Wagner SL股骨柄治疗陈旧性或伴髋关节炎的股骨粗隆间骨折疗效观察

目的 :探讨Wagner SL股骨柄治疗陈旧性或伴痛性髋关节炎的股骨粗隆间骨折的临床疗效。方法 :自2006年1月至2009年12月对8例陈旧性粗隆间骨折及21例伤前有痛性关节炎的粗隆间骨折使用Wagner SL股骨柄行全髋关节置换并重建粗隆,其中男18例,女11例;年龄43~58岁,平均49岁。术后临床随访,根据Harris评分、肢体长度差异、髋关节活动范围以及髋外展肌力进行评价。影像学随访包括对股骨柄假体周围骨溶解、假体松动、透光线等进行评价。结果:29例患者均成功完成手术,未出现与髋关节置换手术相关的严重并发症。术后均获得随访,时间6~10年,平均8.2年。均无不可接受的大腿疼痛主诉。8例陈旧性粗隆间骨折患者术后首次行走时均有"手术侧肢体过长"抱怨,随时间推移,这种抱怨在明显减少。术后3个月X线片提示21例伤前痛性关节炎的粗隆间骨折愈合,平均术后6个月(3~8个月)X线片提示8例陈旧性粗隆间骨折患者的植骨块与粗隆有明显骨痂连接,末次随访时X线片均未提示假体明显下沉。髋关节活动度基本恢复正常,无髋外展无力。根据Harris评分方法,手术后6年以上对患髋关节进行评价,优18例,良9例,可2例。结论:Wagner SL股骨柄在治疗陈旧性或伴痛性髋关节炎患者粗隆间骨折的初次全髋关节置换中可取得优良的临床疗效,粗隆重建,有利假体和关节稳定,同时增加骨储备。     

Femoral revision with the Wagner SL revision stem : evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years.

BACKGROUND: It is difficult to achieve a successful revision total hip replacement when a patient has severe proximal femoral bone loss. The Wagner SL revision stem has some theoretical advantages, but the durability of this prosthesis is not known. METHODS: We reviewed the results of 129 revisions of the femoral component with a Wagner SL revision stem in 123 patients. The indication for revision was aseptic loosening in ninety-seven hips, periprosthetic fracture in thirteen (one of which also had an infection), and septic loosening in sixteen. In the three remaining hips, a Wagner revision stem was inserted during a second-stage reimplantation after the performance of a Girdlestone resection arthroplasty to treat chronic deep infection. The prerevision defects were classified with the system described by Pak et al. as well as with our system. A functional evaluation of the patients and a survival analysis of the revision stems were performed. RESULTS: The mean duration of follow-up was 4.8 years (range, two months to 11.1 years). Six revision stems required repeat revision. With removal of the stem for any cause or the worst case (removal of the stem for any cause and/or lost to follow-up) as the end point, cumulative survival at 11.1 years was 93.9% and 92.8%, respectively. The mean Merle d'Aubigné score improved from 7.7 points preoperatively to 14.8 points at the latest follow-up examination. The most recent radiographs showed good or excellent restoration of the proximal part of the femur in 113 hips (88%). CONCLUSIONS: Because of the encouraging results of implantation of this femoral component with distal fixation, we will continue to use it in the majority of femoral revisions. However, the need for regular follow-up remains, since the rate of complications such as osteolysis of the femur, aseptic loosening, periprosthetic fracture, and late infection may increase in the future.     

Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report

IntroductionThe thrust plate hip prosthesis (TPP; Zimmer, Winterthur, Switzerland) is a hip prosthesis that is no longer in production. Few reports have focused on periprosthetic fractures following total hip arthroplasty (THA) with the use of a TPP.Presentation of caseWe report a 57-year-old woman with a periprosthetic femoral fracture 13 years after THA with the use of a TPP. A plain radiograph showed a displaced subtrochanteric fracture of the right femur just below the distal tip of the lateral plate without implant loosening. She underwent revision surgery with a long distally fixed intramedullary stem in conjunction with a plate and cable system. Three months after surgery, bone union was confirmed using radiography and the patient was clinically asymptomatic.DiscussionWe encountered three major problems while planning surgical treatment, these being, discontinuation of the TPP system, loss of proximal femoral cancellous bone, and difficulties with the type of subtrochanteric fracture. After considering these problems, we planned revision surgery using a long distally fixed intramedullary stem in conjunction with a plate and cable system.ConclusionThis case shows that sufficient implant preparation based on precise preoperative planning is necessary to obtain good clinical results for the surgical treatment of periprosthetic femoral fractures following THA with the use of a TPP.     

