Reconstruction of the hip after resection of periacetabular oncological lesions

AimsReconstruction of the acetabulum after resection of a periacetabular malignancy is technically challenging and many different techniques have been used with varying success. Our aim was to prepare a systematic review of the literature dealing with these techniques in order to clarify the management, the rate of complications and the outcomes.Patients and MethodsA search of PubMed and MEDLINE was conducted for English language articles published between January 1990 and February 2017 with combinations of key search terms to identify studies dealing with periacetabular resection with reconstruction in patients with a malignancy. Studies in English that reported radiographic or clinical outcomes were included. Data collected from each study included: the number and type of reconstructions, the pathological diagnosis of the lesions, the mean age and follow-up, gender distribution, implant survivorship, complications, functional outcome, and mortality. The results from individual studies were combined for the general analysis, and then grouped according to the type of reconstruction.ResultsA total of 57 studies met the inclusion criteria and included 1700 patients. Most lesions were metastatic (41%), followed by chondrosarcoma (29%), osteosarcoma (10%), Ewing’s sarcoma (7%), and multiple myeloma (2%). The techniques of reconstruction were divided into seven types for analysis: those involving a Harrington reconstruction, a saddle prosthesis, an allograft and allograft prosthesis composite, a pasteurised autograft, a porous tantalum implant, a custom-made prosthesis and a modular hemipelvic reconstruction. The rate of complications was 50%, with infection (14%) and instability (8%) being the most common. Mortality data were available for 1427 patients (84%); 50% had died of disease progression, 23% were alive with disease, and 27% had no evidence of disease at a mean follow-up of 3.4 years (0 to 34).ConclusionBoth the rate of complications and mortality are high following resection of oncological periacetabular lesions and reconstruction. Many types of reconstruction have been used with unique challenges and complications for each technique. Newer prostheses, including custom-made prostheses and porous tantalum implants and augments, have shown promising early functional and radiographic outcomes. Cite this article: Bone Joint J 2018;100-B(1 Supple A):22–30.

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Cementless Ceramic-on-Ceramic Total Hip Replacement in Children and Adolescents

Children ◽

10.3390/children8100858 ◽

2021 ◽

Vol 8 (10) ◽

pp. 858

Author(s):

Giovanni Trisolino ◽

Stefano Stallone ◽

Francesco Castagnini ◽

Barbara Bordini ◽

Monica Cosentino ◽

...

Keyword(s):

Survival Rate ◽

Children And Adolescents ◽

Total Hip Replacement ◽

Hip Replacement ◽

Inclusion Criteria ◽

Single Institution ◽

Radiographic Outcomes ◽

Implant Survivorship ◽

Ceramic On Ceramic

Background: total hip replacement (THR) is a rare surgical option in children and adolescents with disabling hip diseases. The aim of this study is to report results from a retrospective cohort of patients aged 18 years or less who underwent cementless Ceramic-on-Ceramic (CoC) THR at a single institution, investigating clinical and radiographic outcomes, survival rates, and reasons for revision of the implants. Materials and methods: we queried the Registry of Prosthetic Orthopedic Implants (RIPO) to identify all children and adolescents undergoing THR between 2000 and 2019 at a single Institution. Inclusion criteria were patients undergoing cementless CoC THR, aged less than 18 years at surgery, followed for at least 2 years. Sixty-eight patients (74 hips) matched all the inclusion criteria and were enrolled in the study. We assessed the clinical and radiographic outcomes, the rate of complications, the survival rate, and reasons for revision of the implants. Results: The mean follow-up was 6.6 ± 4.4 years (range 2–20). The most frequent reason for THR was post-traumatic or chemotherapy-induced avascular necrosis (38%). The overall survival rate of the cohort was 97.6% (95% CI: 84.9–99.7%) at 5 years of follow-up, 94.4% (95% CI: 79.8–98.6%) at 10 years and 15 years of follow-up. Two THR in two patients (2.7%) required revision. With the numbers available, Cox regression analysis could not detect any significant interaction between preoperative or intraoperative variables and implant survivorship (p-value 0.242 to 0.989).” The average HOOS was 85 ± 14.3 (range 30.6–100). Overall, 23 patients (48%) reported excellent HOOS scores (>90 points), 21 patients (44%) reported acceptable HOOS scores (60–90 points) while 4 patients (8%) reported poor outcomes (<60 points). Twenty-one patients (43%) were regularly involved into moderate- to high-intensity sport activities (UCLA ≥ 6). Conclusions: Cementless CoC THR is a successful procedure in children and teenagers, having demonstrated high implant survivorship and low rates of complications and failure. A meticulous preoperative planning and implant selection is mandatory, to avoid implant malposition, which is the main reason of failure and revision in these cases. Further studies are needed to assess the impact of the THR on the psychosocial wellbeing of teenagers, as well as risks and benefits and cost-effectiveness in comparison to the hip preserving surgical procedures.

