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Meier MP, Hawellek T, Lehmann W, von Lewinski G. [Tips and tricks of cement removal in the case of revision surgery]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:176-184. [PMID: 37855912 PMCID: PMC10896878 DOI: 10.1007/s00132-023-04453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND In Germany, current revision rates after arthroplasty range between 28-37%. In particular, remaining cement residues are causative for additional revision surgery after periprosthetic joint infection, which is why complete cement removal is of high importance. However, the removal of remaining cement residues often confronts the surgeon with technical challenges. Complication-free and complete cement removal requires extensive preoperative preparation in order to develop the best possible surgical strategy. TREATMENT Special instrument sets to facilitate cement removal in revision cases are available from various manufacturers. In addition to endoluminal approaches, access enhancements such as extended osteotomies exist to facilitate complete cement removal. Finally, the surgeon should be able to give the indication for an intraoperative procedural change after a defined time interval.
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Affiliation(s)
- Marc-Pascal Meier
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Thelonius Hawellek
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Wolfgang Lehmann
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Gabriela von Lewinski
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
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Jayasinghe G, Kumar R, Buckle C, Vinayakam P, Slack R. Patient mortality after total hip arthroplasty revision surgery. J Orthop 2024; 47:45-49. [PMID: 38022843 PMCID: PMC10679522 DOI: 10.1016/j.jor.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background Complications following revision total hip arthroplasty can cause significant morbidity and have a high mortality rate. Patient age and American Society of Anaesthesiologists (ASA) physical status classification system score are important determinants of mortality following revision hip arthroplasty. There is a paucity of high-quality evidence assessing the risk of mortality following revision hip arthroplasty stratified by indications of surgery. The aim of this study is to compare survival of patients undergoing revision THA for different indications. Methods This retrospective case series reviewed the mortality rate following revision hip surgery performed by a single surgeon between 2009 and 2016 with a minimum 2 year follow up. Kaplan Meir analysis was performed using mortality as the end point. Log rank testing was used to determine if the indication for surgery conferred a difference in survival. Results One hundred and ninety-eight consecutive cases were done using a tapered modular uncemented stem in 183 patients and were followed up for a mean period of 51.8 months (range, 24-121). Sixty patients died (67 % survivorship) during the follow up period with a 5-year survival rate of 78 %. Revision surgery performed for aseptic loosening had the best survival and hemiarthroplasty had the worst and differences in survival were statistically significant (P = 0.000002). Conclusion The indication for revision surgery is an important criterion which must be given weightage along with age, functional status of patient and ASA physical status score while planning revision surgery and counselling patients.
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Affiliation(s)
- Gihan Jayasinghe
- Queen Elizabeth The Queen Mother Hospital, Ramsgate Road, Margate, CT9 4AN, UK
| | - Rohit Kumar
- William Harvey Hospital, Kennington Road, Willesborough, Ashford, TN24 0LZ, UK
| | - Chris Buckle
- Queen Elizabeth The Queen Mother Hospital, Ramsgate Road, Margate, CT9 4AN, UK
| | - Parthiban Vinayakam
- Queen Elizabeth The Queen Mother Hospital, Ramsgate Road, Margate, CT9 4AN, UK
| | - Richard Slack
- Queen Elizabeth The Queen Mother Hospital, Ramsgate Road, Margate, CT9 4AN, UK
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Domingue G, Warren D, Koval KJ, Riehl JT. Complications of Hip Hemiarthroplasty. Orthopedics 2023; 46:e199-e209. [PMID: 36719411 DOI: 10.3928/01477447-20230125-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hip hemiarthroplasty is a commonly performed orthopedic surgery, used to treat proximal femur fractures in the elderly population. Although hip hemiarthroplasty is frequently successful in addressing these injuries, complications can occur. Commonly seen complications include dislocation, periprosthetic fracture, acetabular erosion, and leg-length inequality. Less frequently seen complications include neurovascular injury and capsular interposition. This article presents a comprehensive review of the complications associated with the management of hip hemiarthroplasty. [Orthopedics. 2023;46(4):e199-e209.].
