Rescate de osteosíntesis intertrocantéricas y subtrocantéricas fallidas con un reemplazo articular. Técnica y resultados de una serie de 61 casos. [Rescue of failed inter - and subtrochanteric osteosynthesis with a joint replacement. Technique and results of a series of 61 cases.]

IntroducciónEl objetivo del trabajo es revisar los aspectos técnicos de la artroplastía de cadera como rescate de una osteosíntesis fallida de un fractura intertrocantérica o subtrocantérica así como evaluar los resultados funcionales y las complicaciones asociadas en una serie consecutiva de 61 casos.Materiales y MétodoRealizamos 61 artroplastías de cadera, en 61 pacientes, como rescate de una osteosíntesis fallida de una fractura intertrocantérica o subtrocantérica. El promedio de edad fue de 76 años (50-93). %). Treinta y cuatro casos (56%) fueron tratados inicialmente con un tornillo deslizante de cadera, 8 (13%) con un DCS, 2 (3%) con clavos de Ender y 17 (28%) con un clavo de fémur proximal (corto o largo). Cincuenta y cinco 55 (90%) fueron rescatadas con una artroplastía total y 6 (10%) con una hemiartroplastía. En 17 (28%) casos utilizamos tallos no cementados y en 44 (72%) tallos cementados. En 12 casos el largo del tallo fue estándar y 49 de revisión.ResultadosAl año post-operatorio el HHS (Harris Hip Score) mejoró de 47 (rango de 32 - 54) en el pre-operatorio a 84 (rango 67-93). Siete pacientes (11.5%) presentaron complicaciones. Tres (4.9%) fueron fracturas femorales periprotésicas. Dos (3.2%) luxaciones. Una (1.6%) infección y un (1.6%) hematoma de la herida.ConclusiónLa artroplastía de cadera se presenta como un método eficaz para el salvataje de las osteosíntesis fallidas de fracturas intertrocantérica y subtrocantéricas. La mayoría de los pacientes logran recuperar una significativa mejoría del dolor y de su capacidad funcional. Sin embargo, es un procedimiento más demandante y con más complicaciones asociadas que el de una artroplastía de cadera primaria. Abstract Introduction: The aim of this study was to review technical issues of hip arthroplasty after a failed proximal femur fixation, as well as to evaluate results and complications associated with this procedure.Methods: Sixty-one hip arthroplasties after a failed intertrochanteric or subtrochanteric fixation were performed. Average age of patients was 76 years (range 50-93). Thirty-four patients (56%) were originally treated with a dynamic hip screw, 8 (13%) with a DCS, 2 (3%) with Ender nail and 17 (28%) with proximal femoral nail. Fifty-five patients (90%) were treated with total hip arthroplasty and 6 (10%) with hemiarthroplasty. Uncemented stem was used in 17 patients (28%) and a cemented stem in 44 (72%). A standard length stem was used in 12 patients, and a long stem in 49 cases. Results: The HHS improved from 47 (range 32-54) before surgery to 84 (range 67-93) at one-year follow-up. Seven patients (11.5%) had complications: 3 (4.9%) periprosthetic femoral fractures, 2 (3.2%) dislocations, one (1.6%) wound hematoma, and one (1.6%) deep infection. Conclusions: Hip arthroplasty after a failed fixation of an intertrochanteric or subtrochanteric fracture is an effective method. Pain and functional outcomes improve significantly in most patients. However, it is a more technically challenging procedure and causes more complications than primary hip replacement.

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Periprosthetic Femoral Fractures Treated with a Modular Distally Cemented Stem

Journal of Orthopaedic Surgery ◽

10.1177/230949900701500207 ◽

2007 ◽

Vol 15 (2) ◽

pp. 163-166 ◽

Cited By ~ 5

Author(s):

SH Zaki ◽

S Sadiq ◽

B Purbach ◽

BM Wroblewski

Keyword(s):

