scholarly journals Proximal Femoral Bone Regeneration After an Uncemented Hydroxyapatite-coated Long-stem in Revision Hip Surgery

2018 ◽  
Vol 12 (1) ◽  
pp. 125-133 ◽  
Author(s):  
José Cordero-Ampuero ◽  
Eduardo Garcia-Rey ◽  
Eduardo Garcia-Cimbrelo
Keyword(s):  
Clinical Outcome ◽  
Aseptic Loosening ◽  
Revision Surgery ◽  
Bone Remodelling ◽  
Osteolytic Lesions ◽  
Femoral Cortex ◽  
Revision Hip Surgery ◽  
Long Stem ◽  
Different Levels

Background: Bone remodelling with lateral femoral cortex thinning is a major concern after extensively porous-coated long-stem in revision surgery. Extensive hydroxyapatite coated long-stems were introduced to improve osseointegration, but bone remodelling changes have not been quantified. Objective: The question of whether bone remodelling changes from extensive hydroxyapatite-coated long stems influence the durability of femoral revision, clinical outcome is assessed in follow-up radiographs. Methods: Uncemented straight monoblock hydroxyapatite-coated long-stems used in revision hip surgery for aseptic loosening were assessed in a consecutive series of 64 hips (60 patients). Mean follow-up was 8.6 years and the mean age at surgery was 70 years (27-91). The pre-operative bone defect was classified according to Paprosky. Cortical struts were not used in this series. Cortical index and femoral cortical width were measured at three different levels at different periods. Results: Four patients with pain under level 4 due to stem loosening needed an exchange surgery of their femoral component, but two patients rejected re-surgery. The cumulative probability of not having aseptic loosening was 91.2% (95% confidence interval 73.5-96.9) at 10 years according to Kaplan and Meier. Twenty-seven of 35 osteolytic lesions had disappeared or decreased at the last follow-up. The thickness of the lateral and medial cortex increased over the course of the study at different levels. Increases of femoral cortex thickness were greater in men and in cases with mild bone defects. Conclusion: Although clinical outcome of the hydroxyapatite-coated long stem in revision surgery is good but not outstanding, most osteolytic lesions heal and the femoral cortex thickness increases at different levels.

Extended Routine Follow-up of Primary Uncomplicated Hip and Knee Arthroplasty is not Necessary

2019 ◽  
Vol 13 (1) ◽  
pp. 266-271
Author(s):  
Georgina Kakra Wartemberg ◽  
Thomas Goff ◽  
Simon Jones ◽  
James Newman
Keyword(s):  
Aseptic Loosening ◽  
Revision Surgery ◽  
Revision Arthroplasty ◽  
Cost Effective ◽  
Face To Face ◽  
Primary Surgery ◽  
Effective System ◽  
Knee Revision Surgery ◽  
Knee Revision

Aims: To create a more effective system to identify patients in need of revision surgery. Background: There are over 160,000 total hip and knee replacements performed per year in England and Wales. Currently, most trusts review patients for up to 10 years or more. When we consider the cost of prolonged reviews, we cannot justify the expenditure within a limited budget. Study Design & Methods: We reviewed all patients' notes that underwent primary hip and knee revision surgery at our institution, noting age, gender, symptoms at presentation, referral source, details of the surgery, reason for revision and follow up history from primary surgery. Results: There were 145 revision arthroplasties (60 THR and 85 TKR) that met our inclusion criteria. Within the hip arthroplasty group, indications for revision included aseptic loosening (37), dislocation (10), and infection (3), periprosthetic fracture, acetabular liner wear and implant failure. All thirty-seven patients with aseptic loosening presented with pain. Twenty-five were referred from general practice with new symptoms. The remaining were clinic follow-ups. The most common reason for knee revision was aseptic loosening (37), followed by infection (21) and then progressive osteoarthritis (8). Most were referred from GP as a new referral or were clinic follow-ups. All patients were symptomatic. Conclusion: All the patients that underwent revision arthroplasty were symptomatic. Rather than yearly follow up, we recommend a cost-effective system. We are implementing a 'non face-to-face' system. Patients would be directly sent a questionnaire and x-ray form. The radiographs and forms will be reviewed by an experienced arthroplasty surgeon. The concerning cases will be seen urgently in a face-to-face clinic.