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Klasan A, Millar J, Quayle J, Farrington B, Misur PN. Comparable outcomes of in-cement revision and uncemented modular stem revision for Vancouver B2 periprosthetic femoral fracture at 5 years. Arch Orthop Trauma Surg 2022; 142:1039-1046. [PMID: 33575925 DOI: 10.1007/s00402-021-03776-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Periprosthetic femoral fractures (PFF) are detrimental for patients. Vancouver B2 fractures about a cemented stem can be revised to a longer uncemented stem or using an in-cement revision, if the cement mantle is adequate. There are reports documenting the success of both techniques. The aim of this single centre study was to perform a direct comparison of these two procedures. MATERIALS AND METHODS A retrospective study of consecutive Vancouver B2 PFFs around a cemented stem during 16 years was performed. All study cases were treated either using an in-cement revision or with an uncemented stem revision. Preoperatively, the groups were compared based upon age, gender, ASA, BMI, and Charlson comorbidity score. The outcome measures were surgical time, complications, in-hospital stay, revisions, 1-year readmission rate, and survivorship. RESULTS After a median of 3.5 years, there were 70 patients in the uncemented and 31 in the in-cement group. There was no difference in any of the preoperative variables. Surgical time was shorter for in-cement revisions by a mean of 45 min (p < 0.001). There was no difference in in-hospital stay, surgical complications or readmissions. Implant survival at 5 years was 93.5% for the in-cement and 94.4% for the uncemented revision (p = 0.946). Patient survivorship at 5 years was 62.5% for the in-cement and 69.8% for the uncemented group (p = 0.094). CONCLUSIONS This study demonstrates that in-cement revision is a valid treatment option for Vancouver B2 fractures, comparable to uncemented stem revision, if certain criteria are met. There was no difference in revision rate, patient survivorship, complications, readmissions or in-hospital stay.
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Affiliation(s)
- Antonio Klasan
- North Shore Hospital, Auckland, New Zealand. .,Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria. .,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
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5
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Kennedy JW, Ng NYB, Young D, Kane N, Marsh AG, Meek RMD. Cement-in-cement femoral component revision : a comparison of two different taper-slip designs with medium-term follow up. Bone Joint J 2021; 103-B:1215-1221. [PMID: 34192939 DOI: 10.1302/0301-620x.103b7.bjj-2020-1953.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Cement-in-cement revision of the femoral component represents a widely practised technique for a variety of indications in revision total hip arthroplasty. In this study, we compare the clinical and radiological outcomes of two polished tapered femoral components. METHODS From our prospectively collated database, we identified all patients undergoing cement-in-cement revision from January 2005 to January 2013 who had a minimum of two years' follow-up. All cases were performed by the senior author using either an Exeter short revision stem or the C-Stem AMT high offset No. 1 prosthesis. Patients were followed-up annually with clinical and radiological assessment. RESULTS A total of 97 patients matched the inclusion criteria (50 Exeter and 47 C-Stem AMT components). There were no significant differences between the patient demographic data in either group. Mean follow-up was 9.7 years. A significant improvement in Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-item Short-Form Survey (SF-12) scores was observed in both cohorts. Leg lengths were significantly shorter in the Exeter group, with a mean of -4 mm in this cohort compared with 0 mm in the C-Stem AMT group. One patient in the Exeter group had early evidence of radiological loosening. In total, 16 patients (15%) underwent further revision of the femoral component (seven in the C-Stem AMT group and nine in the Exeter group). No femoral components were revised for aseptic loosening. There were two cases of femoral component fracture in the Exeter group. CONCLUSION Our series shows promising mid-term outcomes for the cement-in-cement revision technique using either the Exeter or C-Stem AMT components. These results demonstrate that cement-in-cement revision using a double or triple taper-slip design is a safe and reliable technique when used for the correct indications. Cite this article: Bone Joint J 2021;103-B(7):1215-1221.