Hip Arthroplasty ◽

Femoral Fractures ◽

Healing Time ◽

Revision Hip Arthroplasty ◽

Harris Hip Score ◽

Bone Stock ◽

Non Union ◽

Periprosthetic Femoral Fractures ◽

Cemented Stem ◽

The Mean

Purpose. To assess the treatment outcome of revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures using a modular distally cemented stem. Methods. 22 men and 14 women (37 hips) aged 66 to 79 (mean, 70) years underwent revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures. The indication for surgery was periprosthetic fracture with stem loosening and loss of proximal bone stock. The patients were referred from other hospitals after previous surgeries had failed: 8 with 3 previous surgeries, 19 with 2, and 9 with one. Using a transtrochanteric approach, the existing prosthesis was removed and a modular proximal femoral replacement stem was inserted, bypassing the area of proximal femoral fracture and bone loss. The stem was distally cemented. Patients were immobilised within 48 hours of surgery. Results. Patients were followed up for a mean of 14 (range, 8–18) years. The mean Harris hip score improved from 29 (range, 5–40) to 78 (range, 56–88); 24 patients attained excellent or good scores (>80), 10 attained fair, and 2 attained poor scores. The mean healing time was 7 (range, 6–14) months; there was no non-union. Improvement in proximal bone stock was noted on serial radiographs. None of the stems had cement fracture or migration, requiring revision. Two (5%) of the patients had dislocations. Conclusion. Vancouver type B3 periprosthetic femoral fractures can be successfully treated with a distally cemented modular proximal femoral replacement prosthesis.

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Cementless Revision for Failed Cemented total Hip Arthroplasty

Hip International ◽

10.1177/112070009600600204 ◽

1996 ◽

Vol 6 (2) ◽

pp. 69-74 ◽

Cited By ~ 1

Author(s):

J.G. Hussell ◽

E.J. Smith ◽

I.D. Learmonth

Keyword(s):

Hip Arthroplasty ◽

Harris Hip Score ◽

Late Dislocation ◽

Hip Function ◽

Long Stem ◽

And Migration ◽

Lost To Follow Up ◽

Hip Arthroplasties ◽

Cemented Total Hip Arthroplasty

Sixty-two consecutive revision hip arthroplasties were carried out in 57 patients between 1986 and 1990 using the long stem Porous Coated Anatomic (PCA) prosthesis. Fifty-two hips were available for clinical and radiological review. The remainder had either died or were lost to follow-up. The average follow-up was 4.8 years (range 3-7.8 years) and the mean age was 56 years (range 25-77 years). Using the Harris Hip Score, 38/53 (73%) were regarded as good/excellent, 6/52 (11.5%) as fair and 8/52 (15.5%) as poor. The incidence of femoral component subsidence (31/52 - 60%) was a cause of concern, and accounted for two cases of late dislocation. Of the remaining six hips regarded as failures, two had been revised for acetabular graft resorption and migration of the cup while four had moderate persistent pain despite fair hip function. The authors are unable to recommend the long stem PCA prosthesis for routine use in revision hip arthroplasty.

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Proximal femur locking compression plate in complex proximal femoral fractures: a retrospective analysis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20162805 ◽

2016 ◽

Vol 2 (3) ◽

pp. 104 ◽

Cited By ~ 3

Author(s):

Rajesh Govindasamy ◽

Ramkumar Gnanasundaram ◽

Saravanan Kasirajan ◽

Jimmy J Meleppuram ◽

Kumar Archit

Keyword(s):

Femoral Fractures ◽

Subtrochanteric Fracture ◽

Fracture Pattern ◽

Locking Compression Plate ◽

Harris Hip Score ◽

Proximal Femoral Fractures ◽

Compression Plate ◽

Hip Screw ◽

One Year ◽

Mobility Score

Background: Proximal femoral fractures are one of the most common fractures in old age patients. Fixation of these fractures is technically high demanding owing to the high risk of complications. The aim of our study is to analyze the outcomes of proximal femoral locking compression plate (PF-LCP) in these fractures.Methods: We retrospectively analyzed 18 proximal femoral fractures treated with PF-LCP from May 2012 to May 2015. There were 12 females (67%) and six males (33%) with an average age of 59.6 years (range, 32 to 84 years). The peritrochanteric fractures constituted by intertrochanteric and subtrochanteric fractures were classified by Boyd and Griffin classification along with Seinshemier’s classification, respectively. Among that, 14 cases (77%) were of intertrochanteric and four cases (23%) were of subtrochanteric fracture pattern. The functional outcome was evaluated by harris hip score and the parker palmer mobility score one year after surgery.Results: Among 18 patients, 16 patients obtained fracture union without further intervention; two patients required additional bone grafting. There were no cases of hip screw cutting the femoral head. There was no post-operative mortality in our study. The average harris hip score was 85.5 (83-94). The assessment by parker and palmar mobility score was 7.6 (range 4-9).Conclusions: The PF-LCP is a good stable alternative in the treatment of complex proximal femoral fractures. It provides good to excellent bone healing with limited complications.