Treatment of periprosthetic femoral fractures following total hip arthroplasty with femoral component revision

BACKGROUND: Revision total hip arthroplasty is indicated for most periprosthetic fractures that occur around the stem of the femoral implant. The purpose of the present study was to assess the results and complications of revision total hip arthroplasty for the treatment of periprosthetic femoral fractures. METHODS: We evaluated 118 hips in 116 patients who underwent revision total hip arthroplasty because of an acute Vancouver type-B periprosthetic femoral fracture. The femoral implant used for the revision was a cemented stem in forty-two hips, a proximally porous-coated uncemented stem in twenty-eight, an extensively porous-coated stem in thirty, and an allograft-prosthesis composite or tumor prosthesis in eighteen. The mean duration of follow-up was 5.4 years. RESULTS: Kaplan-Meier analysis demonstrated that the probability of survival was 90% at five years and 79.2% at ten years with revision or removal of the femoral implant for any reason as the end point. Sixteen femoral components were rerevised: ten were rerevised because of loosening; three, because of loosening in association with a fracture nonunion; two, because of recurrent dislocation; and one, because of a new periprosthetic fracture. Additionally, six femoral implants were resected because of deep infection (five) or prosthetic loosening (one). Radiographs of the ninety-six hips with a surviving implant showed that twenty-one had evidence of loosening of the femoral implant, four had a nonunion of the femoral fracture, and two had both a nonunion and loosening of the femoral implant. CONCLUSIONS: Revision total hip arthroplasty for the treatment of a periprosthetic fracture around the stem of the femoral implant successfully restored function for most patients. The greatest long-term problems were prosthetic loosening and fracture nonunion. Better results were seen when an uncemented, extensively porous-coated stem was used.     

Proximal femoral allograft treatment of Vancouver type-B3 periprosthetic femoral fractures after total hip arthroplasty

BACKGROUND: Periprosthetic femoral fractures following total hip arthroplasty are becoming more prevalent. When a fracture occurs in a femur with substantial proximal bone deficiency, the surgical options for revision are limited. One option includes the use of a proximal femoral allograft. METHODS: We retrospectively assessed the results and complications of the use of a proximal femoral allograft to treat twenty-five Vancouver type-B3 periprosthetic fractures in twenty-four patients. The mean duration of follow-up was 5.1 years. Clinical results were graded with use of the Harris hip score. Radiographs were assessed for evidence of trochanteric union, host-allograft union, allograft resorption, and component loosening or fracture. Failure of the procedure was defined as the need for revision surgery requiring graft removal. RESULTS: The mean postoperative Harris hip score was 70.8. At the time of the final follow-up, twenty-one of the twenty-four patients reported no or mild pain and twenty-three patients were able to walk; fifteen required a walking aid. The greater trochanter united in seventeen of the twenty-five hips, and osseous union of the allograft to the host femur occurred in twenty hips. There was mild graft resorption in four hips and moderate graft resorption in two. Four (16%) of the twenty-five hips required repeat revision. CONCLUSIONS: The use of a proximal femoral allograft for the treatment of a Vancouver type-B3 periprosthetic femoral fracture can provide a satisfactory result in terms of pain relief and function at five years.     

