scholarly journals A Complication During Femoral Broaching in Total Hip Arthroplasty: A Case Report

2013 ◽  
Vol 7 (1) ◽  
pp. 272-274 ◽  
Author(s):  
Wenzel Waldstein ◽  
Friedrich Boettner
Keyword(s):  
Case Report ◽  
Total Hip Arthroplasty ◽  
Femoral Component ◽  
Hip Arthroplasty ◽  
Load Transfer ◽  
Femoral Canal ◽  
Stem Size ◽  
Total Hip ◽  
Press Fit ◽  
Uncemented Total Hip Arthroplasty

Press-fit component fixation is one of the primary goals in uncemented total hip arthroplasty. When aiming at proximal load transfer, the stem size has to be selected with regard to the shape of the proximal femoral canal. This can be challenging in patients with ‘champagne flute’ femurs with a relatively narrow diaphysis, especially when a long stem femoral component is used. The present case report describes a complication during femoral broaching for a primary uncemented femoral component. Because of the narrow diaphysis, the distal portion of the broach got caught in the narrow canal and it became impossible to remove the broach with conventional techniques. Via a second distal incision, the femur was split from the distal tip of the broach to approximately 5 cm distal of the femoral neck cut along the posterior aspects of the femur. This loosened the broach enough to allow for an uncomplicated removal. The longitudinal split was secured with cables before a similar size primary implant was press fitted into the femoral canal.

Total hip arthroplasty using a short-stemmed femoral component in the presence of a proximal femoral fixation device – a case report

2010 ◽  
Vol 20 (2) ◽  
pp. 261-264 ◽  
Author(s):  
Tae-Young Kim ◽  
Kee-Byoung Lee ◽  
Duck-Joo Kwon ◽  
Yong-Chan Ha ◽  
Kyung-Hoi Koo
Keyword(s):  
Case Report ◽  
Total Hip Arthroplasty ◽  
Femoral Component ◽  
Hip Arthroplasty ◽  
Fixation Device ◽  
Femoral Fixation ◽  
Total Hip

scholarly journals Assessment of clinical and functional outcomes following uncemented total hip arthroplasty in failed primary hemiarthroplasty

2017 ◽  
Vol 3 (3) ◽  
pp. 551
Author(s):  
Pavankumar H. Patil ◽  
Srinivas Pamarathi
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Operative Procedure ◽  
Walking Distance ◽  
Harris Hip Score ◽  
Loss Of Function ◽  
Stem Size ◽  
Total Hip ◽  
Uncemented Total Hip Arthroplasty

<p class="abstract"><strong>Background:</strong> Modern hip replacement has resulted in huge benefit for patients with arthritic hip disease, providing them with reduction of pain, return of function and consequently an improved quality of life. Evaluation of long term outcomes of an operative procedure is important to determine the durability of the procedures like uncemented total revision hip arthroplasty. In the present study, clinical and functional outcome and complications of uncemented total hip arthroplasty in failed primary hemiarthroplasty was assessed.</p><p class="abstract"><strong>Methods:</strong> Patients with failed primary hemiarthroplasty with Unipolar or Bipolar prosthesis (cemented and uncemented) due to aseptic loosening, protrusio causing groin pain, dislocation, breakage of implant leading to loss of function, periprosthetic fracture and acetabular osteolysis were included. During each visit, medical history was taken and physical examination was done. Range of movements (ROM) was recorded. The clinical and functional outcomes were evaluated by Harris Hip Score evaluation. Statistical analysis: Student’s paired t-test was used to find out the significance of difference between pre-operative and post-operative Harris Hip scores.<strong></strong></p><p class="abstract"><strong>Results:</strong> In 7 cases modular series was used for uncemented total hip arthroplasty, of which calcar replacement was done in 4 cases, and in one case constrained liner was placed. The maximum stem size used was 15mm and the minimum stem size 11mm. Stem size 11 was most frequently used. About 30% of the cases presented with pain postoperatively till the last follow-up, of which two cases reported mild pain with no effect on average activities and one case reported with moderate pain with some limitation of ordinary activity or work. The difference between the average pre-operative Harris Hip Score post-operative score was found to be highly significant (p=0.0001).</p><p><strong>Conclusions:</strong> This study has shown excellent results following the uncemented modular total hip arthroplasty in failed primary hemiarthroplasty in terms of pain relief, increased walking distance, and functional capabilities of the patients.</p>

scholarly journals Fracture of the neck of a femoral component in a total hip arthroplasty: a case report

