Aseptic Revision of Total Hip Arthroplasty With a Single Modular Femoral Stem and a Modified Extended Trochanteric Osteotomy-Treatment Assessment With the Forgotten Joint Score-12

Background

Aseptic loosening is among the most common reasons for revision total hip arthroplasty (RTHA). Modular revision stems implanted through an extended trochanteric osteotomy (ETO) promise good results, but patient-reported outcome measures (PROMs) are rarely conveyed. This study used the Forgotten Joint Score-12 (FJS-12) to assess patient-reported outcome in patients who had undergone RTHA for aseptic stem loosening using a modified ETO approach with a tapered, fluted modular stem.

Material and methods

A single-center analysis of aseptic RTHA was performed (2007–2019). Clinical results (range of motion, walking ability, function), radiographic results (ETO healing, stem subsidence), and PROMs (FJS-12, Harris Hip Score, European Quality of Life 5D Score) were assessed. Minimum follow-up duration was 1 year. Complications including revisions were recorded.

Results

Primary outcome parameters were assessed on 72 patients (mean age 73.3 years, mean body mass index 27.6kg/m²). Additional PROMs were collected by phone interviews from 41 patients (mean follow-up 5.7 years). In 76%, leg length was restored, and a normal gait was achieved. After 1 year, the ETO was healed in 93%; subsidence occurred in 8.3% of cases. The mean FJS-12 at the final follow-up was 85.6 ± 23.6, and the respective Harris Hip Score and European Quality of Life 5D Score averaged 87 ± 17.8 and 72.9 ± 15.9. Complication and revision rates were 33.3% and 13.9%, respectively.

Conclusion

Aseptic RTHA as presented here resulted in excellent PROMs in the medium term. FJS-12 score averaged 85.6 with a mean follow-up of 5.7 years. Treatment using a modular implant and a modified ETO was associated with good clinical and radiographic outcomes. Complication and revision rates were 33.3% and 13.9%, respectively.

Mid-term outcomes following transfemoral revision of total hip arthroplasty for Vancouver B2/B3 periprosthetic fractures

INTRODUCTION

Periprosthetic femoral fractures (PFF) are often the reason for revising total hip arthroplasty (RTHA). Converting these fractures into modified extended trochanteric osteotomy (mETO) facilitates stem revision. Modular revision stems are a common choice with good results. We present mid-term outcomes in patients undergoing RTHA for Vancouver B2/B3 PFF using a tapered, fluted modular stem with an mETO approach.

MATERIALS AND METHODS

A single-center analysis of patients with RTHA for Vancouver B2/B3 PFF using a single modular implant with mETO was performed (2007 - 2019). Clinical outcome (mobility, range of motion, function), radiological outcome (fracture healing, stem subsidence) and patient reported outcome measures (FJS-12, HHS, EQ-5D) were assessed.

RESULTS

Ninety-seven patients (mean age 78.1 years, BMI 25.8 kg/m², 85.6% B2-fractures) were included; 80 patients had complete clinical and radiological follow-ups. Normal unaided gait without limping was achieved in 38/80 patients. After one year fracture / mETO healing occurred in 74/80 patients; 5.3 years after surgery, the respective FJS-12, HHS and EQ-5D (available in 34 patients) averaged 81.3 ± 30.2, 71.4 ± 18.7 and 0.8 ± 0.2. We documented 7 in-hospital deaths, 18.8% postoperative complications and 13.8% revisions with stem revisions being most commonly for subsequent PFF or subsidence.

CONCLUSION

Good clinical and radiological outcomes and rather low complication and revision rates (18.8% and 13.8%) were achieved. FJS-12 showed excellent results in patients undergoing RTHA for Vancouver B2/B3 PFF using a cementless, dual modular titanium revision stem and an mETO approach. Joint awareness was thereby similar to previously reported primary THA results at 5.3 years follow-up.

Modified Extended Trochanteric Osteotomy for the Treatment of Vancouver B2/B3 Periprosthetic Fractures of the Femur

BACKGROUND

Femoral component revision is the treatment of choice for Vancouver type B2/B3 periprosthetic femur fractures (PFFs). The purpose of this study was to report the clinical outcome of revision total hip arthroplasty with the use of a modified extended trochanteric osteotomy (ETO) in PFF treatment.

METHODS

A total of 43 cases between 2000 and 2014 were analyzed. Clinical and radiographic evaluation was performed with a mean follow-up of 40 months. Patient survival after revision surgery, complications, radiographic outcomes, and quality of life and hip function were assessed.

RESULTS

Merle d'Aubignè and Postel score averaged 15, and mean postoperative Harris hip score was 70. Radiographic evaluation revealed that the ETO and fractures healed in all but 1 patient within 9 months. Component stability and apparent osseointegration were not coincident with healing of the osteotomy and fracture sites proximal to the inserted stem. Six patients (15%) developed postoperative complications, which included the following: 1 nonunion with progressive subsidence, 2 hip dislocations, 2 deep infections, and 1 breakage of the modular junction of the revision stem.

CONCLUSION

The modified ETO with a lateral approach to the hip for the treatment of PFF is compatible with fracture healing, a low dislocation rate, and good clinical results. However, component stability and apparent osseointegration are coincident with fracture healing only in the distal aspect of the inserted stem. Absence of proximal osseointegration might lead to poor osseous support resulting in inadequate fatigue strength at the junction of the dual modular revision stem.

Reoperations and late adverse outcome in Marfan patients following cardiovascular surgery☆

OBJECTIVES

Anulo-aortic ectasia represents the most common cardiovascular manifestation requiring surgery in Marfan patients. Aim of this report was to analyze the type of presentation and the incidence of cardiovascular lesions and the clinical follow-up after initial surgery, mainly aortic root repair or replacement.

METHODS

Between 1/1990 and 6/2003 a total of 71 patients (mean age 29+/-17 years, 8-65 years) received first surgical treatment at our institution. 69 received root repair or replacement. 22 patients presented with acute aortic dissection (31%), out of them, 3 pregnant females and 1 just after delivery. Composite graft replacement was performed in the majority of patients (61/71, 85%). Aortic valve sparing root repair was performed in 7 patients, supra-coronary graft with refixation of the aortic valve in 2 and replacement of the descending aorta in 1 patient. All patients underwent close clinical and imaging follow-up in a specialized outpatient consultation.

RESULTS

During a mean follow-up interval of 5.2+/-1.8 years, 14 patients (20.5%) underwent a total of 27 aortic reoperations. Seven patients had one and 6 patients had up to 4 reoperations; 13/14 patients had chronic aortic dissection. There was no hospital mortality and no major cardiac or neurologic morbidity following reoperation. During follow-up, 2 patients suffered from acute type B dissection following aortic root surgery and 3 patients surprisingly died: 2 from a rupture of a normal-sized descending aorta and one from intracranial hemorrhage. These 5 patients had had uncomplicated primary aortic root operation.

CONCLUSIONS

The incidence of reoperations is significantly higher in patients who presented initially with acute type A aortic dissection than in those with dilatation only. In addition, this survey demonstrates that unexpected fatal outcome may appear in the remaining native aorta following uncomplicated elective aortic root surgery, even if the aorta is normal-sized. A close follow-up of all Marfan patients is necessary to detect asymptomatic changes requiring surgery because complex elective redo-operations can be performed with a very low perioperative risk.