Cement-in-cement femoral component revision

2021 ◽  
Vol 103-B (7) ◽  
pp. 1215-1221
Author(s):  
John W. Kennedy ◽  
Nigel Y. B. Ng ◽  
David Young ◽  
Nicholas Kane ◽  
Andrew G. Marsh ◽  
...  
Keyword(s):  
Femoral Component ◽  
Short Form ◽  
Demographic Data ◽  
Senior Author ◽  
Inclusion Criteria ◽  
Reliable Technique ◽  
Patient Demographic Data ◽  
Oxford Hip Score ◽  
Component Revision

Aims Cement-in-cement revision of the femoral component represents a widely practised technique for a variety of indications in revision total hip arthroplasty. In this study, we compare the clinical and radiological outcomes of two polished tapered femoral components. Methods From our prospectively collated database, we identified all patients undergoing cement-in-cement revision from January 2005 to January 2013 who had a minimum of two years' follow-up. All cases were performed by the senior author using either an Exeter short revision stem or the C-Stem AMT high offset No. 1 prosthesis. Patients were followed-up annually with clinical and radiological assessment. Results A total of 97 patients matched the inclusion criteria (50 Exeter and 47 C-Stem AMT components). There were no significant differences between the patient demographic data in either group. Mean follow-up was 9.7 years. A significant improvement in Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-item Short-Form Survey (SF-12) scores was observed in both cohorts. Leg lengths were significantly shorter in the Exeter group, with a mean of -4 mm in this cohort compared with 0 mm in the C-Stem AMT group. One patient in the Exeter group had early evidence of radiological loosening. In total, 16 patients (15%) underwent further revision of the femoral component (seven in the C-Stem AMT group and nine in the Exeter group). No femoral components were revised for aseptic loosening. There were two cases of femoral component fracture in the Exeter group. Conclusion Our series shows promising mid-term outcomes for the cement-in-cement revision technique using either the Exeter or C-Stem AMT components. These results demonstrate that cement-in-cement revision using a double or triple taper-slip design is a safe and reliable technique when used for the correct indications. Cite this article: Bone Joint J 2021;103-B(7):1215–1221.

Mono-Unit Alar Rim Graft Technique for Tip-Alar Margin Support

2020 ◽  
Vol 40 (10) ◽  
pp. NP588-NP596
Author(s):  
Shin Ae Kim ◽  
Yong Ju Jang
Keyword(s):  
Demographic Data ◽  
Costal Cartilage ◽  
Case Series ◽  
Senior Author ◽  
Open Approach ◽  
Level Of Evidence ◽  
Appropriate Treatment ◽  
Patient Demographic Data ◽  
Patient Series ◽  
Alar Rim

Abstract Background The appropriate treatment of alar rim deformities, such as alar pinching or concavity, and soft triangle notching is essential for perfecting nasal aesthetics. Objectives The authors introduced the “mono-unit alar rim graft” technique as a treatment option for these abnormalities. Methods A case series of 29 rhinoplasties conducted by the senior author between May 2017 and June 2019 utilizing the mono-unit alar rim graft technique was retrospectively reviewed. The surgical technique involved an open approach with costal cartilage harvesting. The cortical portion of the harvested costal cartilage was sectioned into a 1-mm-thick strip and soaked with saline for about 15 minutes to let the natural warping occur. The curved cartilage graft was then trimmed, and the midportion was sutured to the tip in an onlay fashion. Both ends of the graft were housed in the vestibular pocket. Patient demographic data and pre- and postoperative facial photos were reviewed. Results Among the 29 cases analyzed, 14 (48.3%) were men and 15 (51.7%) were women. Ten (34.5%) patients had a preoperative parenthesis deformity, but a near-complete correction was achieved in 8 (80.0%) cases. An alar concavity from the basal view was found in 16 patients, 15 (93.8%) of whom had a partial or near-complete correction. Eleven patients had soft triangle notching, 9 (81.8%) of whom had a partial or near-complete correction. There were no technique-related complications in this patient series. Conclusions The mono-unit alar rim graft technique is a viable option for treating various alar rim deformities. Level of Evidence: 4

scholarly journals Charnley femoral cemented stem with a permeable and resorbable cement restrictor and low-viscosity cement