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Affiliation(s)
| | - Nigel Y B Ng
- Queen Elizabeth University Hospital, Glasgow, UK
| | - David Young
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
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Malahias MA, Mancino F, Agarwal A, Roumeliotis L, Gu A, Gkiatas I, Togninalli D, Nikolaou VS, Alexiades MM. Cement-in-cement technique of the femoral component in aseptic total hip arthroplasty revision: A systematic review of the contemporary literature. J Orthop 2021; 26:14-22. [PMID: 34276146 DOI: 10.1016/j.jor.2021.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/27/2021] [Indexed: 10/21/2022] Open
Abstract
Background Clinical outcomes of cemented femoral stems revisions using the cement-in-cement technique in aseptic conditions after total hip arthroplasty have been widely described. Methods The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried. Results Twelve articles were included (620 revision THA). Revision rate for complications related to the femoral side was 1.4% at mid-term follow-up (5.4 years). Periprosthetic femoral fracture rate was 1.1%, aseptic loosening of the femoral component 0.3%. Conclusions Cement-in-cement revision technique of the femoral component is associated with a high mid-term success rates (98.6%) and is potentially less challenging than other revision techniques.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.,Department of Orthopedics and Traumatology, Clinica ARS Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | - Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amil Agarwal
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington, DC, 20037, USA
| | - Leonidas Roumeliotis
- Department of Trauma and Orthopaedics, Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Ioannis Gkiatas
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Danilo Togninalli
- Department of Orthopedics and Traumatology, Clinica ARS Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | - Vasileios S Nikolaou
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Michael M Alexiades
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
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Ceynowa M, Zerdzicki K, Klosowski P, Zrodowski M, Pankowski R, Roclawski M, Mazurek T. The cement-bone bond is weaker than cement-cement bond in cement-in-cement revision arthroplasty. A comparative biomechanical study. PLoS One 2021; 16:e0246740. [PMID: 33571251 PMCID: PMC7877659 DOI: 10.1371/journal.pone.0246740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022] Open
Abstract
This study compares the strength of the native bone-cement bond and the old-new cement bond under cyclic loading, using third generation cementing technique, rasping and contamination of the surface of the old cement with biological tissue. The possible advantages of additional drilling of the cement surface is also taken into account. Femoral heads from 21 patients who underwent a total hip arthroplasty performed for hip arthritis were used to prepare bone-cement samples. The following groups of samples were prepared. A bone—cement sample and a composite sample of a 6 weeks old cement part attached to new cement were tested 24 hours after preparation to avoid bone decay. Additionally, a uniform cement sample was prepared as control (6 weeks polymerization time) and 2 groups of cement-cement samples with and without anchoring drill hole on its surface, where the old cement polymerized for 6 weeks before preparing composite samples and then another 6 weeks after preparation. The uniaxial cyclic tension-compression tests were carried out using the Zwick-Roell Z020 testing machine. The uniform cement sample had the highest ultimate force of all specimens (n = 15; Rm = 3149 N). The composite cement sample (n = 15; Rm = 902 N) had higher ultimate force as the bone-cement sample (n = 31; Rm = 284 N; p <0.001). There were no significant differences between composite samples with 24 hours (n = 15; Rm = 902 N) and 6 weeks polymerization periods (n = 22; Rm = 890 N; p = 0.93). The composite cement samples with drill hole (n = 16; Rm = 607 N) were weaker than those without it (n = 22; Rm = 890 N; p < 0.001). This study shows that the bond between the old and new cement was stronger than the bond between cement and bone. This suggests that it is better to leave the cement that is not loosened from the bone and perform cement in cement revision, than compromising bone stock by removal of the old cement with the resulting weaker cement-bone interface. The results support performing cement-in-cement revision arthroplasty The drill holes in the old cement mantle decrease cement binding strength and are not recommended in this type of surgery.
