Abstract
Objective
Biological repair of femoral bone loss using bone impaction grafting. Reconstruction of the centre of rotation of the hip using a cemented stem, the size and offset of which are at the discretion of the surgeon.
Indications
Femoral implant loosening with bone loss.
Contraindications
Infection, neurological disorders, noncompliant patient.
Surgical technique
Extraction of the loose femoral implant, cortical reconstruction using meshes if required, impaction bone grafting with special instruments, cement fixation of a polished tapered stem.
Postoperative management
Individualized period of bed rest and limited weight bearing.
Results
Impaction bone grafting and a cemented polished stem were used to perform 33 femoral reconstructions. After a mean follow-up of 15 years, no femoral reconstruction had to be revised. One unrecognized intraoperative fracture healed after nonsurgical treatment, three postoperative femoral fractures healed after plate fixation with the stem left in situ. The average Harris Hip Score improved from 49 prior to surgery to 85 points thereafter. Kaplan–Meier analysis with femoral revision for any reason as the end point showed a survival rate of 100 %.
Zusammenfasssung
Operationsziel
Biologische Rekonstruktion von Knochenverlusten des Femurs mittels Impaction-Bone-Grafting-Technik. Rekonstruktion des Hüftrotationszentrums mit einem zementierten Schaft, dessen Länge und Offset im Ermessen des Operateurs liegen.
Indikationen
Femurimplantatlockerung mit Knochenverlust.
Kontraindikationen
Infektion, neurologische Erkrankungen, unkooperativer Patient.
Operationstechnik
Entfernung des gelockerten Femurimplantats, Kortikalisrekonstruktion, ggf. mit Netzen, Impaction-Bone-Grafting-Technik mit speziellen Instrumenten, Zementfixation eines angeschliffenen, abgeschrägten Schafts.
Weiterbehandlung
Individualisierte Phase der Bettruhe und Teilbelastung.
Ergebnisse
Die Impaction-Bone-Grafting-Technik mit zementierten, angeschliffenen Schaft wurden für 33 Femurrekonstruktionen verwendet. Bei einer durchschnittlichen Nachbeobachtungsphase von 15 Jahren musste keine Femurrekonstruktion revidiert werden. Eine unerkannte intraoperative Fraktur heilte unter konservativer Behandlung aus, 3 postoperative Femurfrakturen heilten nach Plattenfixation mit in situ belassenem Schaft. Der durchschnittliche Harris-Hip-Score verbesserte sich von präoperativ 49 auf postoperativ 85 Punkte. Die Kaplan-Meier-Analyse bei Femurrevision aus jeglichem Grund als Endpunkt ergab eine Überlebensrate von 100 %.
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References
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Compliance with ethical guidelines
Conflict of interest. A commercial entity, Stryker, paid or directed, or agreed to pay or direct benefits to a research fund, foundation, educational institution or other charitable or nonprofit organization with which the authors are affiliated or associated. The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits, or a commitment or agreement to provide such benefits from a commercial entity. I.C. Heyligers, B.W. Schreurs and E.H. van Haaren state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.
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Heyligers, I., Schreurs, B. & van Haaren, E. Femoral revision with impaction bone grafting and a cemented polished tapered stem. Oper Orthop Traumatol 26, 156–161 (2014). https://doi.org/10.1007/s00064-013-0272-1
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DOI: https://doi.org/10.1007/s00064-013-0272-1