Impaction bone grafting in hip re-revision surgery

2021 ◽  
Vol 103-B (3) ◽  
pp. 492-499
Author(s):  
Eduardo Garcia-Rey ◽  
Laura Saldaña ◽  
Eduardo Garcia-Cimbrelo
Keyword(s):  
Aseptic Loosening ◽  
Acetabular Component ◽  
Revision Surgery ◽  
Bone Grafting ◽  
Bone Defects ◽  
Bone Stock ◽  
Impaction Bone Grafting ◽  
Acetabular Bone ◽  
Acetabular Bone Defects

Aims Bone stock restoration of acetabular bone defects using impaction bone grafting (IBG) in total hip arthroplasty may facilitate future re-revision in the event of failure of the reconstruction. We hypothesized that the acetabular bone defect during re-revision surgery after IBG was smaller than during the previous revision surgery. The clinical and radiological results of re-revisions with repeated use of IBG were also analyzed. Methods In a series of 382 acetabular revisions using IBG and a cemented component, 45 hips (45 patients) that had failed due to aseptic loosening were re-revised between 1992 and 2016. Acetabular bone defects graded according to Paprosky during the first and the re-revision surgery were compared. Clinical and radiological findings were analyzed over time. Survival analysis was performed using a competing risk analysis. Results Intraoperative bone defect during the initial revision included 19 Paprosky type IIIA and 29 Paprosky type IIIB hips; at re-revision, seven hips were Paprosky type II, 27 type IIIA and 11 were type IIIB (p = 0.020). The mean preoperative Harris Hip Score was 45.4 (SD 6.4), becoming 80.7 (SD 12.7) at the final follow-up. In all, 12 hips showed radiological migration of the acetabular component, and three required further revision surgery. The nine-year cumulative failure incidence (nine patients at risk) of the acetabular component for further revision surgery was 9.6% (95% confidence interval (CI) 2.9 to 21.0) for any cause, and 7.5% (95% CI 1.9 to 18.5) for aseptic loosening. Hips with a greater hip height had a higher risk for radiological migration (odds ratio 1.09, 95% CI 1.02 to 1.17; p = 0.008). Conclusion Bone stock restoration can be obtained using IBG in revision hip surgery. This technique is also useful in re-revision surgery; however, a better surgical technique including a closer distance to hip rotation centre could decrease the risk of radiological migration of the acetabular component. A longer follow-up is required to assess potential fixation deterioration. Cite this article: Bone Joint J 2021;103-B(3):492–499.

scholarly journals Revision Meniscal Repair - Failure rates, clinical outcome and patient satisfaction

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0022
Author(s):  
Andreas Fuchs ◽  
Ferdinand Kloos ◽  
Gerrit Bode ◽  
Kaywan Izadpanah ◽  
Norbert Südkamp ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Revision Surgery ◽  
Meniscal Repair ◽  
Sports Participation ◽  
Lysholm Score ◽  
Failure Rates ◽  
The Mean ◽  
High Level

