Cementless modular neck stems: are they a safe option in primary total hip arthroplasty?

Purpose

The objective was to assess aseptic complications and functional outcome using a primary total hip arthroplasty with modular neck.

Methods

Prospective cohort of 317 consecutive patients. The mean age was 61.1 (range, 41–84) years. The H-Max-M model (Lima, Italy) system was used in all patients. The functional assessment was made by the Harris Hip Score, Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index and visual analogue scale for pain. Radiological outcomes were also assessed, and adverse events and complications were noted.

Results

The mean follow-up was 6.1 (range, 2–8) years. Functional outcome significantly improved in most patients. There were 3 deep infections (0.9%) and 17 aseptic complications (5.3%) including 1 intraoperative acetabular fracture, 3 later periprosthetic femoral fractures, 1 broken ceramic insert, 1 acetabular loosening, 3 femoral loosening and 1 broken titanium modular neck in a obese patient. No pseudotumors or elevated serum levels of metal ions were found among the patients with radiolucent lines or aseptic loosening.

Conclusions

The findings in the present study showed that the H-MAX-M stem provided satisfactory functional outcome in most patients with a low rate of complications attributable to the modular neck design. We consider that using this novel modular neck-stem coupling design can be an alternative to the conventional monoblock stems in patients without overweight.

     

Periprosthetic Joint Infection Is the Main Cause of Failure for Modern Knee Arthroplasty: An Analysis of 11,134 Knees

Background

Although large series from national joint registries may accurately reflect indications for revision TKAs, they may lack the granularity to detect the true incidence and relative importance of such indications, especially periprosthetic joint infections (PJI).

Questions/purposes

Using a combination of individual chart review supplemented with New Zealand Joint Registry data, we asked: (1) What is the cumulative incidence of revision TKA? (2) What are the common indications for revising a contemporary primary TKA? (3) Do revision TKA indications differ at various followup times after primary TKA?

Methods

We identified 11,134 primary TKAs performed between 2000 and 2015 in three tertiary referral hospitals. The New Zealand Joint Registry and individual patient chart review were used to identify 357 patients undergoing subsequent revision surgery or any reoperation for PJI. All clinical records, radiographs, and laboratory results were reviewed to identify the primary revision reason. The cumulative incidence of each revision reason was calculated using a competing risk estimator.

Results

The cumulative incidence for revision TKA at 15 years followup was 6.1% (95% CI, 5.1%–7.1%). The two most-common revision reasons at 15 years followup were PJI followed by aseptic loosening. The risk of revision or reoperation for PJI was 2.0% (95% CI, 1.7%–2.3%) and aseptic loosening was 1.2% (95% CI, 0.7%–1.6%). Approximately half of the revision TKAs secondary to PJI occurred within 2 years of the index TKA (95% CI, 0.8%–1.2%), whereas half of the revision TKAs secondary to aseptic loosening occurred 8 years after the index TKA (95% CI, 0.4%–0.7%).

Conclusions

In this large cohort of patients with comprehensive followup of revision procedures, PJI was the dominant reason for failure during the first 15 years after primary TKA. Aseptic loosening became more important with longer followup. Efforts to improve outcome after primary TKA should focus on these areas, particularly prevention of PJI.

Level of Evidence

Level III, therapeutic study.

     

MRI Findings at the Bone-Component Interface in Symptomatic Unicompartmental Knee Arthroplasty and the Relationship to Radiographic Findings

Background

The most common modes of failure of cemented unicompartmental knee arthroplasty (UKA) designs are aseptic loosening and unexplained pain at short- to mid-term follow-up, which is likely linked to early fixation failure. Determining these modes of failure remains challenging; conventional radiographs are limited for use in assessing radiolucent lines, with only fair sensitivity and specificity for aseptic loosening.

Questions/Purposes

We sought to characterize the bone-component interface of patients with symptomatic cemented medial unicompartmental knee arthroplasty (UKA) using magnetic resonance imaging (MRI) and to determine the relationship between MRI and conventional radiographic findings.