The Management of Periprosthetic Fractures Oxford Trimodular Femoral Stem: A Survivorship Study

A consecutive series of 40 periprosthetic femoral fractures, treated with revision hip surgery using the Oxford trimodular femoral stem, were retrospectively studied, with an average follow-up of 7.9 years. Fractures were classified according to the Vancouver classification. There were 5 type B1 fractures, 28 type B2, and 7 type C. Radiographic union was achieved in 38 (95%) hips. The mean time to fracture union was 3.5 months. The prosthesis survival at 5 years was 95% (confidence interval, 88%-100%). Clinical results were good with a mean Oxford hip score of 30 (hip score maximum, 48). Complications included 1 nonunion, 1 infection, 1 dislocation, and 2 aseptic loosening. The Oxford trimodular femoral component is a safe and reliable prosthesis for the treatment of periprosthetic femoral fractures with satisfactory medium-term results.     

Radiographic bone regeneration and clinical outcome with the Wagner SL revision stem: a 5-year to 12-year follow-up study

We used 79 Wagner SL stems (Sulzer Orthopedics, Baar, Switzerland) in femoral revisions with a minimum 5-year follow-up. There were 11 dislocations. A limb length discrepancy and limp were frequent. One loosened stem was rerevised. The cumulative probability of not having a stem revision for any reason was 92.3% in the best case scenario. Stem subsidence was associated with poor femoral canal filling. Definite proximal new bone regeneration (50 hips) was associated with an absence of major bone defects (P = .01). Lateral and medial femoral cortex and the outside femoral diameter had increased at the end of follow-up (P < .001). Wagner SL femoral revision stems can solve difficult cases with major proximal bone defects or periprosthetic fractures. Radiographic bone fixation and bone regeneration were frequent. Dislocations and stem subsidence were also frequent.     

Total hip arthroplasty using cementless grit-blasted femoral component: a minimum 10-year follow-up study

The grit-blasted cementless Spotorno (CLS) stem, which has excellent survival rates up to 10 years, is widely used in total hip arthroplasty (THA). We investigated the survivorships of CLS stems in THA at a minimum follow-up of 10 years and sought to identify factors that influence outcomes. A total of 227 hips of 191 patients who underwent cementless THA with a CLS stem were retrospectively reviewed at a mean follow-up of 12.3 years. All patients were evaluated clinically and radiographically according to implant type and surgery-related and patient-related factors. Survivorship was 97.2% when femoral revision for any reason was defined as the end point. Femoral revisions were performed in 3 hips because of periprosthetic fractures. Survivorship for all hips, using revision for any reason as the end point, was 92.6%. Two metal-on-metal THAs were revised because of aseptic loosening or osteolysis around the cup. No significant differences were evident for type of stem, type of bearing surface, stem alignment, or patient-related factors. However, a canal fill index of 80% or less was found to affect cortical remodeling, subsidence, and a change in stem position of 5° or more, which indicates that care must be taken not to undersize stems. In addition, in view of the revisions performed, bearing surfaces appear to importantly influence THA survivorship.     

Periprosthetic femoral fractures treated with a modular distally cemented stem

PURPOSE: To assess the treatment outcome of revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures using a modular distally cemented stem. METHODS: 22 men and 14 women (37 hips) aged 66 to 79 (mean, 70) years underwent revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures. The indication for surgery was periprosthetic fracture with stem loosening and loss of proximal bone stock. The patients were referred from other hospitals after previous surgeries had failed: 8 with 3 previous surgeries, 19 with 2, and 9 with one. Using a transtrochanteric approach, the existing prosthesis was removed and a modular proximal femoral replacement stem was inserted, bypassing the area of proximal femoral fracture and bone loss. The stem was distally cemented. Patients were immobilised within 48 hours of surgery. RESULTS: Patients were followed up for a mean of 14 (range, 8-18) years. The mean Harris hip score improved from 29 (range, 5-40) to 78 (range, 56-88); 24 patients attained excellent or good scores (>80), 10 attained fair, and 2 attained poor scores. The mean healing time was 7 (range, 6-14) months; there was no non-union. Improvement in proximal bone stock was noted on serial radiographs. None of the stems had cement fracture or migration, requiring revision. Two (5%) of the patients had dislocations. CONCLUSION: Vancouver type B3 periprosthetic femoral fractures can be successfully treated with a distally cemented modular proximal femoral replacement prosthesis.     