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Early to medium-term outcomes of uncemented ceramic-bearing total hip arthroplasty in teenagers for paediatric hip conditions

The Bone & Joint Journal ◽

10.1302/0301-620x.102b11.bjj-2020-0668.r1 ◽

2020 ◽

Vol 102-B (11) ◽

pp. 1491-1496

Author(s):

Pranai K. Buddhdev ◽

Ivor S. Vanhegan ◽

Tahir Khan ◽

Aresh Hashemi-Nejad

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Adolescent And Young Adult ◽

Medium Term ◽

Total Hip ◽

Custom Made ◽

The Mean ◽

Custom Made Prostheses

Aims Despite advances in the treatment of paediatric hip disease, adolescent and young adult patients can develop early onset end-stage osteoarthritis. The aims of this study were to address the indications and medium-term outcomes for total hip arthroplasty (THA) with ceramic bearings for teenage patients. Methods Surgery was performed by a single surgeon working in the paediatric orthopaedic unit of a tertiary referral hospital. Databases were interrogated from 2003 to 2017 for all teenage patients undergoing THA with a minimum 2.3 year follow-up. Data capture included patient demographics, the underlying hip pathology, number of previous surgeries, and THA prostheses used. Institutional ethical approval was granted to contact patients for prospective clinical outcomes and obtain up-to-date radiographs. In total, 60 primary hips were implanted in 51 patients (35 female, 16 male) with nine bilateral cases. The mean age was 16.7 years (12 to 19) and mean follow-up was 9.3 years (2.3 to 16.8). Results The most common indication for teenage hip arthroplasty was avascular necrosis secondary to slipped upper femoral epiphysis (31%; n = 16). Overall, 64% of patients (n = 33) had undergone multiple previous operations. The survival at follow-up was 97%; two patients required revision for aseptic loosening (one femoral stem, one acetabular component). Both patients had fused hips noted at the time of arthroplasty. A further two patients had radiolucent lines but were asymptomatic. At latest follow-up the mean Oxford Hip Score was 44 (31 to 48) and a Visual Analogue Scale measurement of 1.5, indicating satisfactory function. Conclusion Operating on this cohort can be complicated by multiple previous surgeries and distorted anatomy, which in some cases require custom-made prostheses. We have demonstrated a good outcome with low revision rate in this complex group of patients. Cite this article: Bone Joint J 2020;102-B(11):1491–1496.

