 9.4 years. It was observed that in the primary THA, metal-on-ceramic (MoC), ceramic-on-ceramic (CoC) and metal-on-conventional polyethylene (MoCPE) bearings were used in 1, 3 and 11 hips, respectively. Grade III metallosis was observed in all patients during revision surgeries. The mean Harris hip score increased from 55 points before revision THA to 75 points at the final follow-up. In revision arthroplasty, MoCPE and CoC bearings were used in 13 and 2 hips, respectively. The femoral stem was replaced in 5 hips. All acetabular cups, except that of one hip, were revised. Conclusions: Revisions of THAs with catastrophic failures and metallosis are quite challenging. Routine follow-up of arthroplasty patients is beneficial to examine for osteolysis, loosening, and asymmetric wear.

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.

scholarly journals 324 Outcomes of the Exeter V40 Cemented Femoral Stem at a Minimum of 10 Years in a Non-designer Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Mahon ◽  
C McCarthy ◽  
G Sheridan ◽  
J Cashman ◽  
J O'Byrne ◽  
...  
Keyword(s):  
Femoral Stem ◽  
High Volume ◽  
Womac Score ◽  
Long Term Outcomes ◽  
Data Set ◽  
The Mean ◽  
Primary Total Hip Arthroplasty

Abstract Introduction The Exeter V40 cemented femoral stem was first introduced in 2000. The largest single-centre analysis of this implant to date was published in 2018, with excellent results at a minimum of 10-years for the first 540 cases performed at the designer centre in the Exeter NHS Trust. The aim of this current study is to report long term outcomes and survivorship for the Exeter V40 stem in a non-designer centre. Method All patients undergoing primary total hip arthroplasty using the Exeter V40 femoral stem between January 1st 2005 and January 31st 2010 were eligible for inclusion. Outcome measures included data on all components in situ beyond 10 years, death occurring within 10 years with components in situ and all-cause revision surgery. Results A total of 829 stems were included in the data set. Of these, 808 (97.5%) had no further surgery within the follow-up period; 648 stems (78.1%) were in situ beyond 10 years, and 165 (19.9%) were in situ at death before 10 years. The mean preoperative WOMAC score was 61±15.9 with a mean postoperative score of 20.4±19.3. Conclusions The Exeter V40 cemented femoral stem demonstrates excellent functional outcomes and survival when used in a high-volume non-designer centre.

scholarly journals Catastrophic failure and metallosis of the acetabular component in total hip arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fırat Ozan ◽  
Murat Kahraman ◽  
Ali Baktır ◽  
Kürşat Gençer
Keyword(s):  
Revision Arthroplasty ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Catastrophic Failure ◽  
Total Hip ◽  
Catastrophic Failures ◽  
Revision Tha ◽  
The Mean ◽  
Hip Arthroplasties

Abstract Background To evaluate the clinical features and results of the revision total hip arthroplasties (THA) in patients with catastrophic failures and metallosis. Methods Fifteen hips of 14 patients with catastrophic failure and metallosis in hip arthroplasties were evaluated. They were followed for at least 4.2 years after the revision THA. Clinical evaluation was performed using Harris hip score. Osteolysis, loosening or presence of metallosis was evaluated with standard radiographs. Metallosis was evaluated intraoperatively according to the metallosis severity classification. Results The mean time from failure until revision surgery was 9.4 years. It was observed that in the primary THA, metal-on-ceramic (MoC), ceramic-on-ceramic (CoC) and metal-on-conventional polyethylene (MoCPE) bearings were used in 1, 3 and 11 hips, respectively. Grade III metallosis was observed in all patients during revision surgeries. The mean Harris hip score increased from 55 points before revision THA to 75 points at the final follow-up. In revision arthroplasty, MoCPE and CoC bearings were used in 13 and 2 hips, respectively. The femoral stem was replaced in 5 hips. All acetabular cups, except that of one hip, were revised. Conclusions Revisions of THAs with catastrophic failures and metallosis are quite challenging. Routine follow-up of arthroplasty patients is beneficial to examine for osteolysis, loosening, and asymmetric wear.

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

2021 ◽  
pp. 221049172098511
Author(s):  
Liu Wing Hong ◽  
Chung Kwong Yin ◽  
Cheung Kin Wing ◽  
Chiu Kwok Hing ◽  
Ho Ki Wai Kevin
Keyword(s):  
Survival Rate ◽  
Clinical Outcome ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Revision Hip Arthroplasty ◽  
Harris Hip Score ◽  
High Survival ◽  
Stem Revision ◽  
The Mean

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.

scholarly journals Exeter Small Femoral Stem for Patients with Small Femurs

2011 ◽  
Vol 19 (3) ◽  
pp. 279-283 ◽  
Author(s):  
Kwok-Hing Chiu ◽  
Kin-Wing Cheung ◽  
Kwong-Yin Chung ◽  
Wan-Yiu Shen
Keyword(s):  
Femoral Stem ◽  
Cement Mantle ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Ectopic Ossification ◽  
Radiolucent Lines ◽  
Intramedullary Reaming ◽  
The Mean

