Review on the Article by A.A. Belokobylov et al. “Copper-Coated Spacer for Total Femoral Replacement in Recurrent Periprosthetic Joint Infection: A Case Report”

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Dual-mobility bearings in complex revision hip arthroplasty

Background: Revision total hip arthroplasty (rTHA) is associated with an increased dislocation risk. Dual-mobility (DM) bearings have been used to address this issue. Such constructs offer increased range of motion and enhanced stability whilst avoiding some issues associated with fully-constrained devices. DM bearings have been used in our unit since 2013. Methods: All rTHA cases since 2013 were reviewed using the following criteria: (1) use of a DM bearing; (2) extensive soft tissue or bone loss resulting from ARMD, infection or multiple revisions, or requiring custom or megaprosthetic reconstruction; (3) minimum 2-month follow-up. Results: 52 cases were identified with a median of 2 previous operations (range 1–6) and mean follow-up of 14 (2–41) months. The Novae-Stick component was used in 50 cases, the Avantage in 2 and the Trident MDM in 1 case. 19 required acetabular reconstruction using trabecular metal and four required custom acetabular components. 19 required femoral reconstruction with a proximal or total femoral replacement. Postoperatively, 8 patients (15.4%) sustained a dislocation at a mean of 1.6 (range 1–3) months. 3 (5.8%) requiring re-revision. 1 required excision arthroplasty and 2 a constrained liner, 1 of which went on to have further instability. There were no intraprosthetic dislocations. Conclusions: Dual-mobility components are a viable option in the complex rTHA setting. Early dislocations can occur but the rate of instability is acceptable in this high-risk group.

Total Femoral Replacement- A Case Report

Introduction: Total femoral replacement(TFR) is a well-recognized salvage procedure performed after multiple failed endoprosthetic replacements, which result in severely compromised bone stock and damaged structural integrity. TFR is performed as an alternative to lower limb amputation, restoring femoral integrity and enabling patients to resume ambulation. TFR is expected to be performed more frequently as the worldwide rate of revision arthroplasty increases due to improved patient survival rates and their underlying diseases, exceeding the functional life of endoprosthetic arthroplasty. We present a 74-year-old, overweight woman with an extensive surgical history with respect to her right knee. Her right lower extremity x-rays showed a long-cemented stem knee tumour prosthesis and a Garden 4 subcapital fracture of the ipsilateral hip. Due to multiple surgeries of the knee and femur in the past, a total femoral replacement was required to be performed. The procedure was successful, and the expected outcome was met. A successful procedure performed by a skilled and experienced surgical team, a thorough rehabilitation program, and prompt post-operative management of complications, can overcome the high incidence of infection and dislocation to preserve the limb with improved functionality and reduce pain. TFR is a drastic operative intervention that can preserve the quality of life for most patients.

Revision Arthroplasty with Total Femur Replacement for the Management of Complex Post-traumatic Bone Defect in a Patient with Dwarfism

Dwarfism leads to an early onset of osteoarthritis of the joints of the lower limb. Due to bone deformities, arthroplasty is challenging. The incidence of implant-associated complications is higher compared to the normal population and often ends up with multiple revision arthroplasties. We report the first case in the literature of a 48-year-old patient with dwarfism who required implantation of a custom-made total femoral replacement due to aseptic stem loosening and a concomitant valgus gonarthrosis.

A new biarticular cement spacer technique for infected total hip and knee arthroplasty with massive bone loss

Introduction: The management of massive femoral bone defects following prosthetic infection remains a surgical challenge, particularly when the entire femur is affected. Methods: We present the first results of a new biarticular cement spacer with antibiotic technique using a cephalomedullary nail for the treatment of infected hip arthroplasty involving complete femoral bone loss. Results: 5 patients with a minimum follow-up of 1 year were included. In all cases 2-stage replacement due to hip periprosthetic infection was carried out, with the need for a biarticular complete femoral spacer in view of the magnitude of the bone defect. The infection was resolved in all patients, with no complications (spacer fracture or dislocation) associated to spacer use, and the patients were all able to maintain the sitting position with active knee movements between the 2 surgical stages. Improvement with respect to preoperative functional status was observed in all cases, as evidenced by the Harris Hip Score (HHS) (from 24.2 to 73; p < 0.001) and 12-Item Short-Form Health Survey (SF-12) (from 16.8 to 33.2; p = 0.001), with a lessened need for walking aids. Discussion: The described technique offers a possible solution to a number of complications observed with the use of spacers in massive defects, affording greater patient comfort and autonomy while waiting to receive total femoral replacement.