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Affiliation(s)
- Marcin Ceynowa
- Department of Orthopedic Surgery, Medical University of Gdańsk, Gdańsk, Poland
- * E-mail:
| | - Krzysztof Zerdzicki
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdańsk, Poland
| | - Pawel Klosowski
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdańsk, Poland
| | - Maciej Zrodowski
- Department of Orthopedic Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Rafal Pankowski
- Department of Orthopedic Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Marek Roclawski
- Department of Orthopedic Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Mazurek
- Department of Orthopedic Surgery, Medical University of Gdańsk, Gdańsk, Poland
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Xará-Leite F, Pereira AD, Andrade R, Sarmento A, Sousa R, Ayeni OR, Espregueira-Mendes J, Soares D. The cement-in-cement technique is a reliable option in hip arthroplasty revision surgery: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:7-22. [PMID: 32666308 DOI: 10.1007/s00590-020-02736-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The cement-in-cement technique for revision hip arthroplasty has many potential advantages and has recently gained widespread interest but still lacks evidence to support it. Our aim was to examine the surgical and patient-reported outcomes after cement-in-cement revision hip arthroplasty. MATERIALS AND METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and EMBASE databases were searched up to February 2019 for original studies reporting the outcomes of revision hip arthroplasty surgeries using the cement-in-cement technique. The methodological quality was assessed using the methodological index for non-randomized studies scale. RESULTS Sixteen non-comparative studies met the eligibility criteria, comprising 1899 hips in 1856 patients (72.2 mean age, 37% male), with a mean follow-up of 7.2 years. Most studies reported only primary revisions and focused on the stem component. Intraoperative complications such as femoral or acetabular fractures (5.3%) were low and easily manageable with no relevant sequelae, as were dislocation rates (2.8% of uncomplicated events and 1.6% of cases requiring re-revision). Failure (considered if there was aseptic loosening of the cement-in-cement revised component, 2%), re-revision (9.3%), implant survival and late complication rates were favourable. Functional patient-reported outcomes showed an overall improvement above the minimal clinically important difference at final follow-up. CONCLUSION The cement-in-cement technique is a viable option for hip arthroplasty revision surgery with low intraoperative and late complication rates, dislocations and immediate post-operative morbidity, resulting in good functional patient-reported outcomes and favourable medium-term implant survival.
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Affiliation(s)
- Francisco Xará-Leite
- GRIP Unit, Orthopaedics Department, Centro Hospitalar e Universitário do Porto, Largo do Prof Abel Salazar, 4099-001, Porto, Portugal.
| | | | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Faculty of Sports, University of Porto, Porto, Portugal
| | - André Sarmento
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Orthopaedics Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Sousa
- GRIP Unit, Orthopaedics Department, Centro Hospitalar e Universitário do Porto, Largo do Prof Abel Salazar, 4099-001, Porto, Portugal
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Orthopaedics Department, Minho University, Minho, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Daniel Soares
- GRIP Unit, Orthopaedics Department, Centro Hospitalar e Universitário do Porto, Largo do Prof Abel Salazar, 4099-001, Porto, Portugal
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Optimizing humeral stem fixation in revision reverse shoulder arthroplasty with the cement-within-cement technique. J Shoulder Elbow Surg 2020; 29:S9-S16. [PMID: 32360178 DOI: 10.1016/j.jse.2020.01.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 01/21/2020] [Accepted: 01/28/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to report on the clinical outcomes of patients undergoing revision reverse shoulder arthroplasty (RSA) by the cement-within-cement technique, as well as to identify whether surgical technique can affect subsequent humeral loosening. METHODS In 98 patients, cemented humeral components that were revised to RSA using the cement-within-cement technique were identified and included in this study. We compared 8 patients in whom humeral stem loosening developed with 90 patients whose stem remained fixed. Preoperative and postoperative radiographs of each patient were downloaded in DICOM (Digital Imaging and Communications in Medicine) format and analyzed in Mimics. The total area of the cement mantle (in square millimeters) and of the stem (in square millimeters), as visualized on 2-dimensional plain films, was measured in each subject on both preoperative and postoperative radiographs. Outcomes at a minimum of 2 years of follow-up were analyzed. RESULTS Clinical outcomes were available in 57 patients, with a mean follow-up period of 54 months (range, 21-156 months). Patients demonstrated significantly improved functional outcome scores and shoulder range of motion. In the group without loosening, the mean increase in the cement mantle area was 4380 ± 12701 mm2 (P < .0001). In the group with loosening, the mean increase in the cement mantle area was only 811 ± 4014 mm2 (P = .484). CONCLUSIONS Use of the cement-within-cement technique for fixation of the humeral component in revision RSA is effective in improving functional outcome scores and shoulder range of motion. Furthermore, these findings suggest that efforts to maximize the cement volume during reimplantation may lessen the chance of humeral stem loosening requiring additional revision.