Aims and Objectives: Failure of isolated primary meniscal repair must be expected in 14% - 28%. Patients requiring revision surgery may benefit from revision meniscal repair, however, the results of revision meniscal repair remain unclear. The purpose of this study was therefore to evaluate the clinical outcome and failure rates of revision meniscal repair in patients with re-tears or failed healing after previous isolated meniscal repair in stable knee joints. Materials and Methods: A chart review was performed to identify all patients undergoing revision meniscal repair between 08/2010 and 02/2016. Only patients without concomitant procedures, without ligamentous insufficiency, and a minimum follow-up of 24 months were included. The records of all patients were reviewed to collect patient demographics, injury patterns of the meniscus, and details about primary and revision surgery. Follow-up evaluation included failure rates, clinical outcome scores (Lysholm Score, KOOS Score), sporting activity (Tegner scale), and patient satisfaction. Results: A total of 12 patients with a mean age of 22 ± 5 years were included. The mean time between primary repair and revision repair was 27 ± 21 months. Reasons for failed primary repairs were traumatic re-tears in 10 patients (83%) and failed healing in two patients (17%). The mean follow-up period after revision meniscal repair was 43 months. Failure of revision meniscal repair occurred in 3 patients (25%). In two of these patients, re-revision repair was performed. At final follow-up, the mean Lysholm Score was 95.2 with a range of 90-100, representing a good to excellent result in all patients. The final assessment of the KOOS subscores also showed good to excellent results. The mean Tegner scale was 6.8 ± 1.8, indicating a relatively high level of sports participation. Ten patients (83%) were either very satisfied or satisfied with the outcome. Conclusion: In patients with re-tears or failed healing after previous isolated meniscal repair, revision meniscal repair results in good to excellent knee function, high level of sports participation, and high patient satisfaction. The failure rate is comparable to isolated meniscal repair. Therefore, revision meniscal repair is worthwhile in order to save as much meniscal tissue as possible.

Effect of age on outcome and revision in total ankle arthroplasty

2020 ◽  
Vol 102-B (7) ◽  
pp. 925-932 ◽  
Author(s):  
Mario Gaugler ◽  
Nicola Krähenbühl ◽  
Alexej Barg ◽  
Roxa Ruiz ◽  
Tamara Horn-Lang ◽  
...  
Keyword(s):  
Pain Relief ◽  
Clinical Outcome ◽  
Revision Surgery ◽  
Preoperative Assessment ◽  
Total Ankle Arthroplasty ◽  
Consecutive Series ◽  
Ankle Arthroplasty ◽  
Major Revision ◽  
Effect Of Age

Aims To assess the effect of age on clinical outcome and revision rates in patients who underwent total ankle arthroplasty (TAA) for end-stage ankle osteoarthritis (OA). Methods A consecutive series of 811 ankles (789 patients) that underwent TAA between May 2003 and December 2013 were enrolled. The influence of age on clinical outcome, including the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and pain according to the visual analogue scale (VAS) was assessed. In addition, the risk for revision surgery that includes soft tissue procedures, periarticular arthrodeses/osteotomies, ankle joint debridement, and/or inlay exchange (defined as minor revision), as well as the risk for revision surgery necessitating the exchange of any of the metallic components or removal of implant followed by ankle/hindfoot fusion (defined as major revision) was calculated. Results A significant improvement in the AOFAS hindfoot score and pain relief between the preoperative assessment and the last follow-up was evident. Age had a positive effect on pain relief. The risk for a minor or major revision was 28.7 % at the mean follow-up of 5.4 years and 11.0 % at a mean follow-up of 6.9 years respectively. The hazard of revision was not affected by age. Conclusion The clinical outcome, as well as the probability for revision surgery following TAA, is comparable between younger and older patients. The overall revision rate of the Hintegra total ankle is comparable with other three component designs. TAA should no longer be reserved for low demand elderly patients, but should also be recognized as a viable option for active patients of younger age. Cite this article: Bone Joint J 2020;102-B(7):925–932.

scholarly journals Is cementing technique the cause of early aseptic loosening of the tibial component in total knee arthroplasty? A report of 22 failed tibial components

2011 ◽  
Vol 3 (1) ◽  
pp. 5 ◽  
Author(s):  
Stefan Endres ◽  
Axel Wilke
Keyword(s):  
Aseptic Loosening ◽  
Tibial Component ◽  
Lateral View ◽  
Cementing Technique ◽  
Revision Procedure ◽  
Osteolytic Lesions ◽  
Cement Penetration ◽  
The Mean ◽  
Loosening Rate