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A systematic review of short metaphyseal loading cementless stems in hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b5.bjj-2018-1199.r1 ◽

2019 ◽

Vol 101-B (5) ◽

pp. 502-511 ◽

Cited By ~ 10

Author(s):

S. Lidder ◽

D. J. Epstein ◽

G. Scott

Keyword(s):

Systematic Review ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Ethical Practice ◽

Term Survival ◽

The Mean ◽

Review Reports ◽

Femoral Implants ◽

Hip Arthroplasties

Aims Short-stemmed femoral implants have been used for total hip arthroplasty (THA) in young and active patients to conserve bone, provide physiological loading, and reduce the incidence of thigh pain. Only short- to mid-term results have been presented and there have been concerns regarding component malalignment, incorrect sizing, and subsidence. This systematic review reports clinical and radiological outcomes, complications, revision rates, and implant survival in THA using short-stemmed femoral components. Materials and Methods A literature review was performed using the EMBASE, Medline, and Cochrane databases. Strict inclusion and exclusion criteria were used to identify studies reporting clinical and radiological follow-up for short-stemmed hip arthroplasties. Results A total of 28 studies were eligible for inclusion. This included 5322 hips in 4657 patients with a mean age of 59 years (13 to 94). The mean follow-up was 6.1 years (0.5 to 20). The mean Harris Hip Score improved from 46 (0 to 100) to 92 (39 to 100). The mean Oxford Hip Score improved from 25 (2 to 42.5) to 35 (12.4 to 48). The mean Western Ontario & McMaster Universities Osteoarthritis Index improved from 54 (2 to 95) to 22 (0 to 98). Components were aligned in a neutral coronal alignment in up to 90.9% of cases. A total of 15 studies reported component survivorship, which was 98.6% (92% to 100%) at a mean follow-up of 12.1 years. Conclusion Short-stemmed femoral implants show similar improvement in clinical and radiological outcomes compared with conventional length implants. Only mid-term survivorship, however, is known. An abundance of short components have been developed and used commercially without staged clinical trials. Long-term survival is still unknown for many of these components. There remains tension between innovation and the moral duty to ensure that the introduction of new implants is controlled until safety and patient benefit are demonstrated. Implant innovation and subsequent use should be driven by proven clinical outcomes, rather than market and financial forces, and ethical practice must be ensured. Cite this article: Bone Joint J 2019;101-B:502–511.

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Anterolateral Bone Window for Revision Broken Cemented Stem of Unipolar Hemiarthroplasty

Advances in Orthopedics ◽

10.1155/2021/6620395 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Mohamed Mosa Mohamed Mahmoud ◽

Bahaaeldin Ibrahim ◽

Amr Abdelhalem Amr ◽

Maysara Abdelhalem Bayoumy

Keyword(s):

Hip Prosthesis ◽

Femoral Stem ◽

Functional Improvement ◽

Bone Window ◽

Cemented Stem ◽

Long Stem ◽

Revision Total Hip Replacement ◽

Short Time ◽

Hip Arthroplasties

Background. Fractured stem of the hip prosthesis is well documented in the literature. Although it is rare, it is considered as a challenging problem. Many techniques have been described to solve this problem. Purpose of the Study. Evaluation of the effect of anterolateral bone window for extraction of the cemented femoral stem of hemiarthroplasty in revision total hip replacement. Methods. The study included eight revision hip arthroplasties in eight patients, with a broken stem of cemented (Thompson) hemiarthroplasty, which has been revised by the anterolateral proximal femoral window. All cases received cemented cups and cement-in-cement stems, except one case who received cementless long stem. Clinical follow-up of cases by Harries hip score (HHS) and X-ray. Results. Functional improvement of HHS of all cases, with no signs of loosening, after a mean follow-up period of 1.5 years. Conclusion. Extraction of broken stem is a challenging procedure. Many techniques have been described for revision of cases with a fractured stem of hip prosthesis, but we think that the anterolateral femoral bone window is a reproducible technique due to the characteristics of simplicity, short-time procedure, less invasive, not requiring extra instruments, and can be successful for most patients.