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A call to action for delirium research: Meta-analysis and regression of delirium associated mortality

BMC Geriatrics ◽

10.1186/s12877-020-01723-4 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

May Zin Aung Thein ◽

Jarett V. Pereira ◽

Anita Nitchingham ◽

Gideon A. Caplan

Keyword(s):

English Language ◽

Meta Analysis ◽

A Priori ◽

Group Analysis ◽

Hospital Setting ◽

Mortality Data ◽

Mixed Effect ◽

Elderly Inpatients ◽

Registration Number

Abstract Background Delirium is an extremely common hospital complication. No study to date has assessed whether a priori defined covariates; type of hospital setting and year of study publication, influence the relationship between delirium and mortality. This is also the first study to examine the longitudinal trend of delirium-associated mortality over recent decades, to analyse the trajectory of our efforts in combating this disease. Methods MEDLINE, EMBASE and PsycINFO, were searched from January 1981 to May 2018 for English-language primary articles. Rigorous title and abstract screen and full-text screen were conducted independently by two reviewers. This paper adhered to MOOSE guidelines. Data was extracted independently by one reviewer using standardised data-collection sheets, with a separate reviewer verifying for accuracy. The quality of included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Unadjusted effect sizes and event counts were analysed with a random effects model in primary meta-analysis and meta-regression, whereas a mixed effect model was used in secondary sub-group analysis. Mortality data at longest follow-up and cumulative mortality (hospital mortality combined with mortality at longest follow-up) data were analysed. Results As part of a larger project, 446 of 6790 articles were retrieved, including 71 studies that measured mortality. Our results demonstrate that elderly inpatients with delirium had significantly greater odds of mortality (OR 3.18 [95%CI: 2.73, 3.70]) compared to non-delirious controls. Patients with delirium in the ICU had the highest odds for mortality (OR: 7.09 [95%CI: 3.60, 14.0]); double the risk compared to the average. Curiously, despite advancements in delirium research, delirium associated in-hospital odds of mortality has not changed in 30 years. Conclusion This is the largest meta-analysis to confirm the association between delirium and mortality, in older (age ≥ 65) hospital inpatients. The current meta-analysis highlights the significant odds of mortality after an episode of delirium, and these odds are much higher for ICU patients. However, in contrast to other medical conditions that have seen a decrease in associated mortality over the past few decades, delirium associated mortality remains unchanged. These findings underscore the urgent need for better delirium treatments. PROSPERO Registration Number: CRD42018098627, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=98627

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Hand-Modelled Composite Prostheses after Resection of Peri-Acetabular Bone Malignancies

Sarcoma ◽

10.1080/1357714031000114174 ◽

2003 ◽

Vol 7 (1) ◽

pp. 19-27

Author(s):

G. Delepine ◽

F. Delepine ◽

T. Sokolov ◽

N. Delepine

Keyword(s):

Hip Prosthesis ◽

Staging System ◽

Deep Infection ◽

Extensive Resection ◽

Reconstructive Procedures ◽

Acetabular Bone ◽

Titanium Screws ◽

Custom Made ◽

Custom Made Prostheses

Purpose: To improve function after pelvic resection involving the acetabulum, using an anatomic composite implant built with screws and cement.Material and method: Since 1990, 66 patients with peri-acetabular bone malignancies have been treated by extensive resection followed by hand-modelled innominate prosthesis with partially constrained total hip prosthesis. The hand-modelled innominate prosthesis was made of a titanium cup, a set of long titanium screws and two or three packs of gentamycine-loaded cement.Results: Many postoperative complications were observed: deep infection (14%), hip prosthesis dislocation (25%) and local recurrence (15%). Sixteen patients (25%) had to be reoperated. Nevertheless, at last follow-up, 62 patients still had composite prosthesis. The mean functional result, rated according to a modified Enneking's staging system, was 80% with unlimited walking without support, average hip flexion 100°, length discrepancy less than 1 cm.Discussion: These results were similar to those described in the literature for custom-made innominate prostheses and much better than those of alternative reconstructive procedures. Hand-modelled composite prostheses are cheaper, easier, more adaptable and enables better anchorage than custom-made prostheses. Such a procedure can be used even after total iliac wing resection.Conclusion: The advantages of such a procedure plead for its extensive use after acetabular resection. But long-term follow-up is necessary to validate indications.