Despite excellent results of bicondylar knee resurfacing when both the tibial and femoral components are cemented, loosening of the cemented tibial component (surface cementing) occurs in approximately 10% of the implants within a 4-year interval after the procedure. Based on our own experience, we want to report of early failed tibial components in 22 patients after a mean follow up of 51 months, necessitating a revision procedure. We analysed retrospectively 22 cases of failed tibial components in patients after a mean follow up of 51 months, necessitating a revision procedure. This raised the question of whether the cementing technique was implicated in the loosening. Every correlation between early loosening and clinically relevant covariates were investigated. All patients were evaluated for radiolucency and osteolytic lesions at the bone–cement interfaces by radiographic assessment according to Rossi et al. (a.p. view and lateral view divided into two zones). The mean radiographic cement penetration in anterior-posterior view was 1.2 mm (SD 0.8) in zone 1 and 1.6 mm (SD 0.9) in zone 2. The mean radiographic cement penetration in lateral view was 1.1 mm (SD 0.4) in zone 1 and 1.3 mm (SD 0.3) in zone 2. Osteolytic lesions were seen in all cases around the implant after a mean of 51 months. In all cases a revision procedure was done. Based on clinical presentation, haematological screening, joint aspiration (synovial fluid diagnostic, microbiological analyses) and histological evaluation of intraoperative samples an infection was excluded. The authors have a critical attitude toward a loosening rate of almost 10% as stated by the recent literature within the first 4 to 5 years and consider that a reduction of the loosening rate when using the full cementation technique /cementing the stem) will mean a greater benefit for patients than the possible advantage of a better bone stock in case of revision surgery. Apart from this aspect, the question of whether early aseptic loosening is still acceptable nowadays from the medical economic aspects also warrants discussion.

Survival of Hydroxy Apatite-Coated Cups: Acetabular Screws Involve a Lower Rate of Revision Surgery due to Aseptic Loosening

2017 ◽  
Vol 27 (2) ◽  
pp. 153-161 ◽  
Author(s):  
Luis Natera ◽  
Marius Valera ◽  
Esther Moya Gómez ◽  
Natalia Ibañez ◽  
Xavier Crusi ◽  
...  
Keyword(s):  
Aseptic Loosening ◽  
Revision Surgery ◽  
Statistical Relationship ◽  
Hydroxy Apatite ◽  
Multicentric Study ◽  
Total Hip ◽  
Hip Arthroplasties ◽  
The Relationship

Background It is believed that the path of acetabular screws may represent a shuttle between hydroxyapatite (HA) particles and the liner. The aim was to assess the relationship between acetabular screws and revision surgery for aseptic loosening in total hip arthroplasties (THAs). Material and methods A retrospective multicentric study was performed. Patients older than 18 years and patients who underwent THA with both the stem and cup HA-coated were included. The rate of revision-surgery considering only aseptic loosening was calculated. The proportion of cases in which acetabular screws were used was registered, as well as the proportion of cups that showed osteolysis. The statistical relationship between acetabular screws and osteolysis, as well as acetabular screws and revision-surgery for aseptic loosening were assessed. Results There were 749 cases. Mean age 62.1 (45–84) years. Mean follow-up 14.19 (8.9-16.7) years. Revision surgery was performed in 12.8% (96/749) of the cups. 73.95% (71/96) of the revised cups showed aseptic loosening. The overall 15-year survival of the cups considering only aseptic loosening was 84.4%. Acetabular screws were used in 47.5% (356/749) of the cups. Acetabular screws were used in 40.44% (55/136) of the cups that showed osteolysis. The use of acetabular screws was associated with less osteolysis (p = 0.006). Acetabular screws were used in 35.21% (25/71) of the cups that were revised for aseptic loosening. The use of acetabular screws was associated with a lower rate of revision surgery (p = 0.020). Conclusions In THA with the stem and cup HA-coated, the use of acetabular screws is associated with a lower rate of revision surgery.