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 39
Author(s):  
Jean-Louis Prudhon ◽  
Jacques H. Caton ◽  
Thierry Aslanian
Keyword(s):  
Survival Rate ◽  
Femoral Component ◽  
First Year ◽  
Low Friction ◽  
Low Viscosity ◽  
Kaplan Meier ◽  
Cemented Stem ◽  
Component Revision ◽  
Cement Restrictor

Introduction: In 1979, in his first book dealing with low-friction arthroplasty (LFA), Charnley highlighted the use of a cement restrictor. Breusch and Malchau described in 2005 the “second-generation cementing technique.” The main objective of this study was to report on the clinical survival of 100 cases of Charnley femoral component implanted in 2007 and 2008 using a permeable and resorbable cement restrictor and a low-viscosity antibiotic-loaded cement. The secondary objectives were to analyze the complications and side effects and the accuracy of the device positioning. Material and methods: This was a monocentric retrospective review of a prospectively compiled database. Diaphyseal restrictor was biodegradable and permeable to gas, blood, and fluids to avoid intramedullary over pression during cementation. The cement was a low-viscosity antibiotic-loaded cement. Among 3555 patients, we selected the first continuous 100 cases of patients where we implanted the device. Survival probability was computed according to Kaplan–Meier method. Results: Mean follow-up was 6.55 ± 2.6 (range 1–11). Considering femoral component revision as the endpoint, survival rate was 100%. No patients died intraoperatively, none in the first month and the first year after surgery. No early periprosthetic fractures have been reported. Discussion: As described initially by Charnley, the use of a cement restrictor was highly recommended through the different generations of cementing techniques. Hypotensive episodes and cardiac arrest have been reported during cement insertion. In our series, we did not deplore any adverse effect related to the cementation. Conclusion: Our study demonstrates a 100% survival rate of a cemented femoral component without adverse effects when using routinely a resorbable and permeable cement restrictor and a low-viscosity cement. Bone cement is still a fantastic ally for the surgeon and the patients.

Mid- and long-term results of femoral component revision using the cement-in-cement technique: Average 10.8-year follow-up study

2016 ◽  
Vol 21 (6) ◽  
pp. 810-814 ◽  
Author(s):  
Yaichiro Okuzu ◽  
Koji Goto ◽  
Kazutaka So ◽  
Yutaka Kuroda ◽  
Shuichi Matsuda
Keyword(s):  
Femoral Component ◽  
Long Term Results ◽  
Follow Up Study ◽  
Component Revision

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.

scholarly journals Medial Displacement Osteotomy Performed Concurrently with Triple Arthrodesis Improves Pain and Mobility in Patients with Rigid Flatfoot Deformity and Hindfoot Valgus

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Mitchell Fourman ◽  
Patrick Ward ◽  
Dane Wukich
Keyword(s):  
Demographic Data ◽  
Categorical Variables ◽  
Wound Complications ◽  
Deltoid Ligament ◽  
Posterior Tibial Tendon ◽  
Triple Arthrodesis ◽  
Patient Demographic ◽  
Displacement Osteotomy ◽  
Patient Demographic Data