Methods

This retrospective observational study included 55 consecutive patients with symptomatic cemented UKA. All underwent MRI with addition of multiacquisition variable-resonance image combination (MAVRIC) at an average of 17.8 ± 13.9 months after surgery. MRI studies were reviewed by two independent musculoskeletal radiologists. MRI findings at the bone-cement interface were quantified, including bone marrow edema, fibrous membrane, osteolysis, and loosening. Radiographs were reviewed for existence of radiolucent lines. Inter-rater agreement was determined using Cohen’s κ statistic.

Results

The vast majority of symptomatic UKA patients demonstrated bone marrow edema pattern (71% and 75%, respectively) and fibrous membrane (69% and 89%, respectively) at the femoral and tibial interface. Excellent and substantial inter-rater agreement was found for the femoral and tibial interface, respectively. Furthermore, MRI findings and radiolucent lines observed on conventional radiographs were poorly correlated.

Conclusion

MRI with the addition of MAVRIC sequences could be a complementary tool for assessing symptomatic UKA and for quantifying appearances at the bone-component interface. This technique showed good reproducibility of analysis of the bone-component interface after cemented UKA. Future studies are necessary to define the bone-component interface of symptomatic and asymptomatic UKA patients.

     

Reasons for revision of failed hemiarthroplasty: Are there any differences between unipolar and bipolar?

Background

Hemiarthroplasty (HA) is an effective procedure for treatment of femoral neck fracture. However, it is debatable whether unipolar or bipolar HA is the most suitable implant.

Objective

The purpose of this study was to compare the causes of failure and longevity in both types of HA.

Materials and methods

We retrospectively reviewed 133 cases that underwent revision surgery of HA between 2002 and 2012. The causes of revision surgery were identified and stratified into early (≤?5 years) failure and late (>?5 years) failure. Survival analyses were performed for each implant type.

Results

The common causes for revision were aseptic loosening (49.6%), infection (22.6%) and acetabular erosion (15.0%). Unipolar and bipolar HA were not different in causes for revision, but the unipolar group had a statistically significantly higher number of acetabular erosion events compared with the bipolar group (p?=?0.002). In the early period, 24 unipolar HA (52.9%) and 28 bipolar HA (34.1%) failed. There were no statistically significant differences in the numbers of revised HA in each period between the two groups (p?=?0.138). The median survival times in the unipolar and bipolar groups were 84.0?±?24.5 and 120.0?±?5.5 months, respectively. However, the survival times of both implants were not statistically significantly different.

Conclusions

Aseptic loosening was the most common reason for revision surgery after hemiarthroplasty surgery in early and late failures. Unipolar and bipolar hemiarthroplasty were not different in terms of causes of failure and survivorship except bipolar hemiarthroplasty had many fewer acetabular erosion events.

     

Early results in the treatment of proximal humeral fractures with a polyaxial locking plate

Objectives

We report early results using a second generation locking plate, non-contact bridging plate (NCB PH^®, Zimmer Inc. Warsaw, IN, USA), for the treatment of proximal humeral fractures. The NCB PH^® combines conventional plating technique with polyaxial screw placement and angular stability.

Design

Prospective case series.

Setting

A single level-1 trauma center.

Patients

A total of 50 patients with proximal humeral fractures were treated from May 2004 to December 2005.

Intervention

Surgery was performed in open technique in all cases.

Main outcome measures

Implant-related complications, clinical parameters (duration of surgery, range of motion, Constant–Murley Score, subjective patient satisfaction, complications) and radiographic evaluation [union, implant loosening, implant-related complications and avascular necrosis (AVN) of the humeral head] at 6, 12 and 24 weeks.

Results

All fractures available to follow-up (48 of 50) went to union within the follow-up period of 6 months. One patient was lost to follow-up, one patient died of a cause unrelated to the trauma, four patients developed AVN with cutout, one patient had implant loosening, three patients experienced cutout and one patient had an axillary nerve lesion (onset unknown). The average age- and gender-related Constant Score (n = 35) was 76.