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Outcomes of Cementless-Backed Patellar Components

The Journal of Knee Surgery ◽

10.1055/s-0040-1710378 ◽

2020 ◽

Vol 33 (09) ◽

pp. 856-861

Author(s):

Steven F. Harwin ◽

William DeGouveia ◽

Nipun Sodhi ◽

Peter A. Gold ◽

Luke J. Garbarino ◽

...

Keyword(s):

High Volume ◽

Large Cohort ◽

Successful Outcome ◽

Patellar Component ◽

Radiographic Outcomes ◽

Implant Survivorship ◽

Safe Technique ◽

Total Knee ◽

The One

AbstractBecause of the early follow-up positive outcomes with cementless fixation, continued evaluations need to be performed to ensure longer-term efficacy. Additionally, although many studies report on the results of femoral and tibial component fixation, few studies report specifically on patellar outcomes. Therefore, the purpose of this study was to report on the: (1) implant survivorship; (2) complications; and (3) radiographic outcomes in a large cohort of patients who received cementless total knee arthroplasties (TKAs), with particular attention to the patellar component. A total of 261 patients who underwent cementless TKA by a single, high-volume academic surgeon were studied. Patients had a mean age of 66 years and were distributed between 192 women (74%) and 69 men. All patients received the same cementless tibial, femoral, and patellar components. Mean follow-up period was 4.5 years (range, 4–5 years). Primary outcomes evaluated included all postoperative complications, with particular emphasis on the patellar component. Only one patellar loosened leading to a patellar aseptic loosening rate of 0.3% (1 of 261). The one patellar loosening was the component being dislodged after a manipulation under anesthesia (MUA) at 6 weeks. This was revised to a cemented component and the patient is doing well 4 years later. A second patient experienced a patellar tendon rupture, later surgically repaired. Another patient sustained a patella fracture that was managed nonoperatively. The fracture healed by 1 year and the patient continued to have an otherwise successful outcome, now at 2 years follow-up. No progressive radiolucencies, subsidence, or changes in initial postoperative axial alignment were observed at final follow-up. The results from this study highlight a 98% success rate at mean 4.5 years follow-up in a large cohort of patients with a diverse spread of demographic details. Specific to the patella, only one patient experienced an adverse event, which was managed nonoperatively. Therefore, based on this data, patellar fixation in cementless TKA can be considered a safe technique.

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Quality of life, infection control, and complication rates using a novel custom-made articulating hip spacer during two-stage revision for periprosthetic joint infection

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04274-4 ◽

2021 ◽

Author(s):

Andre Lunz ◽

Georg W. Omlor ◽

Gunter Schmidt ◽

Babak Moradi ◽

Burkhard Lehner ◽

...

Keyword(s):

Infection Control ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Complication Rates ◽

Two Stage ◽

Implant Survivorship ◽

Custom Made ◽

Patient Reported

Abstract Introduction Two-stage revision remains the gold standard treatment for most chronically infected and complex total hip arthroplasty infections. To improve patient outcome and reduce complication rates, we have developed a novel custom-made articulating hip spacer technique and present our short-term results. Materials and methods Between November 2017 and November 2019, 27 patients (mean age 70 years) underwent two-stage revision for periprosthetic joint infection of the hip using the articulating spacer design described here. We retrospectively analyzed spacer-related complications as well as rates for complication, infection control, and implant survivorship after final reimplantation. Furthermore, we prospectively collected patient-reported health-related quality of life (HRQoL) scores prior to spacer implantation, with the spacer and after reimplantation of the new prosthesis. Results An additional round of spacer exchange was performed in two patients (8.3%), persistent wound discharge was the reason in both cases. We had one (4.2%) spacer-related mechanical complication, a dislocation that was treated with closed reduction. After reimplantation, infection control was achieved in 96% with an implant survivorship of 92% after a mean follow-up time of 19 (range 7–32, SD 7.2) months. While the scores for VR-12 MCS, VAS hip pain and patient-reported overall satisfaction significantly improved after first stage surgery, the scores for WOMAC, UCLA and VR-12 PCS significantly improved after second stage surgery. Conclusions Our two-stage approach for periprosthetic joint infection shows high infection eradication and implant survivorship rates at short-term follow-up. Spacer-related complication rates were low, and we achieved high patient satisfaction rates and low pain levels already during the spacer period. To further simplify comparison between different spacer designs, we propose a new hip spacer classification system.