Category: Hindfoot, Midfoot/Forefoot, Flatfoot Introduction/Purpose: Progression of flatfoot deformity and arthritis affects 6-38% of patients with posterior tibial tendon dysfunction treated with a triple arthrodesis. Current theory suggests that undercorrection of hindfoot valgus places abnormal stresses on the deltoid ligament and tibiotalar joint, contributing to the development of increased valgus tilt of the ankle joint or collapse of the medial arch. No large series to our knowledge has attempted to assess the potential benefit of the prospective correction of hindfoot valgus at the time of the triple fusion. Here we analyze the outcomes of 31 unilateral Stage III or IV rigid flatfoot corrections performed with concurrent medial displacement osteotomies. Methods: In an institutional review board approved retrospective study, a total of 31 feet in 31 patients were operated upon from 1/1/2009 to 1/1/2016 by a single surgeon at a large academic medical center. American Orthopaedic Foot & Ankle Society hindfoot scores and visual analog pain scores (VAS) were obtained prior to surgery and at the final post-operative follow-up where available). Foot and Ankle Ability Measure (FAAM) scores were available for 17 (54.8%) of patients. Patient demographic data, including age, body mass index (BMI), charlson comorbidity score, smoking status, and HbA1c where available were recorded. Additional surgical outcomes of interest included a return to unassisted mobility in a shoe or boot, infection and wound complication rate, 90 day re-admissions and revision/subsequent procedures. Pre-and post-operative data were analyzed using Student’s t-test for continuous variables, and Fisher’s exact test for categorical variables using Graphpad Prism (LaJolla, CA). Results: Patient demographic data is demonstrated in figure 1. Average follow-up was 1.3 ± 1.1 years (range .5 to 6.0 years). Average Pre-operative AOFAS scores available from 23/31 (74.2% of patients) averaged 33.5, with 1-year post-operative scores (8/31, 25.8%) of 76.8 ± 4.6 (p < .0001). VAS scores decreased from 6 ± 2.9 to 2 ± 2.7 (p < .0001). Superficial infections were treated in 3/31 (9.7%) of patients, while wounds developed in 6.5%. Mobility without assistive modality in a shoe or boot was reported by 30/31 (96.8%) patients, with one patient requiring a walker. No 90-day readmissions occurred, no amputations occurred, and a single patient returned to the OR 393 days after admission for symptomatic hardware removal. Conclusion: Here we demonstrate in a large retrospective analysis that performing a medial displacement osteotomy in patients with hindfoot valgus in the setting of rigid flatfoot deformity results in nearly universal remobilization, substantially improved functional outcomes, and significantly decreased pain. Few patients had wound complications or infections, and no revision reconstructions were required. Limitations to this study include inconsistent post-operative reporting, and a lack of long term post-operative outcomes. Further work includes a re-surveying of this patient base for updated patient outcomes, as well as quantitative radiographic analysis.

scholarly journals Scoliosis may increase the risk of recurrence of lumbar disc herniation after microdiscectomy

2016 ◽  
Vol 24 (4) ◽  
pp. 586-591 ◽  
Author(s):  
Hsuan-Kan Chang ◽  
Huang-Chou Chang ◽  
Jau-Ching Wu ◽  
Tsung-Hsi Tu ◽  
Li-Yu Fay ◽  
...  
Keyword(s):  
Young Adults ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Demographic Data ◽  
Exclusion Criterion ◽  
Inclusion Criteria ◽  
Risk Of Recurrence ◽  
The Mean

OBJECT The aim of this paper was to investigate the risk of recurrence of lumbar disc herniation (LDH) in patients with scoliosis who underwent microdiscectomy. METHODS A series of consecutive patients who underwent microdiscectomy for LDH was retrospectively reviewed. The inclusion criteria were young adults younger than 40 years who received microdiscectomy for symptomatic 1-level LDH. An exclusion criterion was any previous spinal surgery, including fusion or correction of scoliosis. The patients were divided into 2 groups: those with scoliosis and those without scoliosis. The demographic data in the 2 groups were similar. All medical records and clinical and radiological evaluations were reviewed. RESULTS A total of 58 patients who underwent 1-level microdiscectomy for LDH were analyzed. During the mean follow-up of 24.6 months, 6 patients (10.3%) experienced a recurrence of LDH with variable symptoms. The recurrence rate was significantly higher among the scoliosis group than the nonscoliosis group (33.3% vs 2.3%, p = 0.001). Furthermore, the recurrence-free interval in the scoliosis group was short. CONCLUSIONS Young adults (< 40 years) with uncorrected scoliosis are at higher risk of recurrent LDH after microdiscectomy.