Conclusions

The NCB PH^® combines conventional plating technique with polyaxial screw placement and angular stability. Although the complication rate was 19%, with a reoperation rate of 12%, the early results show that the NCB PH^® is a safe implant for the treatment of proximal humeral fractures.

     

Ten to fifteen-year clinical and radiographic follow-up with a third-generation cementless stem in a young patient population

Purpose

Outcome data beyond 11 years of follow-up is not available for the third-generation Zweymüller femoral stem in combination with a polyethylene bearing. We report ten to 15-year results with this total hip arthroplasty (THA) combination in a young population.

Methods

A retrospective, observational, non-randomised, single-centre, clinical observational study was conducted in which 311 primary THAs were performed in 276 patients between 1996 and 2000 using a third-generation Zweymüller stem. The mean age of the patients at operation was 47.4 years (range 18–77 years).

Results

Stem survival for any reason was 93.5 % after ten years and 89.6 % after 13 years, and the probability of aseptic stem loosening was 98.7 % at both ten and 13 years. The occurrence of femoral radiolucent lines was low, at just 17.2 %. Minor femoral osteolysis was identified in 30 % of patients and was attributed to polyethylene liner wear. Clinical and patient satisfaction outcomes were in line with previous investigations, and the rate of adverse events was low.

Conclusions

The third-generation Zweymüller stem shows good radiographic and clinical results and good longevity, including in the younger osteoarthritic patient. The use of low-wear bearings may further reduce the rate of osteolysis and wear-related revision in young and active patients.

     

Anterior approach for total hip arthroplasty conversion of hip fusion

Purpose

Hip fusion conversion has shown mixed results, in particular a higher rate of failure than primary total hip replacement. Conversion is usually carried out by a lateral approach.

Methods

We reported a series of 37 hip fusion conversions performed by an anterior approach. Clinical and radiographic outcomes of this unusual approach were reported at eight years of follow up.

Results

At eight years of follow up, survivorship was 86. 6 % (IC 95 %: 62.4–95.7 %). Sixteen patients reported good relief of the pre-operative back spine or knee pain. PMA score was significantly improved. Two implant aseptic loosenings needing revision surgery were reported.

Conclusion

The anterior approach seemed to be as good as the other hip approaches for hip fusion conversion to total hip replacement.

     

Trochanteric fragility fractures

Objective

Use of standardized cement augmentation of the proximal femur nail antirotation (PFNA) for the treatment of trochanteric fragility fractures, which are associated with high morbidity and mortality, to achieve safer conditions for immediate full weight-bearing and mobilization, thus, improving preservation of function and independency of orthogeriatric patients.

Indications

Trochanteric fragility fractures (type 31-A1–3).

Contraindications

Ipsilateral arthritis of the hip, leakage of contrast agent into the hip joint, femoral neck fractures.

Surgical technique

Reduction of the fracture on a fracture table if possible, or minimally invasive open reduction of the proximal femur, i.?e., using collinear forceps if necessary. Positioning of guidewires for adjustment of the PFNA and the spiral blade, respectively. Exclusion of leakage of contrast agent and subsequent injection of TRAUMACEM? V⁺ into the femoral head–neck fragment via a trauma needle kit introduced into the spiral blade. Dynamic or static locking of the PFNA at the diaphyseal level.

Postoperative management

Immediate mobilization of the patients with full weight-bearing and secondary prevention, such as osteoporosis management is necessary to avoid further fractures in the treatment of these patients.

Results

A total of 110 patients older than 65 years underwent the procedure. Of the 72 patients available for follow-up (average age 85.3 years), all fractures healed after an average of 15.3 months. No complications related with cement augmentation were observed. Approximately 60?% of patients achieved the mobility level prior to trauma.

     

Medium-term outcomes of the S-ROM modular femoral stem in revision hip replacement

Introduction

The objective of this study was to analyse results achieved with the S-ROM modular stem in revision surgery.