Our First Experience with Extended Proximal Femoral Osteotomy for Revision Hip Surgery

2007 ◽  
Vol 17 (4) ◽  
pp. 224-229 ◽  
Author(s):  
G. Tulic ◽  
B. Dulic ◽  
C. Vucetic ◽  
A. Todorovic
Keyword(s):  
Aseptic Loosening ◽  
Recurrent Dislocation ◽  
Femoral Osteotomy ◽  
Hip Surgery ◽  
Septic Loosening ◽  
Reliable Technique ◽  
Proximal Femoral Osteotomy ◽  
Revision Hip Surgery ◽  
The Mean

Introduction The extended proximal femoral osteotomy (EPFO) is a demanding but useful techniquefor revision of both cemented or noncemented femoral components. Materials and methods: Between 2000 and 2004 we performed extended proximal femoral osteotomy (EPFO) in 25 cases during revision hip surgery The main indication for doing revision surgery was aseptic loosening of both total hip arthroplasty (THA) components (18 patients), whilst in the remaining 7 patients the indications were: aseptic loosening of acetabular component in three patients, septic loosening of THA in two patients, recurrent dislocation of the THA because of incorrectly positioned femoral component in one patient and aseptic loosening of cemented hip hemiarthroplasty in one patient. Results There were 14 women and 11 men. The mean follow-up was 22 months. The average time to revision was 8.3 years. The mean age at the time of revision was 70.3 years (range 55 to 81). At the time of the last control examination all osteotomy sites had healed with signs of remodelling. The mean time to union ranged from 11 weeks to 6 months, shown by the bridging callous formation in both radiographic projections. Bone remodelling occured in all patients by 12 months and no complications such as nonunion, excessive fragment migration or wire breakage were found. Conclusion In our experience, the extended proximal femoral osteotomy when properly indicated represents an efficient and reliable technique in revision hip surgery.

scholarly journals Complications in TLIF spondylodesis–do they influence the outcome for patients? A prospective two-center study

2020 ◽  
Author(s):  
Philipp Poppenborg ◽  
Ulf Liljenqvist ◽  
Georg Gosheger ◽  
Albert Schulze Boevingloh ◽  
Lukas Lampe ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Revision Surgery ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Clinical Work ◽  
Leg Pain ◽  
Complication Rates ◽  
Major Complications ◽  
Group I ◽  
Center Study

Abstract Purpose  Transforaminal lumbar interbody fusion (TLIF) is a widely accepted surgical procedure for degenerative disk disease. While numerous studies have analyzed complication rates and risk factors this study investigates the extent to which complications after TLIF spondylodesis alter the clinical outcome regarding pain and physical function. Methods  A prospective clinical two-center study was conducted, including 157 patients undergoing TLIF spondylodesis with 12-month follow-up (FU). Our study classified complications into three subgroups: none (I), minor (IIa), and major complications (IIb). Complications were considered “major” if revision surgery was required or new permanent physical impairment ensued. Clinical outcome was assessed using visual analog scales for back (VAS-B) and leg pain (VAS-L), and Oswestry Disability Index (ODI). Results  Thirty-nine of 157 patients (24.8%) had at least one complication during follow-up. At FU, significant improvement was seen for group I (n = 118) in VAS-B (–50%), VAS-L (–54%), and ODI (–48%) and for group IIa (n = 27) in VAS-B (–40%), VAS-L (–64%), and ODI (–47%). In group IIb (n = 12), VAS-B (–22%, P = 0.089) and ODI (–33%, P = 0.056) improved not significantly, while VAS-L dropped significantly less (–32%, P = 0.013) compared to both other groups. Conclusion  Our results suggest that major complications with need of revision surgery after TLIF spondylodesis lead to a significantly worse clinical outcome (VAS-B, VAS-L, and ODI) compared to no or minor complications. It is therefore vitally important to raise the surgeon´s awareness of consequences of major complications, and the topic should be given high priority in clinical work.

scholarly journals Using Tantalum Augments for Major Acetabular Bone Defects in Revision Hip Surgery