1997 ◽  
Vol 21 (1) ◽  
pp. 56-58 ◽  
Author(s):  
V. Artime ◽  
J. C. Ramos ◽  
J. M. Fernandez-Medina ◽  
M. C. de Luis ◽  
L. Aguilera
Keyword(s):  
Case Report ◽  
Total Hip Arthroplasty ◽  
Femoral Component ◽  
Hip Arthroplasty ◽  
Total Hip

Definition and validation of a system for classifying the undersized Corail femoral stem in total hip arthroplasty

2021 ◽  
pp. 112070002199600
Author(s):  
Jamie S McConnell ◽  
Farhan A Syed ◽  
Paul Saunders ◽  
Raviprasad Kattimani ◽  
Anthony Ugwuoke ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Classification System ◽  
Femoral Stem ◽  
Observer Agreement ◽  
Stem Size ◽  
Total Hip ◽  
Initial Fixation ◽  
Uncemented Total Hip Arthroplasty ◽  
Hip Arthroplasties

Introduction: The uncemented total hip arthroplasty relies on a secure initial fixation of the femoral stem to achieve osseointegration. Undersizing of the femoral implant compromises this. Surgeons routinely review postoperative radiographs to assess appropriate sizing, but existing methods of assessment lack standardisation. We present a system of accurately and reliably classifying radiological undersizing, which will help us better understand the factors that might have led to undersizing. Aim: To describe and evaluate a classification system for assessing radiological undersizing of the uncemented stem in hip arthroplasty. Method: We conducted a retrospective review of 1,337 consecutive hip arthroplasties using the Corail stem. Two independent investigators reviewed post-operative radiographs and classified them as either appropriately sized or undersized. Undersized stems were sub-categorised into four subtypes: uniformly undersized, varus undersized, valgus undersized or ‘cocktail-glass’ undersized. Inter- and intra-observer agreement was determined. The accuracy of our classification system was validated by comparison with digital re-templating. We further assessed patient demographics and stem size in relation to sizing. Results: 1 in 5 cases (19.75%) were deemed radiologically undersized. The commonest subtypes of undersizing were uniformly (47%) and varus (39%) undersized. When assessing sizing and subtype categorisation, inter-observer agreement was 89–92% and intra-observer agreement 86%. Classification decisions showed 92% and 97% accuracy for uniformly undersizing and varus undersizing respectively when validated against digital re-templating. Age, gender and smaller stem size were significantly associated with radiological undersizing. The Corail KLA model (125° neck) was found to have a higher incidence of stems undersized in varus. Conclusions: This study describes and validates a classification system for the analysis of radiological undersizing.

scholarly journals Second-generation uncemented total hip arthroplasty: a minimum 20-year follow-up

2021 ◽  
Vol 2 (1) ◽  
pp. 33-39
Author(s):  
Jeffrey R. McLaughlin ◽  
Kyla R. Lee ◽  
Mary Ann Johnson
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Femoral Component ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Second Generation ◽  
Total Hip ◽  
Uncemented Total Hip Arthroplasty ◽  
Acetabular Components

Aims We present the clinical and radiological results at a minimum follow-up of 20 years using a second-generation uncemented total hip arthroplasty (THA). These results are compared to our previously published results using a first-generation hip arthroplasty followed for 20 years. Methods A total of 62 uncemented THAs in 60 patients were performed between 1993 and 1994. The titanium femoral component used in all cases was a Taperloc with a reduced distal stem. The acetabular component was a fully porous coated threaded hemispheric titanium shell (T-Tap ST). The outcome of every femoral and acetabular component with regard to retention or revision was determined for all 62 THAs. Complete clinical follow-up at a minimum of 20 years was obtained on every living patient. Radiological follow-up was obtained on all but one. Results Two femoral components (3.2%) required revision. One stem was revised secondary to a periprosthetic fracture one year postoperatively and one was revised for late sepsis. No femoral component was revised for aseptic loosening. Six acetabular components had required revision, five for aseptic loosening. One additional acetabular component was revised for sepsis. Radiologically, all femoral components remained well fixed. One acetabular was judged loose by radiological criteria. The mean Harris Hip Score improved from 46 points (30 to 67) preoperatively to 89 points (78 to 100) at final follow-up. With revision for aseptic loosening as the endpoint, survival of the acetabular component was 95% (95% confidence interval (CI) 90 to 98) at 25 years. Femoral component survival was 100%. Conclusion The most significant finding of this report was the low prevalence of aseptic loosening and revision of the femoral component at a mean follow-up of 22 years. A second important finding was the survival of over 90% of the hemispheric threaded ring acetabular components. While these shells remain controversial, in this series they performed well. Cite this article: Bone Jt Open 2021;2(1):33–39.