非组配式带棘锥形长柄在髋翻修中的应用

目的评价非组配式带棘锥形长柄在髋关节翻修股骨重建中的疗效。 方法对2010年1月至2015年1月间,在武汉大学人民医院骨关节外科使用非组配式带棘锥形长柄行髋翻修的61例患者临床及影响学资料进行回顾性分析,其中男36例,女25例;年龄平均(61±7)岁。根据骨盆平片及患髋侧位X线片观察髋臼、股骨假体的位置及其周围骨质变化。采用配对t检验对术前术后的疼痛视觉模拟评分(VAS)和Harris髋关节评分进行比较。 结果所有患者均获2年以上随访,平均(5.6±2.2)年。随访期间,无假体周围感染和假体松动发生。1例术后2周脱位,经手法复位后未复发。1例术后2年发生假体周围骨折,行骨折内固定处理。与术前相比,术后1个月(t＝10.5505,P ＝0.000)、3个月(t＝12.6154,P <0.05)和6个月(t＝16.6196,P <0.05)VAS评分较术前明显改善;Harris评分均明显高于对照组(术后1个月t＝14.1128,P <0.05;术后3个月t＝30.0689,P <0.05;术后6个月t＝59.9639,P <0.05)。末次随访时Harris评分优45例,良10例,可6例,优良率为90.2%。末次随访时股骨柄假体的位置无明显改变,中心固定有58髋(95.1%),柄－髓腔匹配优良率100%。所有病例均出现股骨近端骨重塑,其中Ⅰ度56髋,Ⅱ度5髋。 结论在股骨假体周围骨折(Vancouver B2 、Vancouver B3)和股骨近端骨缺损(Parprosky Ⅱ、Parprosky Ⅲ)病例中,采用非组配式带棘锥形长柄假体行股骨侧翻修疗效满意,具有操作简便、骨长入良好等特点。     

Locking compression plate versus revision-prosthesis for Vancouver type B2 periprosthetic femoral fractures after total hip arthroplasty

IntroductionRevision arthroplasty is currently the recommended treatment for periprosthetic femoral fractures after primary total hip arthroplasty (THA) and stem loosening (Vancouver B2). However, open reduction and internal fixation (ORIF) utilizing locking compression plate (LCP) might be an effective treatment with a reduced surgical time and less complex procedure in a typically elderly patient collective with multiple comorbidities. The purpose of this study was to compare the functional and radiographic outcomes in two cohorts with Vancouver B2 periprosthetic femoral fractures after primary THA, treated either by ORIF with LCP fixation, or by revision arthroplasty utilizing a non-cemented long femoral stem.Materials and Methods36 patients with Vancouver B2 periprosthetic femoral fractures following THA, who had been treated between 2000 and 2014, were reviewed. Eight fractures were treated with LCP fixation, fourteen fractures with the first-generation revision prosthesis (Helios^®), and fourteen fractures with the second-generation revision prosthesis (Hyperion™). The patients were assessed clinically with the Parker mobility score and radiographically.ResultsA total of ten males and 26 females formed the basis of this report with an average age of 81years (range, 64 to 96 years). All fractures treated with LCP fixation alone healed uneventfully and there were no signs of secondary stem migration, malalignement or plate breakage. The average surgical time was shorter in the ORIF cohort; however, the results were not statistically significant. The postoperative Parker mobility score at latest follow-up showed no difference between the groups.ConclusionsAccording to the results of the current study, we conclude that the use of LCP fixation can be a sufficient option for the treatment of Vancouver B2 periprosthetic femoral fractures correspondingly with femoral stem loosening.     

Femoral component revision using extensively porous-coated cementless stem

The number of revision hip arthroplasty increasesannually. Because of the loss of proximal femoralbone stock, femoral component revision is still achallenging problem for orthopedic surgeons. In mostcases, the femoral stem should be supported byremaining host bone for avoiding the need for structuralallografts. Previous results of cemented or proximalcoated implant for arthroplasty revision are notencouraging because the remaining bone is frequentlysclerotic and smooth.1-6The extensively porou…     

Cement-free diaphyseal fixation principle for hip shaft exchange in large bone defects--analysis of 12 years experience with the Wagner revision shaft