2019 ◽  
Vol 2 (2) ◽  
pp. 64-68
Author(s):  
Adrian Cursaru ◽  
Bogdan Şerban ◽  
Alexandru George Lupu ◽  
Dan Anghelescu ◽  
Georgian Iacobescu ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Functional Results ◽  
Bone Defects ◽  
Acetabular Bone ◽  
Rotation Center ◽  
Acetabular Bone Defects ◽  
Harris Score ◽  
Revision Hip Surgery ◽  
Hip Rotation

AbstractAim. The purpose of the study was to follow up the clinical and functional results of the patients with major acetabular bone defects in revision hip surgery.Materials and methods. The study was retrospective, over a period of six years (from January 2014 to January 2019), and included all the patients with hip replacement, with major acetabular bone defects, who needed Tantalum blocks substitution.11 patients were included in the study (8 men and 3 women). The average age was 71 years (between 64 and 78 years old). The average follow up period was 23 months (between 11 and 36 months). Paprosky radiological classification was used for the preoperatory evaluation of the bone defects. In 9 cases, the bone defect was of type 2B Paprosky and in 2 cases, of type 3A. Harris score was determined preoperatory and postoperatory for the appreciation of functional results.Results. 6 patients were underwent replacement for coxarthrosis secondary to dysplasia, 2 patients for coxarthrosis secondary to aseptic necrosis and 3 patients for primary coxarthrosis.The average time elapsed from the moment of primary arthroplasty to the need of revision surgery was on average of 13 years (between 7 and 16 years). The postoperatory radiological evaluation showed an improvement of the hip rotation center from an average postoperative vertical position of 3.1 cm (between 1.2 and 4.6 cm) at an average postoperatory position of 1.1 cm (between 0.5 and 2.3). The average result of Harris score postoperatively was 36 (between 39 and 96). During the follow up period, no early loosening, infection or prosthesis dislocation was registered. Conclusions. The Tantalum Augments used in major acetabular bone defects in revision surgery represent a good option, correcting the hip rotation center, thus considerably improving the functional score.

scholarly journals Osteointegration of hydroxyapatite-coated collars in cemented massive endoprostheses following revision surgery

2021 ◽  
Vol 2 (6) ◽  
pp. 371-379
Author(s):  
Benjamin Davies ◽  
Rajiv Kaila ◽  
Loukas Andritsos ◽  
Christian Gray Stephens ◽  
Gordon W. Blunn ◽  
...  
Keyword(s):  
Aseptic Loosening ◽  
Revision Surgery ◽  
Young Patients ◽  
Limited Information ◽  
Tertiary Referral Centre ◽  
Frequency Pattern ◽  
Primary Surgery ◽  
History Of ◽  
Current Infection

Aims Hydroxyapatite (HA)-coated collars have been shown to reduce aseptic loosening of massive endoprostheses following primary surgery. Limited information exists about their effectiveness in revision surgery. The aim of this study was to radiologically assess osteointegration to HA-coated collars of cemented massive endoprostheses following revision surgery. Methods Retrospective review of osseointegration frequency, pattern, and timing to a specific HA-coated collar on massive endoprostheses used in revision surgery at our tertiary referral centre between 2010 to 2017 was undertaken. Osseointegration was radiologically classified on cases with a minimum follow-up of six months. Results In all, 39 patients underwent radiological review at mean 43.5 months; 22/39 (56.4%) showed no osseointegration to the collar. Revision endoprostheses for aseptic loosening were less likely to show osseointegration compared with other indications for revision. Oncological cases with previous or current infection were more likely to show osseointegration to ≥ 1 collar side than those without evidence of prior infection. Conclusion This seven-year review identified osseointegration of HA-coated collars after revision surgery is less likely (43.6%, 17/39) than after primary surgery. Young patients who undergo revision surgery following initial oncological indication may benefit the most from this collar design. Use in revision oncological cases with a history of infection may be beneficial. HA-coated collars showed limited benefit for patients undergoing revision for failed arthroplasty with history of infection. Cite this article: Bone Jt Open 2021;2(6):371–379.

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