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10
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Berg AJ, Hoyle A, Yates E, Chougle A, Mohan R. Cement-in-cement revision with the Exeter Short Revision Stem: A review of 50 consecutive hips. J Clin Orthop Trauma 2020; 11:47-55. [PMID: 32001984 PMCID: PMC6985006 DOI: 10.1016/j.jcot.2019.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022] Open
Abstract
Revision of a well-fixed cemented femoral stem is technically challenging. The Exeter Short Revision Stem (SRS) was developed to facilitate cement-in-cement revision mitigating some of these challenges. We present the short to mid-term results of 50 cement-in-cement revisions performed with this implant. A retrospective review of all cement-in-cement revision with the Exeter SRS, at our institution, over a seven-year period between 2007 and 2014 was conducted. Records were assessed for radiological and clinical component loosening at greater than 12 months follow-up and for revision and complications at all time points. An Oxford Hip Score (OHS) and Numeric Rating Scale (NRS) for groin and thigh pain at rest and initial mobilisation were obtained. 50 implants in 46 patients were identified. Radiographic and clinical follow-up was available for 42 and 38 implants respectively at greater than 12 months. Mean radiographic follow-up was 5.1 years and clinical 4.9 years. There was no radiographic or clinical evidence of loosening. 3 revisions were performed, one for each of recurrent dislocation, infection and stem breakage. Median OHS was 39 (IQR 12) and mean NRS for groin pain at rest and initial mobilisation was 1.7 and 1.7 respectively and NRS for thigh pain at rest and initial mobilisation was 1.3 and 1.6 respectively with mean follow-up of 6.9 years. The Exeter SRS provides a viable option for cement-in-cement stem revision, with low revision, complication and loosening rates and good patient reported outcomes at short to mid-term follow up.
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Affiliation(s)
- Andrew J. Berg
- Department of Trauma and Orthopaedics, North Manchester General Hospital, Pennine Acute Hospitals NHS Foundation Trust, Delaunays Road, Manchester, M8 5RB, UK
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11
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Kumar A, Porter M, Shah N, Gaba C, Siney P. Outcomes of Cement in Cement Revision, in Revision Total Hip Arthroplasty. Open Access Maced J Med Sci 2019; 7:4059-4065. [PMID: 32165952 PMCID: PMC7061388 DOI: 10.3889/oamjms.2019.710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The cement-in-cement femoral revision technique involves removing a femoral component from a well-fixed femoral cement mantle and cementing a new stem into the original mantle. This technique, when carried out for the correct indications, is fast, relatively inexpensive and carries a reduced short-term risk for the patient compared with conventional way of removing well-fixed cement. AIM To analyze the effectiveness of cement in cement revision of the femoral stem while performing a revision Total Hip Arthroplasty (THA). METHODS We analyzed a consecutive series of 79 patients who underwent a cement in cement revision THA between June-2015 to June-2018. All the patients were retrospectively analysed for operative time, complications, clinical and radiological outcomes. RESULTS Average age was 76 years (49-86). The mean follow-up was 16.2 months (12-45). The average operative time was 184.6 (90-290) minutes. Most common indication was cup loosening in 28 patients (42.4%), dislocation in 14 patients (21.2%) and stem loosening in 12 patients (18.2%) Nine patients (11%) had one or more complications. Pre-operatively, 10 patients (13%) had lucency at the cement bone interface. Recent review has shown that 8 of these patients' radiographs have remained unchanged, and in 2 of them there is a slight progression of lucency. Common post op clinical complaintswere persistent pain and abductor weakness. Five (6.3%) patients required a re-revision. Most of the patients had a good or satisfactory outcome.No stems showed radiological loosening. CONCLUSION The cement-in-cement technique for revision of the femoral component gave promising results and had the advantages of speed, less blood or bone stock loss, less risk of femoral perforation or fracture, decreased financial costs and reduced post op morbidity.