PURPOSE: Considering the increasing incidence of revision for failed total hip arthroplasty, we evaluated if the principle of uncemented diaphyseal fixation which is realised with the Wagner SL revision stem, can solve the technical problems of significant bone loss of the proximal femur and can offer good preconditions for bony restoration in the medium term. METHODS: A consecutive series of 129 femoral revisions with the Wagner SL revisions stem was evaluated. In 87 cases, the acetabular component was revised simultaneously. The revision was indicated in 97 cases of aseptic loosening, in 13 periprosthetic fractures (12 aseptic and 1 septic hip), in 16 cases of septic loosening and in 3 Girdlestone-hips after chronic deep infection. At the time of revision, the mean age of the patients was 64.9 (36.7-86.3) years. For classification of the preoperative defects, both the classification system proposed by Pak et al. and our own classification system were used. RESULTS: The mean period of time between operation and latest follow-up examination, rerevision, or death of the patient was 5.4 years (0.13-11.7 years). Six revision stems required rerevision because of malpositioning (1), significant subsidence (1), periprosthetic fracture (1), and deep infection (3). The mean Merle d'Aubigné score improved from preoperatively 7.7 points to 14.8 at follow-up. Cumulative survival (end point removal of the stem for any cause) was 94.4 percent at 11.7 years. A clear, good, or excellent bony restoration of the proximal femur was seen in 87.6 percent of the cases. The cumulative survival of the revised acetabular components was 97.7 percent at 11.7 years and for the non-revised cups it was 86.9 percent at 10.9 years. CONCLUSION: Due to the encouraging results with the Wagner revision stem, the principle of uncemented diaphyseal fixation seems to us to be able to solve most of the technical problems in cases of significant bone loss and obviously offers good preconditions for bony restoration. Our own classification system was effective and useful for preoperative planning.     

Total hip replacement after femoral neck fractures in elderly patients : Results of 8,577 fractures reported to the Norwegian Arthroplasty Register

Background?A total hip arthroplasty (THA) is often used as treatment for failed osteosynthesis of femoral neck fractures and is now also used for acute femoral neck fractures. To investigate the results of THA after femoral neck fractures, we used data from the Norwegian Arthroplasty Register (NAR).

Patients and methods?The results of primary total hip replacements in patients with acute femoral neck fractures (n = 487) and sequelae after femoral neck fractures (n = 8,090) were compared to those of total hip replacements in patients with osteoarthrosis (OA) (n = 55,109). The hips were followed for 0–18 years. The Cox multiple regression model was used to construct adjusted survival curves and to adjust for differences in sex, age, and type of cement among the diagnostic groups. Separate analyses were done on the subgroups of patients who were operated with Charnley prostheses.

Results?The survival rate of the implants after 5 years was 95% for the patients with acute fractures, 96% for the patients with sequelae after fracture, and 97% for the OA patients. With adjustment for age, sex, and type of cement, the patients with acute fractures had an increased risk of revision compared to the OA patients (RR 1.6, 95% CI: 1.0–2.6; p = 0.05) and the sequelae patients had an increased risk of revision (RR 1.3, 95% CI: 1.2–1.5; p < 0.001). Sequelae hips had higher risk of revision due to dislocation (RR 2.0, 95% CI: 1.6–2.4; p < 0.001) and periprosthetic fracture (RR 2.2, 95% CI: 1.5–3.3; p < 0.001), and lower risk of revision due to loosening of the acetabular component (RR 0.72, 95% CI; 0.57–0.93; p = 0.01) compared to the OA patients. The increased risk of revision was most apparent for the first 6 months after primary operation.

Interpretation?THA in fracture patients showed good results, but there was an increased risk of early dislocations and periprosthetic fractures compared to OA patients.     