Femoral Revision with Impaction Allografting and an Uncemented Femoral Component

2008 ◽  
Vol 18 (4) ◽  
pp. 278-285 ◽  
Author(s):  
T.N. Nickelsen ◽  
M. Erenbjerg ◽  
J.B. Retpen ◽  
S. Solgaard
Keyword(s):  
Aseptic Loosening ◽  
Femoral Component ◽  
Clinical Performance ◽  
Successful Outcome ◽  
Femoral Revision ◽  
Slight Pain ◽  
Impaction Allografting ◽  
Component Revision ◽  
Regeneration Of Bone

A technique for uncemented revision of the femoral component which combines impaction allografting and the use of a long-stemmed proximally coated titanium prostheses (Bimetric®, Biomet Inc.) is described. The results after a mean follow-up of 112 months are reported. From 1991 to 1995 femoral component revision for aseptic loosening was performed on 100 hips. In 14 cases (14%) an intraoperative fracture occurred and 7 patients (7%) had other postoperative complications. Seventeen patients (17%) required further revision, 10 because of aseptic loosening. Of 50 surviving patients with retained implants 88% had no pain, 10% had slight pain and only 2% had severe pain. Thirty-eight patients had radiographic signs of remodelling of the graft and/or cortical repair. In cases with a successful outcome, the results have been encouraging in relation to clinical performance, regeneration of bone and implant survival.

scholarly journals Pediatric occipitocervical fixation: radiographic criteria, surgical technique, and clinical outcomes based on experience of a single surgeon

2016 ◽  
Vol 18 (4) ◽  
pp. 452-462 ◽  
Author(s):  
Eduardo Martinez-del-Campo ◽  
Jay D. Turner ◽  
Leonardo Rangel-Castilla ◽  
Hector Soriano-Baron ◽  
Samuel Kalb ◽  
...  
Keyword(s):  
Demographic Data ◽  
Median Number ◽  
Senior Author ◽  
Neurological Injury ◽  
Diagnostic Tools ◽  
Neurological Improvement ◽  
Occipitocervical Fixation ◽  
Chronic Myelopathy ◽  
Atlantooccipital Dislocation

OBJECTIVE If left untreated, occipitocervical (OC) instability may lead to serious neurological injury or death. Open internal fixation is often necessary to protect the neurovascular elements. This study reviews the etiologies for pediatric OC instability, analyzes the radiographic criteria for surgical intervention, discusses surgical fixation techniques, and evaluates long-term postoperative outcomes based on a single surgeon's experience. METHODS The charts of all patients < 18 years old who underwent internal OC fixation conducted by the senior author were retrospectively reviewed. Forty consecutive patients were identified for analysis. Patient demographic data, OC junction pathology, radiological diagnostic tools, surgical indications, and outcomes are reported. RESULTS The study population consisted of 20 boys and 20 girls, with a mean age of 7.3 years. Trauma (45% [n = 18]) was the most common cause of instability, followed by congenital etiologies (37.5% [n = 15]). The condyle-C1 interval had a diagnostic sensitivity of 100% for atlantooccipital dislocation. The median number of fixated segments was 5 (occiput–C4). Structural bone grafts were used in all patients. Postsurgical neurological improvement was seen in 88.2% (15/17) of patients with chronic myelopathy and in 25% (1/4) of patients with acute myelopathy. Preoperatively, 42.5% (17/40) of patients were neurologically intact and remained unchanged at last follow-up, 42.5% (17/40) had neurological improvement, 12.5% (5/40) remained unchanged, and 2.5% (1/40) deteriorated. All patients had successful fusion at 1-year follow-up. The complication rate was 7.5% (3/40), including 1 case of vertebral artery injury. CONCLUSIONS Occipitocervical fixation is safe in children and provides immediate immobilization, with excellent survival and arthrodesis rates. Of the radiographic tools evaluated, the condyle-C1 interval was the most predictive of atlantooccipital dislocation.

scholarly journals Effect of frenotomy on breastfeeding and reflux: results from the BRIEF prospective longitudinal cohort study

2020 ◽  
Author(s):  
Kirsten W. Slagter ◽  
Gerry M. Raghoebar ◽  
Inge Hamming ◽  
Jiska Meijer ◽  
Arjan Vissink
Keyword(s):  
Pain Score ◽  
Self Efficacy ◽  
Short Form ◽  
Safe Procedure ◽  
Inclusion Criteria ◽  
Operative Complications ◽  
Breastfeeding Problems ◽  
Prospective Longitudinal ◽  
Post Operative Complications