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Cementless Metaphyseal Sleeve Fixation in Revision Knee Arthroplasty: Our Experience with an Arabic Population at the Midterm

Advances in Orthopedics ◽

10.1155/2020/5782853 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Abdulrahman D. Algarni

Keyword(s):

Knee Arthroplasty ◽

Obese Patients ◽

Cementless Stem ◽

Viable Option ◽

Revision Knee Arthroplasty ◽

Radiographic Outcomes ◽

Implant Survivorship ◽

The Mean ◽

Different Levels

Objective. Metaphyseal sleeve (MS) fixation in revision knee arthroplasty (RKA) among Western populations has been reported with very encouraging outcomes. The aim of this study was to report our experience with the use of MS in RKA among an Arabic population. Clinical and radiographic outcomes and implant survivorship were reported at a minimum follow-up of 2 years and a mean follow-up of 4.1 years. Methods. A retrospective analysis was conducted on prospectively collected data of patients who underwent RKA with a MS in combination with a cementless stem (femoral or tibial). Range of motion (ROM) and Knee Society Score (KSS) were obtained pre- and postoperatively. Complications, occurrence of stem-tip pain, and implant survival were documented. Knee radiographs were obtained to evaluate the alignment and osseointegration or loosening of the MS. Results. A total of 52 sleeves (27 tibial and 25 femoral) implanted in 27 RKAs (27 patients) were included. The mean follow-up period was 4.1 ± 1.8 (2–7.5) years. Postoperatively, the ROM improved from 89.3 ± 9.2 to 106.3 ± 11.4 (p = 0.19) and the KSS also significantly improved, from 102.9 ± 35.6 to 130.2 ± 33.7 (p < 0.001). One patient (3.7%) developed heterotopic ossification, and another one (3.7 %) had a stem-tip pain on the tibial side; both were managed conservatively. One patient (3.7 %) sustained a fracture and required reoperation. None of the sleeves showed progressive radiolucent lines, and none required revision. The aseptic survivorship and overall survivorship at a mean of 4.1 years were 100% and 96.3%, respectively. Conclusion. MS provided successful midterm outcomes that were maintained in obese patients with different levels of constraint. Our series supports their use as a viable option in RKA.

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Short-term findings of a custom-made 3D-printed titanium partial scaphoid prosthesis and scapholunate interosseous ligament reconstruction

BMJ Case Reports ◽

10.1136/bcr-2020-241090 ◽

2021 ◽

Vol 14 (7) ◽

pp. e241090

Author(s):

Mario Igor Rossello

Keyword(s):

Titanium Implant ◽

Titanium Implants ◽

Proximal Pole ◽

Short Term ◽

Interosseous Ligament ◽

Non Union ◽

Radiographic Outcomes ◽

Custom Made ◽

3D Printed

Following wrist trauma due to a karate accident, an 18-year-old male patient developed non-union of the scaphoid with proximal pole necrosis and significant scapholunate gap from an evident scapholunate interosseous ligament (SLIL) injury. A custom-made 3D-printed titanium implant was used for scaphoid replacement and SLIL reconstruction. Good clinical and radiographic outcomes were observed at his 2-year follow-up. Custom-made 3D-printed titanium implants are thought to provide a surgical solution for patients requiring site-specific scaphoid replacement while allowing the reconstruction of the scapholunate ligament.

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