Total Hip Arthroplasties for Hartofilakidis Type C1 and C2 High Hip Dislocations Demonstrate Similar Survivorship and Clinical Function at Minimum 10-year Follow-up With Cementless Implants

BackgroundThis study aimed to determine the differences in survivorship, clinical function, and complications among patients who have Hartofilakidis Type C1 or C2 developmental dysplasia of the hips and underwent total hip arthroplasty (THA) with cementless implants.MethodsThis retrospective study identified 84 Hartofilakidis Type C hips that underwent THA between 2002 and 2011 with a minimum 10-year follow-up (mean, 13 years, range, 10 to 19 years). Survivorship, latest Harris Hip Scores and satisfaction levels, radiographic outcomes (eg, implant stability, rate and length of subtrochanteric shortening transverse osteotomy, leg-length discrepancy, cup position, and orientation), as well as complications (eg, dislocation, periprosthetic fracture, periprosthetic joint infection) were compared to analyze the differences between Hartofilakidis C1 and C2 hips.ResultsBetween C1 and C2 hips, no difference existed in the 15-year cumulative Kaplan-Meier survivorship, with the endpoint defined as any reoperation (93.1 versus 90.8%), aseptic loosening combined with periprosthetic joint infection (93.1 versus 96.2%), or aseptic loosening (94.8 versus 96.2%), latest Harris Hip Score (87.1 versus 86.1%), vertical (6.1 versus 6.0 mm) and horizontal (11.5 versus 10.3 mm) distance to the anatomic center of rotation, postoperative leg length discrepancy (11.2 versus 15.5 mm), dislocation (5.2 versus 11.5%), stem aseptic loosening (6.9 versus 7.7%), periprosthetic fracture (3.4 versus 7.7%), and intraoperative femoral fracture (32.8 versus 23.1%). However, Type C2 hips demonstrated more severe preoperative leg length discrepancy (66.9 versus 42.5 mm) and required a higher percentage of subtrochanteric shortening transverse osteotomies (84.6 versus 36.2%) that were longer (33.7 versus 26.47 mm) than the Type C1 hips.ConclusionWith cementless cups positioned near the anatomic acetabular center and cementless stems combined with subtrochanteric shortening transverse osteotomies, THAs for the Hartofilakidis Type C1 and C2 hips demonstrated similar survivorship, clinical function, and complications.     

Total Hip Arthroplasty in Patients With Osteopetrosis

BackgroundOsteopetrosis is an inherited bone disease associated with high risk of osteoarthritis and fracture non-union, which can lead to total hip arthroplasty (THA). Bone quality and morphology are altered in these patients, and there are limited data on results of THA in these patients. The goals of this study were to describe implant survivorship, clinical outcomes, radiographic results, and complications in patients with osteopetrosis undergoing primary THA.MethodsWe identified 7 patients (9 hips) with osteopetrosis who underwent primary THA between 1970 and 2017 utilizing our total joint registry. The mean age at index THA was 48 years and included two males and five females. The mean follow-up was 8 years.ResultsThe 10-year survivorship free from any revision or implant removal was 89%, with 1 revision and 1 resection arthroplasty secondary to periprosthetic femoral fractures. The 10-year survivorship free from any reoperation was 42%, with 4 additional reoperations (2 ORIFs for periprosthetic femoral fractures, 1 sciatic nerve palsy lysis of adhesions, 1 hematoma evacuation). Harris hip scores significantly increased at 5 years (P = .04). Five hips had an intraoperative acetabular fracture, and 1 had an intraoperative femur fracture. All postoperative femoral fractures occurred in patients with intramedullary diameter less than 5 mm at a level 10 cm distal to the lesser trochanter.ConclusionPrimary THA in patients with osteopetrosis is associated with good 10-year implant survivorship (89%), but a very high reoperation (58%) and periprosthetic femoral fracture rate (44%). Femoral fractures appear associated with smaller intramedullary diameters.     

Impaction bone grafting for femoral revision hip arthroplasty with Exeter Universal stem in Japan

Objectives

The purpose of the present study was to analyze the retrospective clinical and radiographic results of femoral revision arthroplasties with impaction bone grafting performed by experienced Japanese surgeons.

Patients and methods

We investigated the radiographic and clinical records more than 2?years after the surgery in 99 hips of 93 patients. The average age was 66.3?years (36–84?years) and the average follow-up period was 5.2?years (2–13?years). The Merle d’Aubigné and Postel hip score was used for clinical assessment, and peri-operative fractures were recorded. The survival curve was estimated using Kaplan–Meier method.

