A novel hybrid type (custom-made plus off-the-shelf) total femoral PROSTALAC

Total femur replacement, indications for the procedure and its complications: a systematic review

INTRODUCTION

Total femur replacement (TFR) is a solution that allows orthopedic surgeons to address the most complicated cases in hip, femur, and knee reconstruction. Complete femur prostheses are used in both oncologic patients with femur tumors that require resection and in cases of complicated prosthetic failure with massive bone defects. TFR is an alternative to hip disarticulation that allows the patient to spare the limb and preserve its function. However, the indications for surgery vary and the procedure has been reported to present a high risk of serious complications.

MATERIALS AND METHODS

We follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. An electronic database was searched for articles reporting indications, complications, and primary diagnoses prior to TFR. We reviewed study type, number of patients, and complications reported in the study.

RESULTS

15 articles including 651 patients were analyzed. Primary diagnoses before TFR can be divided into two groups: oncological and non-oncological. In some articles, there is no clear demarcation between the indications for the surgery and the primary diagnosis prior to TFR. The most common primary diagnosis in oncological patients was osteosarcoma (48,3%) and in non-oncological patients it was osteoarthritis (42,2%). The most common indications for the procedure were oncological (50,8%), followed by fracture (17,1%) and loosening (8,9%). The most common categories of postoperative complications were infection (32,4%), soft tissue failure (13,9%), and dislocation (12,9%).

CONCLUSION

Surgeons must be aware of the high risks of complications related to the procedure and should qualify their patients after careful mutual consideration and with a personal approach to potential risks and an overall prognosis. All percussions should be made to avoid periprosthetic infection as main complication. After the surgery any findings indicating possible infection should be investigated to avoid implant failure. High risk of dislocation indicates that more constrained or dual-mobility cups should be considered.

Articulating spacers: what are available and how to utilize them?

Periprosthetic joint infection (PJI) is the most devastating complication following total joint arthroplasty (TJA) and is posing a global healthcare challenge as the demand for TJA mounts. Two-stage exchange arthroplasty with the placement of antibiotic-loaded spacers has been shown to be efficacious against chronic PJI. This study aimed to review the key concepts, types, and outcome evaluations of articulating spacers in the two-stage exchange for PJI. Previous studies indicated that articulating spacers have been widely used due to better functional improvement and a comparable infection control rate relative to static spacers. Several types of articulating spacers are reportedly available, including hand-made spacers, spacers fashioned from molds, commercially preformed spacers, spacers with additional metal or polyethylene elements, new or autoclaved prosthesis, custom-made articulating spacers, and 3D printing-assisted spacers. However, limited evidence suggested no significant difference in clinical outcomes among the different subtypes of articulating spacers. Surgeons should be familiar with different treatment strategies when using various spacers to know which is the most appropriate.

Creating a dual articulating antibiotic spacer for management of an infected total femur prosthesis hemiarthroplasty

The gold standard for management of chronic periprosthetic joint infections is a 2-stage revision arthroplasty with the first stage being explantation, debridement, and placement of a spacer. While there are implants designed to manage periprosthetic infections in hip and knee arthroplasty, there are not any commercially available implants designed to specifically manage an infected total femur megaprosthesis. This creates a unique surgical challenge and requires custom construction of a spacer to be performed by the surgeon intraoperatively. Here, we present our surgical technique for manufacturing a dual articulating total femur spacer. This technique facilitates range of motion at both the hip and knee joints, provides stability for axial loading in the extremity, and preserves the acetabulum while the patient undergoes antibiotic therapy to eradicate the infection.

Complications with cement spacers in 2-stage treatment of periprosthetic joint infection on total hip replacement

INTRODUCTION

The aim of the present study was to assess our management of infected total hip replacement in indications for 2-stage surgical treatment according to current guidelines when a cement spacer has been used. The study hypothesis was that the complications rate related to cement spacers is low.

MATERIAL AND METHOD

A single-center retrospective study included 26 patients receiving a spacer between the two stages of total hip replacement, over a 5 year period. We analyzed the spacers used, mechanical complications, infectious complications and the second stage of surgery.

RESULTS

During the interval between surgeries, in the 26 patients, there were 19 spacer-related mechanical complications (73% of patients): 11 dislocations (42.3%), 5 spacer fractures (19.2%), 5 femoral bone lyses or fractures (19.2%) and 3 acetabular lyses or fractures (11.5%). In 4 cases, complications were associated. The greater the femoral offset of the spacer, the more frequent were femoral bone lyses or fractures (p=0.05), and the smaller the offset the more frequent were acetabular lyses or fractures (p=0.05). The rates of mechanical complications (p=0.003) and spacer fracture (p=0.02) were significantly greater in older patients. There were 4 cases of reinfection (19%): i.e., an 81% treatment success rate. One reinfection implicated a new bacterium: methicillin-susceptible Staphylococcus aureus. The second surgical stage was significantly longer in complex bipolar revision (p=0.009).

CONCLUSION

The present results showed a high risk of spacer-related complications, and thus the importance of selection of patients liable to derive real benefit and those for whom a Gilderstone procedure would be preferable.

LEVEL OF EVIDENCE

IV, retrospective study.