Purpose. To report the long-term results of total hip arthroplasty (THA) using small size Exeter femoral stems. Methods. Eight men and 34 women aged 60 to 83 (mean, 70) years underwent 45 THAs using the Exeter small stem with offsets of 30 mm (n=3), 33 mm (n=15), and 35.5 mm (n=27). The Harris hip score was assessed pre- and post-operatively. Stem alignment and axial subsidence of the stem were measured. Radiolucent lines around the femur were recorded at 14 Gruen zones. Completeness and thickness of the cement mantle and cement fractures were also noted. Ectopic ossification, if present, was graded. Stem loosening was based on the Olsson definitions. Results. The mean follow-up was 9 (range, 5–12) years. The mean Harris hip score improved from 37 (range, 13–61) to 80 (range, 47–96) [p<0.001]. At the latest follow-up, the score was excellent (90–100) in 8 (18%) of the hips, good (80–89) in 21 (47%), fair (70–79) in 9 (20%), and poor (<70) in 7 (16%). All hips had a complete cement mantle of ≥2 mm. All stems were inserted without intramedullary reaming. 11 (24%) of the hips developed stem subsidence of <2 mm; all stabilised within 2 years. None of these patients had pain or other radiological signs of loosening. Six stems showed radiolucent lines of <1 mm in the upper zones, which were not progressive. No cement fracture or subsidence was noted. Using revision for any cause as an endpoint, the overall survival rate of Exeter small femoral stem was 100% at 10 years and 89% at 12 years. Conclusion. The results of Exeter small stems for patients with small femurs are good.

scholarly journals Clinical results of the Metha short hip stem: a perspective for younger patients?

2013 ◽  
Vol 5 (4) ◽  
pp. 34 ◽  
Author(s):  
Fritz Thorey ◽  
Claudia Hoefer ◽  
Nima Abdi-Tabari ◽  
Matthias Lerch ◽  
Stefan Budde ◽  
...  
Keyword(s):  
Bone Ingrowth ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Femoral Revision ◽  
Term Survival ◽  
Younger Patients ◽  
The Mean ◽  
Short Stems

In recent years, various uncemented proximal metaphyseal hip stems were introduced for younger patients as a bone preserving strategy. Initial osteodensitometric analyses of the surrounding bone of short stems indicate an increase of bone mass with secondary bone ingrowth fixation as a predictor of long-term survival of these types of implants. We report the outcome of 151 modular Metha short hip stem implants in 148 patients between March 2005 and October 2007. The mean follow-up was 5.8±0.7 years and the mean age of the patients was 55.7±9.8 years. Along with demographic data and co-morbidities, the Harris Hip Score (HHS), the Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and also the results of a patient-administered questionnaire were recorded pre-operatively and at follow-up. The mean HHS increased from 46±17 pre-operatively to 90±5 the HOOS improved from 55±16 pre-operatively to 89±10 at the final follow-up. A total of three patients have been revised, two for subsidence with femoral revision and one for infection without femoral revision (Kaplan Meier survival estimate 98%). The radiological findings showed no radiolucent lines in any of the patients. The modular Metha short hip stem was implanted in younger patients, who reported an overall high level of satisfaction. The clinical and radiographic results give support to the principle of using short stems with metaphyseal anchorage. However, long-term results are necessary to confirm the success of this concept in the years to come.

Snake envenomation-induced acute kidney injury: prognosis and long-term renal outcomes

2021 ◽  
pp. postgradmedj-2020-139021
Author(s):  
Manoj Kumar ◽  
Maasila Arcot Thanjan ◽  
Natarajan Gopalakrishnan ◽  
Dhanapriya Jeyachandran ◽  
Dineshkumar Thanigachalam ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Long Term Outcomes ◽  
Urine Protein ◽  
Renal Outcomes ◽  
Snake Envenomation ◽  
The Mean ◽  
New Onset

BackgroundSnake bite continues to be a significant cause of acute kidney injury (AKI) in India. There is paucity of data regarding long-term outcomes of such patients. In this study, we aim to assess the prognosis and long-term renal outcomes of such patients.MethodsWe analysed the hospital records of snake envenomation-induced AKI from January 2015 to December 2018. Predictors of in-hospital mortality were assessed. Survivors were advised to visit follow-up clinic to assess their kidney function.ResultsThere were 769 patients with evidence of envenomation and of them, 159 (20.7%) had AKI. There were 112 (70.4%) males. Mortality occurred in 9.4% of patients. Logistic regression analysis identified shock (OR 51.949, 95% CI 4.297 to 628.072) and thrombocytopenia (OR 27.248, 95% CI 3.276 to 226.609) as predictors of mortality. Forty-three patients attended the follow-up. The mean follow-up duration was 30.4±15.23 months. Adverse renal outcomes (eGFR <60 mL/min/1.73 m2 or new-onset hypertension (HTN) or pre-HTN or urine protein creatinine ratio >0.3) occurred in 48.8% of patients. Older age (mean age (years) 53.3 vs 42.8, p=0.004) and longer duration on dialysis (median duration (days) 11.5 vs 5, p=0.024) were significantly associated with adverse renal outcomes.ConclusionsThe incidence of AKI in snake envenomation was 20.7%. The presence of shock and thrombocytopenia were associated with mortality. Adverse renal outcomes occurred in 48.8% of patients in the long term.

Sign in / Sign up

Export Citation Format

Share Document