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Affiliation(s)
- Abhijeet Kumar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | - Martyn Porter
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | - Nikhil Shah
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | | | - Paul Siney
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
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12
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Bayam L, Drampalos E, Nagai H, Kay P. Conversion of Failed Hip Hemiarthroplasty to Low Friction Arthroplasty (LFA). J Clin Med 2019; 8:jcm8040503. [PMID: 31013731 PMCID: PMC6518126 DOI: 10.3390/jcm8040503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 03/31/2019] [Accepted: 04/10/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose: We aimed to study clinical and radiological outcomes of conversion from hemiarthroplasty to Charnley hip replacement (CHR) with a particular concern over reported increased dislocation rate and literature review. Conversion of hip hemiarthroplasty to total hip replacement (THR) is a procedure reported to have high rates of complications. In the literature, there is no specific study on small head conversion. The purpose of this study was to evaluate the conversion of failed hip hemiarthroplasty to CHR with the use of modern implants. Methods: The study included 42 patients, who underwent the above procedure. The operations were carried out using a modern Charnley-type THR with a 22-mm diameter of femoral head and a trans-trochanteric approach. The mean follow-up was 75.7 months (range 25–171). Radiographs from the last follow up were evaluated for loosening and other reasons of failure. Clinical outcome was assessed using postoperative pain, function scores, complications and implant survivorship as well as radiological evaluation. Charnley’s modified pain and mobility scoring system were used for clinical and Hodgkinson and Harris’ criteria were used for radiological assessment. Results: Functionally, all of the patients showed improvement. Mean improvement in the pain level was by average of 2.4. On mobility assessment, 38 patients (90.4%) improved. Three patients (7.1%) had recurrent infections and three (4.8%) cases were treated with revision surgery and pseudarthrosis. Further complications occurred in 19.1%, not requiring operative treatment. On radiological evaluation, one (2.4%) case showed cup demarcation without bone loss, two (4.8%) cup migration, and one (2.4%) stem demarcation. Kaplan Meier survival analysis showed a survival of 90% at 96 months of follow up (95% CI (confidence interval), 60–90). Conclusion: Larger head might not be the answer to decrease the dislocation rate. Complication rates during revision of hip hemiarthroplasty to modern CHR with 22.225-mm head diameter were comparable to first-time THR revision despite having a smaller head.
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Affiliation(s)
- Levent Bayam
- Orthopaedics, Sakarya University, Sakarya 54100, Turkey.
- Orthopaedics, Manchester University Hospitals, Manchester M23 9LT, UK.
| | | | - Hajime Nagai
- Orthopaedics, Wrightington Hospital, Wigan WN6 9EP, UK.
| | - Peter Kay
- Orthopaedics, Wrightington Hospital, Wigan WN6 9EP, UK.