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Mid-Term Outcomes of Cemented Stem and Subtrochanteric Shortening Derotational Osteotomy in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia

10.21203/rs.3.rs-745383/v1 ◽

2021 ◽

Author(s):

Zhe-Yu Huang ◽

Jing Ling ◽

Zhi-Min Zeng ◽

Zheng-Lin Di ◽

Jun-Hui Zhang ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Cement Leakage ◽

Developmental Dysplasia ◽

Harris Hip Score ◽

Total Hip ◽

Derotational Osteotomy ◽

Femoral Shortening ◽

Cemented Stem ◽

The Mean

Abstract Background Performing total hip arthroplasty (THA) in patients with Crowe IV developmental dysplasia of the hip (DDH) is technically challenging. Subtrochanteric shortening osteotomy is typically required for placing the acetabular component within the anatomic hip center. However, the outcomes of subtrochanteric osteotomy using cemented components are not widely reported. This study aimed to evaluate the outcomes of cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy in patients with Crowe IV DDH.Methods We retrospectively evaluated data of patients with Crowe IV DDH who underwent cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy between 2010 and 2018. Patients who underwent surgery at the hip joint were excluded. Data regarding pre- and postoperative clinical and radiological parameters were collected and reviewed.Results Among 14 patients included (14 hips), the mean age was 60.4 (range, 47–73) years. The mean Harris hip score improved from 40.7 to 87.7. The mean limb length discrepancy reduced from 52 mm to 12.7 mm. No neurologic deficits were noted. The mean osteotomy union time was 10.6 months. Delayed union and postoperative dislocation were observed in one and two patients, respectively. Cement leakage into the osteotomy gap was observed in one patient. No revisions were required. No signs of loosening or migration were observed. Conclusions Cemented stem THA combined with subtrochanteric femoral shortening and transverse derotational osteotomy is safe and effective for the treatment of patients with Crowe IV DDH. The cemented femoral component showed promising mid-term follow up results. However, cement leakage affects bone healing. Osteotomy and cementing should be performed meticulously.Trial Registration: Retrospectively registered

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REDUCED INFECTION RATE AFTER ASEPTIC REVISION TOTAL HIP ARTHROPLASTY WITH EXTENDED ORAL ANTIBIOTIC PROTOCOL

Proceedings of IMPRS ◽

10.18060/22733 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Amer Mohiuddin, BS ◽

Justin Rice, BA ◽

Mary Ziemba-Davis, BA ◽

R. Michael Meneghini, MD

Keyword(s):

Total Hip Arthroplasty ◽

Infection Rate ◽

Hip Arthroplasty ◽

Joint Infection ◽

Deep Infection ◽

Oral Antibiotic ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Aseptic Revision ◽

One Year

Background and Hypothesis: Periprosthetic joint infection (PJI is a leading cause of failure after aseptic revision total hip arthroplasty (RTHA). While well documented in the primary setting, perioperative antibiotic duration is not well described in RTHA where the risk of PJI was recently reported to be 8% one-year post-revision. The study purpose was to evaluate whether extended oral antibiotic prophylactic protocol minimizes PJI in aseptic RTHA patients compared to the published literature. Project Methods: 169 consecutive aseptic RTHAs performed with modern perioperative and infection-prevention protocols by a single surgeon at a single center were retrospectively reviewed. 80% of patients were discharged on 7-day oral antibiotic prophylaxis while intra-operative cultures were incubating. Infections and reoperations were documented. Results: Average age and BMI were 63 years and 30 kg/m2. 67% percent of patients were ASA-III/IV, signifying the severity of comorbidities in this revision cohort. There we no cases of PJI in the 90-day postoperative period. Ninety-eight percent of cases were infection free at mean follow-up of 45 months. Three (1.8%) cases underwent reoperation for deep infection at 110, 161 and 581 days. Conclusion and Potential Impact: Our observed infection rate of 0.0% is lower than published infection rates following RTHA and a 1.5% infection rate in primary THA in patients with no identifiable risk factors for PJI. Based on this clinically meaningful decrease in PJI in this challenging cohort, we encourage further study regarding extended antibiotic protocol weighed appropriately against potential consequences.