Materials and methods

A retrospective observational study was conducted from 2007 to 2015 including 51 patients who had a follow-up of ≥?2 years and complete medical history. The mean age was 66.5 years old (34–87). The main reason for revision was aseptic loosening (38 cases, 74.5%), followed by infection (10, 19.6%), instability (2, 3.9%) and an adverse reaction associated with a metal-on-metal hip implant (1, 2%). Using the Paprosky classification, there were 22 cases of type I (43.1%), 27 of type II (52.9%) and 2 of type IIIA (4%). At the end of the follow-up, radiological parameters were assessed using Engh’s criteria. Pre- and postoperative clinical status was assessed using the Harris Hip Score, a visual analogue scale and the Merle D’Aubigné score.

Results

The mean follow-up period was 5.7 years (2–10). The mean Harris Hip Score improved from 45.5 points (22–65) to 85.8 (55–100) (p?<?0.001), and the final mean Merle D’Aubigné scores were 5.2, 4.6 and 5.6 for pain, ability to walk and mobility, respectively. Osseointegration was confirmed in all except one patient with fibrous non-union. No aseptic loosening has been recorded. Postoperative complications were deep infection in four cases (7.8%) and dislocation in three (5.9%).

Conclusion

This study indicates good medium-term outcomes using a modular hip replacement system with porous-coated proximal sleeves in revision surgery in patients with Paprosky type I and II defects.

     

Radiographic assessment of distal femur cemented stems in tumor endoprostheses

Background

Distal femoral endoprosthesis (DFE) has become the optimal method of reconstruction in the skeletally mature patients treated for malignant bone tumor. Albeit literature has reported wide range of aseptic loosening in cemented components (6–32%), few authors showed that cement was not detrimental to long-term success of primary distal femoral implants possibly relating to cementing technique.

Methods

A series of consecutive of DFE (MRS and GMRS, Styker Orthopaedics, Mahwah, NJ) was retrospectively reviewed for evidence of loosening on plain radiographs. All prostheses had the standard straight 127-mm stem and a cemented polyethylene tibial component. Cementing technique involved reaming line to line to the selected stem size and cementing without pressurization. Radiographs were assessed by two independent blinded reviewers and scored for radiolucent zones (>1 mm) and graded as not loose, possibly, probable and definite loose. Furthermore, the final reamer/stem diameters, length of resection, tumor type, adjuvant treatment modalities, bushing exchange/revision surgery and infection rate were recorded.

Results

There were 70 patients and none were lost to follow-up. The average radiographic follow-up was 7.2 years (58% had f/u >5 years). Examiner A found 89% of femoral components to be “Not Loose” and 11% (n = 6) “Possibly Loose”. Examiner B found 96% of femoral components to be “Not Loose” and 4% (n = 2) to be “Possibly Loose”. No components scored as probably or definitely loose. Two DFE stems were reported as “Possibly Loose” by both reviewers. No femoral stem required revisions for either loosening, femur fracture or metal failure. Although infection was frequent, there was no septic loosening.

Conclusion

Despite our study limitations, no radiographic evidence of loosening was found. Cementing distal femur prosthesis with a tight canal fit and with a thin and inconsistent cement mantle appears to be a viable option at short and medium term.

     

Similar outcomes between two-stage revisions for infection and aseptic hip revisions

Purpose

Two-stage revision hip arthroplasty using an antibiotic-loaded spacer is the most widely performed procedure for infected hip arthroplasties. The clinical outcome of this type of surgery compared with aseptic joint revision with exchange of femoral and acetabular components is still controversial due to the relative lack of medium- to long-term follow-up. Therefore, we analysed clinical and radiological outcomes of septic two-stage revisions compared with aseptic hip revision surgeries.

Methods

In this retrospective study we assessed 82 consecutive patients who underwent two-stage revision for septic total hip (45 patients) or one-stage aseptic revision arthroplasty (37 patients). The average follow-up was 53 months for the aseptic group and 55 months for the septic group. For clinical evaluation, we used the Harris Hip Score (HHS) and the Merle d’Aubigné and Postel score. The postoperative pain level was determined with the visual analogue pain scale.