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13
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Abstract
AIMS This study describes and compares the operative management and outcomes in a consecutive case series of patients with dislocated hemiarthroplasties of the hip, and compares outcomes with those of patients not sustaining a dislocation. PATIENTS AND METHODS Of 3326 consecutive patients treated with hemiarthroplasty for fractured neck of femur, 46 (1.4%) sustained dislocations. Of the 46 dislocations, there were 37 female patients (80.4%) and nine male patients (19.6%) with a mean age of 83.8 years (66 to 100). Operative intervention for each, and subsequent dislocations, were recorded. The following outcome measures were recorded: dislocation; mortality up to one-year post-injury; additional surgery; residential status; mobility; and pain score at one year. RESULTS Of 43 dislocations, 30 (70%) occurred within one month and 42 (98%) occurred within three months of hip fracture surgery. Seven (16%) of these patients were treated with a single closed reduction and sustained no further dislocations. Four (9%) were treated with open reduction and experienced no further dislocations. Three (7%) hips were left dislocated and the remaining 32 (74%) patients required additional surgery of further closed reduction, revision, or excision arthroplasty. The one-year mortality rates for patients treated with two or fewer reductions (open or closed), successful revision arthroplasty, and excision arthroplasty were 3/14 (21%), 1/7 (14%), and 8/14 (57%) respectively. The only statistically significant difference in mortality was the difference between patients who did not sustain a dislocation and those who did and were treated by excision arthroplasty (p = 0.03). Patients treated by excision arthroplasty had the greatest reduction in mobility scores and highest pain scores. The excision arthroplasty group also included the greatest proportion of patients not able to mobilize and the smallest proportion of patients remaining in their own home. CONCLUSION Most dislocations of hemiarthroplasties of the hip occur within one month of surgery. Closed reduction is generally unsuccessful. For those patients with unsuccessful closed reduction, revision arthroplasty should be considered when possible, as this results in a better functional outcome with a lower mortality than excision arthroplasty.
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Affiliation(s)
- J R Gill
- Department of Orthopaedics, Peterborough and Stamford Hospital NHS Foundation Trust, Peterborough City Hospital, Peterborough, UK
| | - B Kiliyanpilakkill
- Department of Orthopaedics, Peterborough and Stamford Hospital NHS Foundation Trust, Peterborough City Hospital, Peterborough, UK
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14
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Stott PM, Parikh S. Techniques for the Management of Failed Surgery for Fractures of the Neck of Femur. Open Orthop J 2018; 11:1223-1229. [PMID: 29290860 PMCID: PMC5721322 DOI: 10.2174/1874325001711011223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 12/03/2022] Open
Abstract
Background: The majority of modern surgical treatments for managing hip fracture in the elderly are successful and result in a very low rate of revision surgery. Subsequent operations are however occasionally necessary. Optimal management of complications such as infection, dislocation or failed fixation is critical in ensuring that this frail patient group is able to survive their treatment and return to near normal function. Methods: This paper is a discussion of techniques, tips and tricks from a high volume hip fracture unit Conclusion: This article is a technique-based guide to approaching the surgical management of failed hip fracture treatment and includes sections on revising both failed fixation and failed arthroplasty.
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Affiliation(s)
- Philip M Stott
- Brighton and Sussex University Hospitals, Eastern Rd, Brighton, BN25BE, England
| | - Sunny Parikh
- Brighton and Sussex University Hospitals, Eastern Rd, Brighton, BN25BE, England
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15
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Wagner ER, Houdek MT, Hernandez NM, Cofield RH, Sánchez-Sotelo J, Sperling JW. Cement-within-cement technique in revision reverse shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:1448-1453. [PMID: 28233712 DOI: 10.1016/j.jse.2017.01.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/02/2017] [Accepted: 01/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the complications and results of cement-within cement-humeral fixation in revision reverse shoulder arthroplasty. METHODS In 38 shoulders, a cemented humeral component was revised to a cemented reverse humeral component using a cement-within-cement technique. The mean follow-up time was 3.7 (2.0-7.0) years. Clinical, radiologic, and hard outcomes were assessed using the Kaplan-Meier survival method, Fisher exact test, and Student t-test. RESULTS The average operative time for the cement-within-cement technique was 153 minutes. There were 7 (18%) nondisplaced intraoperative fractures involving the greater tuberosity that occurred on implant removal; all healed at last follow-up. A second revision surgery was performed in 3 (8%) patients who underwent cement-in-cement humeral component revision for glenoid loosening (n = 1), periprosthetic instability associated with glenoid loosening (n = 1), and periprosthetic humerus fracture (n = 1). The overall implant revision-free survival at 2 and 5 years was 95% and 91%, respectively. Patients experienced significant pain relief, improvements in their shoulder range of motion, and high satisfaction. There was 1 "at-risk" humeral component (grade 4 or higher humeral lucency, moderate subsidence) that did not undergo revision surgery. There were 2 other humeral components with grade 3 humeral lucency, no subsidence. CONCLUSIONS Cement-within-cement fixation of the humeral component in revision reverse shoulder arthroplasty is associated with a reasonable operative time, good medium-term survival rates, and good pain relief and functional outcomes with low complications. This technique is an important consideration to preserve humeral bone stock and potentially humeral component and implant stability.
