Top

International Orthopaedics

Published in:

01-08-2015 | Original Paper

Cementless femoral revision in patients with a previous cemented prosthesis

Authors: Min Zeng, Jie Xie, Mingqing Li, Shaoru Lin, Yihe Hu

Published in: International Orthopaedics | Issue 8/2015

Abstract

Purpose

The aim of this study was to evaluate the effectiveness associated with the use of the cementless femoral revision in patients with a previous cemented prosthesis.

Methods

This study reviewed 92 revision femoral stem performed by a single senior surgeon between January 2006 and December 2012 at our institution. All patients complained of unbearable pain before operation, of which 19 cases had extensively porous-coated revision in Paprosky type I or II femoral defects and 73 had modular tapered revision in type IIIA or IIIB defects. All patients had clinical and radiographic follow-up for an average of 3.9 years (range two to seven years), with a mean age of 62.5 years (range 46–86 years) at surgery.

Results

There was no re-revision for loosening. Complications included delayed wound healing in two (2.2 %) patients, dislocation in four (4.3 %), intra-operative femoral fracture in 11 (12.0 %), and periprosthetic fracture postoperatively in three (3.3 %).The average Harris hip scores (HHS) increased from 38.1 (range 20–70) pre-operatively to 82.5 (range 40–95), and the average visual analog scores (VAS) decreased from 8 .3 (range 4–10) pre-operatively to 1.5 (range 0–5) at final follow-up. Radiographic results including stress shielding, subsidence of the stems, bone ingrowth and prosthesis loosening showed that prostheses were stably fixed postoperatively.

Conclusion

This supported that cementless fixation, with the use of extensively porous-coated stems or modular tapered stems, was efficient in patients with a previous failed cemented stem.

Hartman CW, Garvin KL (2012) Femoral fixation in revision total hip arthroplasty. Instr Course Lect 61:313–325PubMed

Weiss RJ, Stark A, Karrholm J (2011) A modular cementless stem vs. cemented long-stem prostheses in revision surgery of the hip: a population-based study from the Swedish hip arthroplasty register. Acta Orthop 82(2):136–142PubMedCentralPubMedCrossRef

Donaldson AJ, Thomson HE, Harper NJ, Kenny NW (2009) Bone cement implantation syndrome. Br J Anaesth 102(1):12–22PubMedCrossRef

Abdulkarim A, Ellanti P, Motterlini N, Fahey T, O'Byrne JM (2013) Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials. Orthop Rev (Pavia) 5(1):e8CrossRef

Bohm P, Bischel O (2001) Femoral revision with the Wagner SL revision stem: evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years. J Bone Joint Surg Am 83-A(7):1023–1031PubMed

Reikeras O, Gunderson RB (2006) Excellent results with femoral revision surgery using an extensively hydroxyapatite-coated stem: 59 patients followed for 10–16 years. Acta Orthop 77(1):98–103PubMedCrossRef

Duncan WW, Hubble MJ, Howell JR, Whitehouse SL, Timperley AJ, Gie GA (2009) Revision of the cemented femoral stem using a cement-in-cement technique: a five- to 15-year review. J Bone Joint Surg Br 91(5):577–582PubMedCrossRef

Neumann D, Dueckelmann L, Thaler C, Dorn U (2012) Revision total hip arthroplasty using a cementless tapered revision stem in patients with a mean age of 82 years. Int Orthop 36(5):961–965PubMedCentralPubMedCrossRef

Sheth NP, Nelson CL, Paprosky WG (2013) Femoral bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg 21(10):601–612PubMedCrossRef

10.

Pak JH, Paprosky WG, Jablonsky WS, Lawrence JM (1993) Femoral strut allografts in cementless revision total hip arthroplasty. Clin Orthop Relat Res (295): 172–178

11.

Engh CA, Bobyn JD, Glassman AH (1987) Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br 69(1):45–55PubMed

12.

Sporer SM, Paprosky WG (2004) Femoral fixation in the face of considerable bone loss: the use of modular stems. Clin Orthop Relat Res (429):227–231

13.

Engh CA, Massin P, Suthers KE (1990) Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res (257):107–128

14.

Moon KH, Kang JS, Lee SH, Jung SR (2009) Revision total hip arthroplasty using an extensively porous coated femoral stem. Clin Orthop Surg 1(2):105–109PubMedCentralPubMedCrossRef

15.

Woolson ST, Delaney TJ (1995) Failure of a proximally porous-coated femoral prosthesis in revision total hip arthroplasty. J Arthroplasty 10(Suppl):S22–S28PubMedCrossRef

16.

Weber M, Hempfing A, Orler R, Ganz R (2002) Femoral revision using the Wagner stem: results at 2–9 years. Int Orthop 26(1):36–39PubMedCentralPubMedCrossRef

17.

Sporer SM, Paprosky WG (2003) Revision total hip arthroplasty: the limits of fully coated stems. Clin Orthop Relat Res (417):203–209

18.

Richards CJ, Duncan CP, Masri BA, Garbuz DS (2010) Femoral revision hip arthroplasty: a comparison of two stem designs. Clin Orthop Relat Res 468(2):491–496PubMedCentralPubMedCrossRef

19.

Babis GC, Sakellariou VI, O'Connor MI, Hanssen AD, Sim FH (2010) Proximal femoral allograft-prosthesis composites in revision hip replacement: a 12-year follow-up study. J Bone Joint Surg Br 92(3):349–355PubMedCrossRef

20.

Lawrence JM, Engh CA, Macalino GE, Lauro GR (1994) Outcome of revision hip arthroplasty done without cement. J Bone Joint Surg Am 76(7):965–973PubMed

21.

Bugbee WD, Culpepper WN, Engh CJ, Engh CS (1997) Long-term clinical consequences of stress-shielding after total hip arthroplasty without cement. J Bone Joint Surg Am 79(7):1007–1012PubMed

22.

Patel PD, Klika AK, Murray TG, Elsharkawy KA, Krebs VE, Barsoum WK (2010) Influence of technique with distally fixed modular stems in revision total hip arthroplasty. J Arthroplasty 25(6):926–931PubMedCrossRef

23.

Lakstein D, Kosashvili Y, Backstein D, Safir O, Lee P, Gross AE (2010) Revision total hip arthroplasty with a modular tapered stem. Hip Int 20(2):136–142PubMed

24.

Wang L, Dai Z, Wen T, Li M, Hu Y (2013) Three to seven year follow-up of a tapered modular femoral prosthesis in revision total hip arthroplasty. Arch Orthop Trauma Surg 133(2):275–281PubMedCrossRef

25.

Paprosky WG, Greidanus NV, Antoniou J (1999) Minimum 10-year-results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res (369):230–242

Title: Cementless femoral revision in patients with a previous cemented prosthesis
Authors: Min Zeng
Jie Xie
Mingqing Li
Shaoru Lin
Yihe Hu
Publication date: 01-08-2015
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 8/2015
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-015-2696-8

ACC 2024 Congress

Springer Medicine

Cementless femoral revision in patients with a previous cemented prosthesis

Abstract

Purpose

Methods

Results

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2015

Evaluation of transforaminal endoscopic lumbar discectomy in the treatment of lumbar disc herniation

Acute and chronic injuries among senior international rowers: a cross-sectional study

Alterations of tendons in diabetes mellitus: what are the current findings?

Vitamin-E diffused highly cross-linked polyethylene liner compared to standard liners in total hip arthroplasty. A randomized, controlled trial

Assessment of clinical outcome of percutaneous needle quadriceps tenotomy in the treatment of congenital knee dislocation

Revision surgery after third generation autologous chondrocyte implantation in the knee