Results

The surgeries were performed 124 months (aseptic group) and 119 months (septic group) after primary total hip arthroplasty on average. The main indications for aseptic revision surgeries were aseptic loosening (96 %), dislocation (2.2 %), and periprosthetic fracture (2.2 %). In the clinical outcome patients achieved 75.5 points in the aseptic group and 73.4 points in the septic group in the Harris Hip Score. The Merle d’Aubigné and Postel Score revealed 12.5 points for the aseptic group and 13.1 points for the septic group. Mean level of persisting pain was 0.8 (aseptic group) and 0.4 (septic group) on the visual analogue scale (VAS). Overall survival in the aseptic group was 85.6 % at 9.8 years 82.7 % at 10.1 years for the septic group, with a repeat revision rate of 8.1 % and 6.7 %, respectively.

Conclusions

Performing aseptic acetabular and femoral revision hip arthroplasty showed equal clinical outcomes in relation to septic two-stage revision hip surgeries. Our results showed a tendency for better outcome in comparison with the information given in the literature for septic and nonseptic exchange arthroplasties, including a lower rate of re-revisions.

     

The Baba classification focused on implant designs is useful in setting the therapeutic strategy for interprosthetic femoral fracture

Purpose

The purpose of this study was to investigate the clinical outcomes of femoral fracture with implants on the proximal and distal sides to verify whether actual fracture morphologies follow the fracture types of Baba classification focusing on implant designs useful for periprosthetic femoral fracture.

Methods

Prosthesis was present in 85 with periprosthetic femoral fractures. Excluding 73 patients with fracture around the femoral stem or fracture of the TKA femoral component alone, 12 patients with 14 legs with both implants were investigated. All patients were radiographically assessed for implant stability according to the Baba classification. For clinical evaluation, intra- and postoperative complications, the operation time, and intra-operative blood loss were investigated.

Results

The Baba classification fracture type showed the implant as unstable and stable types in 3 and 11 legs, respectively. The consistency rate between the Baba classification-based judgment of plain radiograms acquired at the time of injury and actual surgical findings was 100%. As a result of treatment according to the Baba classification, bone union was achieved in all patients. There were no intra- or postoperative complications.

Conclusions

Applying the Baba classification, implant stability could be sufficiently evaluated in not only periprosthetic femoral fractures following hip arthroplasty, but also interprosthetic femoral fractures, thereby verifying its usefulness in setting the treatment strategy.

     

No Difference in Conventional Polyethylene Wear Between Yttria-stabilized Zirconia and Cobalt-chromium-molybdenum Femoral Heads at 10 Years

Background

Concerns have arisen regarding deterioration of wear properties of yttria-stabilized zirconia (YSZ) femoral head on conventional polyethylene (PE) bearings due to YSZ phase transformation.

Questions/Purposes

The purpose of this study was to determine if there is a difference in long-term PE wear properties between YSZ and cobalt-chromium-molybdenum (Co-Cr-Mo) femoral heads.

Methods

Ten-year radiographic wear assessment was performed on a cohort of patients enrolled in a prospective randomized clinical trial comparing total hip arthroplasty with YSZ or Co-Cr-Mo femoral heads on conventional, non-cross-linked PE.

Results

PE linear wear, annualized wear, and steady-state wear rates remained low and similar between groups. No cases of osteolysis were observed.

Conclusions

Measured conventional PE wear was similar between YSZ and Co-Cr-Mo femoral heads with the steady-state wear rates for both remaining below the generally accepted threshold at which osteolysis typically occurs. Whether clinically relevant phase transformation with YSZ femoral heads occurs is uncertain; however, the use of YSZ femoral heads in this study was not associated with increased PE wear, osteolysis, or deterioration of wear properties.