Results

The mean Merle d’Aubigné and Postel hip score improved from 9.0 points to 15.2 points at the final follow-up. Augmentations for segmental defect of femoral cortices were undertaken in 55 hips. Metal or strut allograft plates were applied to 9 hips and 21 hips, respectively. Intra-operative fractures or perforations occurred in 20 hips. Re-operations of the femur were undertaken in nine hips including five post-operative femoral fractures. More than 5?mm of subsidence was observed in only 2 hips. The survival rates at 8?years after the operation were 94.8?% with femoral fractures as the end point, 93.1?% with any stem removal or exchange as the end point, and 99.0?% with aseptic stem loosening as the end point, respectively.

Conclusion

The present study showed encouraging mid-term results of impaction bone grafting for femoral revision arthroplasty by experienced surgeons in Japan. Aggressive augmentation of segmental defects and attenuated femoral shafts prevents massive stem subsidence and periprosthetic fracture.     

Satisfactory Results of the Exeter Revision Femoral Stem Used for Primary Total Hip Arthroplasty

Background

The Exeter cemented femoral stem has demonstrated excellent clinical and radiographic outcomes as well as long-term survivorship free from aseptic loosening. A shorter revision stem (125 mm) with a 44 offset became available for the purpose of cement-in-cement revision situations. In certain cases, this shorter revision stem may be used for various primary total hip arthroplasties (THAs) where the standard length stem would require distally reaming the femoral canal. We sought to report on the early to midterm results of this specific stem when used for primary THA regarding (1) clinical and radiographic outcomes, (2) complications, and (3) survivorship.

Total hip arthroplasty in osteopetrosis. A report of two cases.

Two patients, mother and daughter, had major hip joint problems related to osteopetrosis consisting of (1) subtrochanteric femoral fractures including delayed union, septic nonunion, and failed intramedullary fixation; and (2) coxa vara with symptomatic osteoarthrosis. Total hip arthroplasty (THA) was performed on three hips of these two patients, and the patients were followed for more than three years. One patient continues to ambulate without pain or the need for external support, and the potential for ambulation was established for the second patient, compromised only by her poor motivation. The greatest challenge in all these surgical procedures was the creation of an intramedullary canal in osteopetrotic bone without a semblance of an intramedullary canal. The bone ends presented a solid white amorphous appearance, indistinguishable from the cortex. Great care was required to avoid shattering this brittle bone, also during drilling and reaming. Preoperative assessment of the medullary canals is mandatory. Variations in the intramedullary canals present great difficulties in osteotomizing, reaming, and drilling osteopetrotic bone. However, subtrochanteric femoral fracture can be treated by cemented THA in patients with osteopetrosis.     

Extensively porous-coated stems for femoral revision: reliable choice for stem revision in Paprosky femoral type III defects

Between January 1999 and August 2008, ninety-six femoral revisions were performed with extensively porous-coated stems in Paprosky type III femoral defects (89 type IIIA and 7 type IIIB defects). Seven type IIIB defects with a mean canal of 16.5 mm were observed; 6 defects achieved stable bone ingrowth and 1 achieved stable fibrous condition. Average postoperative Harris Hip Score was 92.3±8 (range, 77-100), and all scores improved postoperatively. At a mean follow-up of 65.7 months, 92 stems achieved bone ingrowth, and 1 stem (type IIIB) achieved a stable fibrous condition. Three patients died from causes unrelated to the surgery during follow-up. The most frequent diagnosis for revision of the femoral component was loosening of the cementless stem (53 patients; 55.2%), followed by status after a Girdlestone procedure (21 patients; 21.8%), after total hip arthroplasty with acetabular wear (10 patients; 10.4%), loosening of the cemented stem (7 patients; 7.3%), and periprosthetic fracture (5 patients; 5.2%). The authors performed 65 total hip arthroplasty revisions, 23 femoral component revisions, and 8 revisions of femoral components with cemented liners in patients with well-fixed acetabular shells. Extensively porous-coated stems in femoral revision for Paprosky type III femoral defects provided good mid-term durability.