One-stage revision of an infected cementless total hip replacement

2016 ◽  
Vol 29 (06) ◽  
pp. 541-546 ◽  
Author(s):  
Michael Ficklin ◽  
Michael Kowaleski ◽  
Kevin Kunkel ◽  
Jonathan Suber
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Bone Ingrowth ◽  
Femoral Stem ◽  
Coagulase Negative Staphylococcus ◽  
Implant Loosening ◽  
Total Hip ◽  
One Stage ◽  
Replacement Procedure ◽  
Cementless Total Hip Replacement

SummaryA two-year-old, 44 kg dog with a right Helica cementless total hip replacement (THR) was radiographically diagnosed with implant loosening eight months after the index total hip replacement procedure. Subsequent synoviocentesis and synovial fluid culture revealed a methicillin-resistant coagulase-negative Staphylococcus spp infection of the right THR. A one-stage revision using a hybrid BFX cementless acetabular cup and CFX cemented femoral stem was performed. Vancomycin and micro-silver antimicrobial powder impregnated cement were used in the revision. At re-evaluation 27 months following the revision procedure, the patient did not exhibit any signs of lameness. Radiographic images confirmed stable implants, with bone ingrowth into the cup and no signs of implant loosening. Our report demonstrates the success of a one-stage THR revision when faced with a multi-drug resistant periprosthetic infection, when combined with the use of micro-silver antimicrobial powder and culture-based antibiotic impregnated cement therapy.

scholarly journals Precision and accuracy of pre-surgical planning of non-cemented total hip replacement with calibrated digital images and acetates

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Luis Fernando Useche Gómez ◽  
Hernando Gaitán-Lee ◽  
María Alejandra Duarte ◽  
Patrick Dennis Halley ◽  
Alejandro Romero Jaramillo ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Gold Standard ◽  
Hip Replacement ◽  
Surgical Planning ◽  
Femoral Stem ◽  
Accurate Estimation ◽  
Hybrid Technique ◽  
Level Of Evidence ◽  
Total Hip ◽  
Replacement Procedure

Abstract Background When approaching a joint replacement procedure, pre-surgical planning is essential to predict an accurate estimation of implant size and position. There are currently two methods to achieve it, analog and digital. The present study aims to demonstrate how the hybrid technique is accurate and precise for pre-surgical planning in a non-cemented total hip replacement. Methods Concordance-type study is used against a gold standard, as well as inter- and intra-observer consistency evaluation of two orthopedic surgeons and two orthopedic surgery residents. Accuracy was calculated with the intra-class correlation coefficient (ICC). Afterwards, the same calculation was done considering a margin of error with one size more and one less. Results Thirty-eight patients were included in the study: 19 women and 19 men. Twenty-two prostheses (57.89%) were right-sided and 16 were left (42.11%). Twelve prostheses (31.57%) were Stryker and 26 Johnson & Johnson (68.43%). Acetabular cup correlation compared with the gold standard was moderate: ICC reported 0.45 (95% CI, 0.15–0.76). When adjusted by ± 1 size, ICC was 0.48 (95% CI, 0.18–0.79). On the other hand, results from the femoral stem reported ICC 0.85 (95% CI, 0.07–0.98). When adjusted by ± 1 size, ICC was 0.86 (95% CI, 0.06–0.99). Conclusions Hybrid templating is a reliable substitute for analog or digital planning. It is quick, inexpensive, accurate, and better results are observed in the femoral component regardless the level of expertise of the evaluator. Level of evidence Grade IV

scholarly journals Femoral Stem Fracture and Successful Reimplantation Using Femoral Window Technique in Canine Cemented Total Hip Replacement: Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Beata Degórska ◽  
Jacek Sterna ◽  
Magdalena Kalwas-Śliwińska
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Late Complication ◽  
Clinical Signs ◽  
Femoral Stem ◽  
Radiographic Findings ◽  
Total Hip ◽  
Replacement Procedure ◽  
Window Technique ◽  
Stem Fracture

A fractured stem is a very rare, late complication in total hip replacement procedure in dogs. Here, we present one case after cemented total hip replacement with successful reimplantation, including clinical signs and radiographic findings.

Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement

2020 ◽  
Vol 33 (05) ◽  
pp. 370-376
Author(s):  
Isobel C. Monotti ◽  
Christopher A. Preston ◽  
Scott W. Kidd
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Plate Fixation ◽  
Femoral Stem ◽  
Femoral Fractures ◽  
Total Hip ◽  
Press Fit ◽  
Periprosthetic Femoral Fractures ◽  
Bone Segment ◽  
Cementless Total Hip Replacement

Abstract Objective The aim of this study was to report outcomes in dogs with periprosthetic femoral fractures associated with a press-fit cementless femoral total hip replacement implant. Materials and Methods Electronic medical records and digital radiographs were used to identify dogs with periprosthetic femoral fractures associated with press-fit cementless total hip replacement. Data collected included signalment, weight, time of fracture, cause of fracture, presence of intra-operative fissure, fracture type, repair technique, and clinical and radiographic outcomes. Long-term patient outcome was assessed by communication with owners or referring veterinarians. Results Twenty-eight dogs with femoral fracture repair associated with cementless press-fit total hip replacement were identified. Eight of the fractures occurred intraoperatively and 20 occurred at a median of 2 days postoperatively. An oblique or spiral configuration was noted in 19 cases and 15 occurred at the distal end of the femoral stem (type B), with thirteen type B1, one type B2 and one type B3 fractures. Fractures were repaired with non-locking (18/28) or locking-plate fixation (10/28). Cerclage wire was applied around the plate and proximal bone segment in 17/28 dogs. Major complications occurred in 7/28 cases (five deep infection, two mechanical failures). Bone healing was noted in 21/23 cases, for which follow-up radiographic interpretation was available. Return to function was complete in 17 cases, acceptable in 8 cases and unacceptable in 3 cases. Conclusions While cementless total hip replacement periprosthetic femoral fractures can be successfully repaired with lateral plate fixation, the risk of infection appears to be high.

Variation in femoral anteversion in patients requiring total hip replacement

2019 ◽  
Vol 30 (3) ◽  
pp. 281-287
Author(s):  
Jim W Pierrepont ◽  
Ed Marel ◽  
Jonathan V Baré ◽  
Leonard R Walter ◽  
Catherine Z Stambouzou ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Femoral Stem ◽  
Femoral Anteversion ◽  
Patient Specific ◽  
3 Dimensional ◽  
Total Hip ◽  
Age Related ◽  
Gender And Age ◽  
Implant Alignment

Background: Optimal implant alignment is important for total hip replacement (THR) longevity. Femoral stem anteversion is influenced by the native femoral anteversion. Knowing a patient’s femoral morphology is therefore important when planning optimal THR alignment. We investigated variation in femoral anteversion across a patient population requiring THR. Methods: Preoperatively, native femoral neck anteversion was measured from 3-dimensional CT reconstructions in 1215 patients. Results: The median femoral anteversion was 14.4° (−27.1–54.5°, IQR 7.4–20.9°). There were significant gender differences (males 12.7°, females 16.0°; p < 0.0001). Femoral anteversion in males decreased significantly with increasing age. 14% of patients had extreme anteversion (<0° or >30°). Conclusions: This is the largest series investigating native femoral anteversion in a THR population. Patient variation was large and was similar to published findings of a non-THR population. Gender and age-related differences were observed. Native femoral anteversion is patient-specific and should be considered when planning THR.

Complications and radiographic findings following cemented total hip replacement

2006 ◽  
Vol 19 (03) ◽  
pp. 172-179 ◽  
Author(s):  
R. S. Gilley ◽  
F. S. Shofer ◽  
A. S. Kapatkin ◽  
M. S. Bergh
Keyword(s):  
Total Hip Replacement ◽  
Revision Surgery ◽  
Hip Replacement ◽  
Femoral Stem ◽  
Short Term ◽  
Radiographic Appearance ◽  
Radiographic Findings ◽  
Total Hip ◽  
Technical Errors ◽  
Radiographic Changes

SummaryCemented total hip replacement (cTHR) is commonly performed to treat intractable coxofemoral pain in dogs. While owners generally perceive a good outcome after the procedure, the longevity of the implant may be limited by complications such as infection and aseptic loosening. The objective of this retrospective study was to identify the prevalence of complications and radiographic changes following cTHR, and to identify factors that may predispose to a need for revision surgery. Medical records and radiographs from 97 dogs that underwent cTHR were evaluated for signalment, preoperative degree of osteoarthritis, technical errors, intra-operative culture results, and the post-operative radiographic appearance of the implant. The complications occurring in the intra-operative and short-term (<eight week) periods, and the radiographic appearance of the implant in the long-term (>eight week) time period were recorded. Mean (±SD) follow-up time was 1.1 ± 1.6 years (range: 0–7.7 years). Seven dogs had a short-term complication and a revision surgery was performed in eleven dogs. Osseous or cement changes were radiographically detectable in the majority of cTHR. Eccentric positioning of the femoral stem and the presence of radiolucent lines at the femoral cement-bone interface were positively associated with the occurrence of revision surgery. The clinical significance of the periprosthetic radiographic changes is unclear and further investigation is warranted.

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