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Affiliation(s)
- Eric R Wagner
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matthew T Houdek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Robert H Cofield
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - John W Sperling
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA.
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16
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Manktelow ARJ, Gehrke T, Haddad FS. Hip surgery - state of the art: Totally Hip 2017: Gothenburg. Bone Joint J 2017; 99-B:1-2. [PMID: 28363887 DOI: 10.1302/0301-620x.99b4.bjj-2017-0188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 11/05/2022]
Affiliation(s)
| | - T Gehrke
- HELIOS ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
| | - F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
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Sandiford NA, Jameson SS, Wilson MJ, Hubble MJW, Timperley AJ, Howell JR. Cement-in-cement femoral component revision in the multiply revised total hip arthroplasty: results with a minimum follow-up of five years. Bone Joint J 2017; 99-B:199-203. [PMID: 28148661 DOI: 10.1302/0301-620x.99b2.bjj-2016-0076.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 10/06/2016] [Indexed: 11/05/2022]
Abstract
AIMS We present the clinical and radiological results at a minimum follow-up of five years for patients who have undergone multiple cement-in-cement revisions of their femoral component at revision total hip arthroplasty (THA). PATIENTS AND METHODS We reviewed the outcome on a consecutive series of 24 patients (10 men, 14 women) (51 procedures) who underwent more than one cement-in-cement revision of the same femoral component. The mean age of the patients was 67.5 years (36 to 92) at final follow-up. Function was assessed using the original Harris hip score (HHS), Oxford Hip Score (OHS) and the Merle D'Aubigné Postel score (MDP). RESULTS The mean length of follow-up was 81.7 months (64 to 240). A total of 41 isolated acetabular revisions were performed in which stem removal facilitated access to the acetabulum, six revisions were conducted for loosening of both components and two were isolated stem revisions (each of these patients had undergone at least two revisions). There was significant improvement in the OHS (p = 0.041), HHS (p = 0.019) and MDP (p = 0.042) scores at final follow-up There were no stem revisions for aseptic loosening. Survival of the femoral component was 91.9% (95% confidence intervals (CI) 71.5 to 97.9) at five years and 91.7% (95% CI 70 to 97) at ten years (number at risk 13), with stem revision for all causes as the endpoint. CONCLUSION Cement-in-cement revision is a viable technique for performing multiple revisions of the well cemented femoral component during revision total hip arthroplasty at a minimum of five years follow-up. Cite this article: Bone Joint J 2017;99-B:199-203.
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Affiliation(s)
- N A Sandiford
- St Georges Hospital, Blackshaw Road, London SW17 0QT, UK
| | - S S Jameson
- The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
| | - M J Wilson
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK
| | - M J W Hubble
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK
| | - A J Timperley
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK
| | - J R Howell
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK
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18
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Total hip replacement for hip fracture: Surgical techniques and concepts. Injury 2016; 47:2060-2064. [PMID: 27451289 DOI: 10.1016/j.injury.2016.06.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 06/26/2016] [Indexed: 02/02/2023]
Abstract
When treating a hip fracture with a total hip replacement (THR) the surgical technique may differ in a number of aspects in comparison to elective arthroplasty. The hip fracture patient is more likely to have poor bone stock secondary to osteoporosis, be older, have a greater number of co-morbidities, and have had limited peri-operative work-up. These factors lead to a higher risk of complications, morbidity and perioperative mortality. Consideration should be made to performing the THR in a laminar flow theatre, by a surgeon experienced in total hip arthroplasty, using an anterolateral approach, cementing the implant in place, using a large head size and with repair of the joint capsule. Combined Ortho-geriatric care is recommended with similar post-operative rehabilitation to elective THR patients but with less expectation of short length of stay and consideration for fracture prevention measures.
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