     

Femoral shortening osteotomy in total hip arthroplasty for severe dysplasia: a comparison of two fixation techniques

Purpose

The purpose of this study was to compare two distinct fixation methods for a total hip replacement performed via transverse femoral shortening osteotomy for patients with severe hip dysplasia.

Methods

In this retrospective study we compared two fixation methods for total hip replacement of 78 hips in 76 patients exhibiting Crowe type IV developmental hip dysplasia (DDH). The hip replacements were performed via a transverse femoral shortening osteotomy and carried out between September 2009 and December 2013. Group I patients underwent fixation of the shortened femoral segment via a cable attached to the osteotomied segment, and group II patients underwent fixation with a plate and screw. We compared the two techniques based on operating time, osteotomy site union time, Harris hip score, hip loosening signs, and overall clinical outcomes.

Results

The mean operating time for groups I and II was determined to be 116.5?±?12.8 min and 137.7?±?14 min, respectively (p?<?0.05), while the average union time was 113?±?51 days for group I and 152?±?37 days for group II (p?<?0.05). Fixation of the femur with a cable (group I) is therefore faster and results in more rapid union time when compared to plate osteosynthesis at the osteotomy site (group II). We observed only one non-union in group I compared with three in group II (p?=?0.49). Harris hip scores at the final patient follow-up were 82.8?±?7.8 and 80.8?±?6.7 for groups I and II, respectively (p?=?0.23). Thus, notably no significant differences were observed between the groups with regard to clinical outcomes such as the Harris hip score or loosening of the replacement components.

Conclusion

Fixation of the removed femoral segment with a cable provided adequate rotational stability and decreased the operating time, leading to early union at the osteotomy site.

     

Clinical results of hemiarthroplasty using new bipolar cups for stage 3 or lower osteonecrosis of the femoral head: a retrospective study

Purpose

The aim of this study was to evaluate clinical and radiographic findings of stage 3 or lower osteonecrosis of the femoral head (ONFH) with intact acetabular cartilage in patients treated with bipolar hemiarthroplasty (BHA).

Methods

A total of 79 hips that underwent BHA for ONFH were included in this study. The average observation period was 7.6 years. Clinical results were evaluated using the Harris hip score. We performed radiographic analysis to assess the migration of the outer cup, the permanent image around the outer cup, and loosening of the stem.

Results

The total Harris hip score improved from 50 points before surgery to 92 points at final follow-up, while pain improved from 14 points to 36 points. Flexion improved from 94° to 120° and abduction from 27° to 37°. One patient on dialysis showed progress in terms of inward migration, and revision surgery was performed on the patient 14 years after the original surgery.

Conclusions

Midterm performance of BHA for stage 3 or lower ONFH at our hospital was good.

     

Intra-prosthetic dislocation of dual-mobility cups after total hip arthroplasty: potential causes from a clinical and biomechanical perspective

Introduction

Recurrent dislocation of total hip arthroplasty is a frequent indication for revision surgery. Hip joint stability depends on implant design, cup position and crucially on femoral head diameter. Due to an effective ultra-large diameter femoral head, dual-mobility cups are considered an attractive solution to prevent dislocation in unstable conditions. Although patients obviously benefit for many years in terms of mobility and pain, an increase of intra-prosthetic dislocation reports using dual-mobility cups has been recently observed. However, the failure mechanism of this implant-specific complication, which is characterized by the loss of the positive-locking between the femoral head and the mobile liner, is not yet completely understood.

Methods

A comprehensive search was performed with the PubMed database and a search engine to overview this topic and to identify potential causes for this implant-specific failure from a clinical and biomechanical perspective.

Results

Peri-operative findings indicate extensive fibrosis at the large articulation as well as cup loosening as potential causes. In addition, current research has shown that the failure mechanism is affected by the surface topography of the femoral neck and in particular by the design of the mobile liner.

Discussion

In clinical practice it is necessary to differentiate a classic dislocation between the mobile liner and the metallic shell from an intra-prosthetic dislocation between the femoral head and the liner.