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Cementless Total Hip Arthroplasty After an Iatrogenic Subtrochanteric Fracture due to Hardware Removal: A Case Report

Hospital Practices and Research ◽

10.15171/hpr.2019.21 ◽

2019 ◽

Vol 4 (3) ◽

pp. 105-106

Author(s):

Francesco Castagnini ◽

Giovanni Bracci ◽

Enrico Tassinari ◽

Federico Biondi

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Hip Osteoarthritis ◽

Subtrochanteric Fracture ◽

Hardware Removal ◽

Femoral Fixation ◽

Case Presentation ◽

Total Hip ◽

Feasible Option ◽

Long Stem

Introduction: Total hip arthroplasty (THA) after proximal femoral fixation is a challenging procedure due to possible hardware-related complications. Case presentation: A 78-year-old female with hip osteoarthritis had a proximal femoral osteotomy fixed using a blade plate in the same femur 41 years ago. A two-step approach was planned. After a challenging hardware removal, an iatrogenic subtrochanteric fracture below the degenerated hip occurred after three months. THA with a tapered long stem was successfully performed with no need for additional osteosynthesis, and good results were seen two years later. Discussion: THAs in subtrochanteric fractures are technically demanding but feasible in selected cases. Hardware removal before THA implantation may carry important risks, and the surgical team should be prepared to perform arthroplasty in case of complications. Conclusion: THA in a subtrochanteric fracture below hip osteoarthritis is a feasible option in selected cases.

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Minimally Invasive Management of Unstable Proximal Femoral Extracapsular Fractures using Reverse LISS Femoral Locking Plates

Hip International ◽

10.1177/112070000901900211 ◽

2009 ◽

Vol 19 (2) ◽

pp. 141-147 ◽

Cited By ~ 12

Author(s):

Ufuk Ozkaya ◽

Fuat Bilgili ◽

Ayhan Kilic ◽

Atilla Sancar Parmaksizoglu ◽

Yavuz Kabukcuoglu

Keyword(s):

Treatment Options ◽

Femoral Fractures ◽

Deep Infection ◽

Harris Hip Score ◽

Proximal Femoral Fractures ◽

Medical Problems ◽

Secondary Procedures ◽

The Mean ◽

Invasive Management

The efficacy of the reverse Less Invasive Plating System in the management of unstable proximal femoral extracapsular fractures was retrospectively evaluated. Twenty-seven patients with complex proximal femoral fractures were identified. There were three open fractures. The mean age was 71 years (range; 65–79). The mean follow up was 24 months (range; 15–32). The main outcome measures were union, union time, requirement for secondary procedures, development of deep infection, pain, and functional impairment. Nonunion was observed in one patient. The average Harris hip score at the last assessment was 73 points (range 58–85). The outcome was adversely affected by concomitant medical problems, anatomical reduction and fixation of the plate. The use of this plate in the management of proximal femoral fractures of all types may be a safe and alternative method to other treatment options.

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Standard transgluteal versus minimal invasive anterior approach in hip arthroplasty: a prospective, consecutive cohort study

Orthopedic Reviews ◽

10.4081/or.2013.e31 ◽

2013 ◽

Vol 5 (4) ◽

pp. 31 ◽

Cited By ~ 29

Author(s):

Thomas Ilchmann ◽

Silke Gersbach ◽

Lukas Zwicky ◽

Martin Clauss

Keyword(s):

Minimally Invasive ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Clinical Results ◽

Lateral Approach ◽

Minimal Invasive ◽

Harris Hip Score ◽

Duration Of Surgery ◽

One Year ◽

Continuous Use

A minimally invasive anterior approach (MIS) was compared to a standard lateral approach in primary total hip arthroplasty. Clinical and radiological outcomes were analyzed 6 weeks, 12 weeks, one year and two years after surgery. The duration of surgery was longer, mobility one week after surgery was better and time of hospitalization was shorter for minimally invasive-treated patients. They had less pain during movement, limping, better Harris Hip Score and satisfaction after 6 weeks, which remained after 12 weeks and 1 year, but not after two years. There were two deep infections in the MIS group. Radiological results were not affected. The infections might be a point of concern, but there were no other disadvantages of the MIS approach. In fact, early rehabilitation was facilitated and clinical results were improved. Our results encourage the continuous use of the MIS anterior approach instead of the lateral approach.

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