Abstract Objectives To assess the Efficacy of Frenotomy with regard to Breastfeeding and Reflux Improvement (BRIEF) in infants with breastfeeding problems. Materials and methods A cohort of 175 consecutive breastfeeding women with breastfeeding and reflux problems related to a tongue-tie or lip-tie fulfilling the inclusion criteria was longitudinally followed for 6 months. The effect of frenotomy on these problems was studied by a standardized oral assessment and completing the validated Breastfeeding Self-Efficacy Short Form (BSES-SF), nipple pain score (Visual Analogue Scale, VAS), and Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) questionnaires pre-frenotomy and at 1 week, 1 month, and 6 months’ post frenotomy. Results All 175 women completed the 1-month follow-up and 146 women the 6 months’ follow-up. Frenotomy resulted in a significant improvement of BSES-SF, nipple pain score, and I-GERQ-R after 1 week, which improvement maintained to be significant after 1 month for BSES-SF and I-GERQ-R, and after 6 months for I-GERQ-R. The improvements were irrespective of the type lip-tie or tongue-tie underlying the breast feeding and reflux problems. No post-operative complications were observed. About 60.7% of infants still was breastfed 6 months after treatment. Conclusions Frenotomy is a safe procedure with no post-operative complications and resulting in significant improvement of breastfeeding self-efficacy, nipple pain, and gastro-oesophageal reflux problems. Clinical relevance Frenotomy of a tongue-tie and or lip-tie can lead to improvement of breastfeeding and reflux problems irrespective of the type of tongue-tie or lip-tie and should be considered by clinicians as a proper tool to resolve these problems if non-interventional support did not help. International trial register ISRCTN64428423

Exeter Universal cemented femoral component

2020 ◽  
Vol 102-B (10) ◽  
pp. 1319-1323
Author(s):  
Fouzia Khatun ◽  
Damien F. Gill ◽  
Amit Atrey ◽  
Matthew Porteous
Keyword(s):  
Femoral Component ◽  
Acetabular Component ◽  
District General Hospital ◽  
Long Term Results ◽  
Case Scenario ◽  
Worst Case ◽  
Joint Registry ◽  
Component Revision ◽  
Lost To Follow Up

Aims We present the results, in terms of survival, clinical outcome, and radiological appearance at 20 years, in a cohort of 225 cemented Exeter Universal femoral components (Stryker, Newbury, UK) implanted in 207 patients, at a district general hospital. Methods All patients in this study had a total hip arthroplasty (THA) using an Exeter Universal femoral component with a cemented (n = 215) or cementless (n = 10) acetabular component. Clinical and radiological data were collected prospectively at one year, five years, and every five years thereafter. Patients lost to radiological and clinical follow-up (five) were cross-referenced with National Joint Registry (NJR) data and general practitioner (GP) records to assess whether they had undergone revision for any reason. Results During this period of study 144 patients (157 hips) died (69.78%). Two patients were lost to follow-up, leaving 61 patients (66 hips) available for review (29.33%). Of the 225 hips, three underwent revision for femoral failure with osteolysis. One underwent femoral component revision for treatment of a periprosthetic fracture. Eight underwent revision of the acetabular component only for loosening. Two hips had both components revised, when components were found to be loose at time of revision for acetabular loosening, though no radiological femoral osteolysis. Two patients underwent revision for infection. Using femoral loosening as an endpoint, the survival of the Exeter Universal femoral component was 98.7% (n = 220, 95% confidence interval (CI) 96.1% to 100%) at 20 to 22 years. Survival with an endpoint of revision for any reason was 92.6% (n = 209, 95% CI 89.4 to 95.55), with a ‘worst-case scenario’ (considering two patients lost to follow-up to have failed), the overall survival rate was 91.7% (n = 207, 95% CI 87.8 to 95.9) at 20 to 22 years. Conclusion Our results confirm excellent long-term results for the cemented Exeter Universal femoral componentimplanted outside of the originating centre. Cite this article: Bone Joint J 2020;102-B(10):1319–1323.

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