Conclusion

Due to the increasing popularity of dual-mobility cups in total hip arthroplasty, the understanding of which implant-specific features or tissue response may increase the risk of intra-prosthetic dislocation is of major importance for reduced revision rates by using optimized surgical techniques and implant designs.

     

Gelenkerhaltende Versorgung der medialen Schenkelhalsfraktur mit einem winkelstabilen Implantat

Objective

Operative stabilization is recommended even for non-displaced or only slightly displaced femoral neck fractures. In addition to the known osteosynthetic procedures, an angular stabile implant system (Targon® FN) has been established since 2006 for treatment of such fractures.

Indications

Displaced femoral neck fractures (Garden III and IV) and non-displaced fractures (Garden I and II).

Contraindications

Fractures close to the hip joint, which are not classified as typical medial femoral neck fractures and patients with advanced osteoarthritis of the hip who would profit from an endoprosthetic procedure.

Surgical technique

The operative procedure is shown after fracture reposition and central positioning of the guide wire as a standard course.

Postoperative Management

Early postoperative mobilization under guidance of a physiotherapist. Initially, partial weight bearing only in selected cases with severe displacement.

Results

In our patients collective the Targon® FN has been implanted in over 100 cases. Revision indications and secondary endoprosthesis were documented in only 9?% of the cases. This angular stable screw osteosynthesis system is a safe procedure to achieve patient mobility if the indications are adhered to and implantation is correctly carried out.

     

Total aortic arch replacement using hypothermic circulatory arrest with antegrade selective cerebral perfusion: are there cerebral deficits other than frank stroke?

Background

It is controversial whether cerebral deficits other than frank stroke develop after total aortic arch replacement using hypothermic circulatory arrest (HCA) with antegrade selective cerebral perfusion (SCP).

Objectives

We investigated neuropsychological functions in patients who received total aortic arch replacement using deep HCA with SCP.

Methods

Eleven patients who underwent elective total arch replacement using deep HCA with antegrade SCP were included. Cognitive functions of the patients were evaluated at baseline, and 3 weeks and 6 months after the aortic arch surgery.

Results

The performance of cognitive tests did not change 3 weeks after surgery, except for the attention/calculation task of the Mini-Mental State Examination (MMSE). Six months after surgery, the decline in score for the attention/calculation task in the MMSE had reversed and the score for this task as well as for all other tests had returned to baseline levels.

Conclusion

Long-lasting cognitive deficits other than frank stroke may not develop after total arch replacement surgery using deep HCA with SCP.

     

Revision knee arthroplasty using a distal femoral replacement prosthesis for periprosthetic fractures in elderly patients

Purpose

Distal femoral periprosthetic fractures above a total knee replacement in elderly patients are technically challenging to treat. Bone quality is often poor, the fractures comminuted, and post-operative mobilisation is difficult. This study assesses the clinical, radiological and functional outcome of revision knee distal femoral replacement (DFR) in these fractures.

Methods

We identified 14 patients over 70 years of age (70–94) who underwent DFR for periprosthetic fractures above a knee replacement. All the 14 fractures were classified as Su type III. Clinical and radiological records were retrospectively reviewed. The mean of clinical follow-up was 27 months (8–46). Functional outcome was assessed using Oxford Knee Score and EQ-5D (UK English Version) score at a mean time of 35 months (20–65). The Knee Society patient category score was also evaluated.

Results

The median post-operative knee flexion was 100° (range 90°–135°). Nine patients (64%) returned to their pre-fracture level of mobility or better. The median post-operative Oxford Knee Score was 27 (range 4–40). The median EQ-5D was 11 (range 6–12). Cognitive impairment negatively impacted the functional outcome in four patients. One patient died early post-operatively, and two patients had complications.

Conclusions

DFR led to satisfactory outcome in our patients with a relatively low complication rate. In our experience, revision knee distal femoral replacement is an appropriate method to treat elderly patients who sustained periprosthetic Su et al. type III distal femoral fractures in association with poor bone stock, caused by osteoporosis and/or comminution.