scholarly journals More than a feeling?—Overruling the preoperatively templated offset option leads to a minor offset increase in short stem total hip arthroplasty

2022 ◽  
Author(s):  
Matthias Luger ◽  
Christian Stadler ◽  
Rainer Hochgatterer ◽  
Jakob Allerstorfer ◽  
Tobias Gotterbarm ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Leg Length ◽  
Digital Templating ◽  
Stem Size ◽  
Total Hip ◽  
Press Fit ◽  
A Minor ◽  
Short Stems

Abstract Purpose Short stems are increasingly used in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Digital templating is essential in determining the correct offset option and stem size in THA. However, the preoperative template sizes might be intraoperatively overruled. Patients and methods We evaluated the effect of intraoperative overruling of the preoperatively templated offset option of a short curved stem on hip offset, leg length, implant positioning, and femoral canal fill index. The overruling was performed in case of intraoperative instability, telescoping, or both. A series of 1052 consecutive THAs with a cementless short curved stem and press-fit cup was retrospectively screened. One hundred patients with unilateral THA and a contralateral native and morphologically healthy hip as a reference met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior–posterior postoperative radiographs. Patients were divided according to the overruling by offset option or stem size. Results Hip offset was increased in all groups, but only with significant increase if an offset option + 1 was used intraoperatively (p = 0.025). LLD was restored without significance in all groups (p = 0.323; p = 0.157). Conclusion Intraoperative overruling of the preoperative digital template in cementless short stem total hip arthroplasty results in an increase of hip offset compared to a contralateral healthy hip. However, the increase is marginal and clearly under 5 mm compared to the contralateral healthy hip.

scholarly journals Influence of femoral morphology and canal fill ratio on early radiological and clinical outcomes of uncemented total hip arthroplasty using a fully coated stem

2020 ◽  
Vol 9 (4) ◽  
pp. 182-191
Author(s):  
Adrien D’Ambrosio ◽  
Lisa Peduzzi ◽  
Olivier Roche ◽  
Hugo Bothorel ◽  
Mo Saffarini ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Component ◽  
Hip Arthroplasty ◽  
Spot Welds ◽  
Fill Ratio ◽  
Total Hip ◽  
Uncemented Total Hip Arthroplasty ◽  
Femoral Morphology ◽  
Hip Function ◽  
And Migration

Aims The diversity of femoral morphology renders femoral component sizing in total hip arthroplasty (THA) challenging. We aimed to determine whether femoral morphology and femoral component filling influence early clinical and radiological outcomes following THA using fully hydroxyapatite (HA)-coated femoral components. Methods We retrospectively reviewed records of 183 primary uncemented THAs. Femoral morphology, including Dorr classification, canal bone ratio (CBR), canal flare index (CFI), and canal-calcar ratio (CCR), were calculated on preoperative radiographs. The canal fill ratio (CFR) was calculated at different levels relative to the lesser trochanter (LT) using immediate postoperative radiographs: P1, 2 cm above LT; P2, at LT; P3, 2 cm below LT; and D1, 7 cm below LT. At two years, radiological femoral component osseointegration was evaluated using the Engh score, and hip function using the Postel Merle d’Aubigné (PMA) and Oxford Hip Score (OHS). Results CFR was moderately correlated with CCR at P1 (r = 0.44; p < 0.001), P2 (r = 0.53; p < 0.001), and CFI at P1 (r = − 0.56; p < 0.001). Absence of spot welds (n = 3, 2%) was associated with lower CCR (p = 0.049), greater CFI (p = 0.017), and lower CFR at P3 (p = 0.015). Migration (n = 9, 7%) was associated with lower CFR at P2 (p = 0.028) and P3 (p = 0.007). Varus malalignment (n = 7, 5%), predominantly in Dorr A femurs (p = 0.028), was associated with lower CFR at all levels (p < 0.05). Absence of spot welds was associated with lower PMA gait (p = 0.012) and migration with worse OHS (p = 0.032). Conclusion This study revealed that femurs with insufficient proximal filling tend to have less favourable radiological outcomes following uncemented THA using a fully HA-coated double-tapered femoral component. Cite this article: Bone Joint Res. 2020;9(4):182–191.

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