46 results on '"femoral bone loss"'
Search Results
2. Recognizing Anterior Metaphyseal Femoral Bone Loss During Uncemented Total Hip Arthroplasty: The Skylight Sign
- Author
-
HARWIN, STEVEN F.
- Published
- 2007
3. The Effects of Severe Femoral Bone Loss on the Flexion Extension Joint Space in Revision Total Knee Arthroplasty: A Cadaveric Analysis and Clinical Consequences
- Author
-
Kenneth A. Krackow and William M. Mihalko
- Subjects
musculoskeletal diseases ,Knee Joint ,Medial Collateral Ligament, Knee ,Knee Injuries ,Osteoarthritis ,Arthritis, Rheumatoid ,Joint capsule ,Cadaver ,medicine ,Humans ,Orthopedics and Sports Medicine ,Femur ,Tibia ,Range of Motion, Articular ,Arthroplasty, Replacement, Knee ,Aged ,Retrospective Studies ,Aged, 80 and over ,Flexion contracture ,Medial collateral ligament ,business.industry ,Anatomy ,Middle Aged ,Osteoarthritis, Knee ,musculoskeletal system ,medicine.disease ,Treatment Outcome ,medicine.anatomical_structure ,Ligament ,Osteoporosis ,Female ,Surgery ,business ,Joint Capsule - Abstract
Five revision total knee arthroplasties (TKAs) involving severe femoral bone loss were performed in 1 994. Each had sufficiently severe femoral bone loss in which collateral ligament origins and posterior capsular attachments were violated. A paradoxical phenomenon was observed in each case. Unlike primary TKAs, in which larger distal femoral bone resection leads to laxity of the knee joint in extension, these cases with severe distal femora! bone loss, after initial component selection, developed the opposite situation, a flexion contracture. It was hypothesized that femoral bone loss involving collateral ligament origins would permit distraction of the tibia below the femur with the knee held in flexion, but when the knee was brought to full extension, intact posterior structures would maintain a normal tibia! position. To investigate this hypothesis, six fresh-frozen cadaveric lower limbs were tested in full extension and 45° and 90° of flexion after release of the femoral attachments of the collateral ligaments and the posterior capsule from the femur. Joint space changes were measured via a motion tracking device. Results showed that with loss of collateral attachments, 17.2±8.9 mm of joint space is created in 90° of flexion, whereas the joint space in full extension is conserved (1.5±1.7 mm). With additional loss of the posterior capsule, the joint space at 90° of flexion increased to 26.2±6.1 mm, with minimal changes in the extension gap (3.4±0.8 mm). Distal femoral bone loss was associated with an increase in the flexion gap compared to the extension gap.
- Published
- 2001
4. Algorithmic approach for reconstruction of proximal femoral bone loss in revision total hip arthroplasty
- Author
-
Wael K. Barsoum, William N. Capello, and Carlos A. Higuera
- Subjects
Bone Transplantation ,Calcar ,business.industry ,Radiography ,Arthroplasty, Replacement, Hip ,Anatomy ,Metaphysis ,Decision Support Systems, Clinical ,Combined Modality Therapy ,Diaphysis ,medicine.anatomical_structure ,Femur Head Necrosis ,Ectasia ,Bone Substitutes ,medicine ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Femur ,Implant ,Hip Prosthesis ,business ,Algorithms ,Fixation (histology) - Abstract
Reconstruction of the femur depends on the quantity of bone loss and the quality of the remaining bone stock. Multiple classifications and reporting systems can be used to characterize the bone defect. We present a simple algorithmic approach for proximal femoral bone loss reconstruction during revision total hip arthroplasty. Quantity of bone loss is assessed using radiographs based on different classification systems, whereas quality of the remaining bone stock is assessed intraoperatively. Based on the type of proximal bone loss and the quality of the available bone, we describe our preferred reconstruction technique. For minor bone loss, the metaphysis is expanded but intact with partially absent calcar. There is minimal bone loss anteriorly and posteriorly, and the diaphysis is intact. For significant bone loss, the metaphysis is compromised, and there is no calcar. There is minimal bone loss anteriorly and posteriorly. The available proximal bone may be thin, sclerotic, and incapable of support. However, the diaphysis is intact. For massive bone loss, there is complete circumferential bone loss in the metaphysis, extending to the diaphysis. The anterolateral bone and supporting subtrochanteric metaphyseal bone are absent. The metaphysis is not stable and will not offer rotational stability. There is massive bone loss anteriorly and posteriorly. The stability of the implant is dependent on distal diaphyseal fixation. For complete proximal bone loss, there is extensive circumferential segmental bone loss proximally and extensive cavitary loss involving the entire diaphysis. Additionally, there is extensive ectasia of the diaphysis.
- Published
- 2009
5. Recognizing anterior metaphyseal femoral bone loss during uncemented total hip arthroplasty: the skylight sign
- Author
-
Steven F Harwin
- Subjects
musculoskeletal diseases ,Adult ,Male ,Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Metaphysis ,medicine ,Humans ,Orthopedics and Sports Medicine ,Femur ,Prospective Studies ,Bone Resorption ,Intraoperative Complications ,Cementation ,Aged ,Aged, 80 and over ,business.industry ,Middle Aged ,Skylight ,medicine.disease ,Arthroplasty ,Surgery ,Osteopenia ,Radiography ,medicine.anatomical_structure ,Hip bone ,Orthopedic surgery ,Female ,business ,Femoral Fractures ,Sign (mathematics) - Abstract
During preparation for uncemeted femoral arthroplasty, a phenomenon has been observed that it in dicates thinning of anterior metaphyseal bone to a critical level light can be seen from within the canal passing through the anterior cortex. This skylight sign alerts the surgeon that a cortical defect or fracture can occur on reaming broaching, or component insertion. In 420 consecutive anthroplasties, a skylig sign was remoted in 97 (23%) hips. In 5 of those hips an oval cortical detect was created and in 3 hips a fracture occured during broaching or inserticon. Loosening developed in 1 hip with fracture. No fractures or defects ocurred in hips without a skylight sign. If a skylight sign is present, the featur is at risk, and preventive measures should be taken.
- Published
- 2007
6. The effects of severe femoral bone loss on the flexion extension joint space in revision total knee arthroplasty: a cadaveric analysis and clinical consequences.
- Author
-
Krackow KA and Mihalko WM
- Subjects
- Aged, Aged, 80 and over, Arthritis, Rheumatoid physiopathology, Arthritis, Rheumatoid surgery, Cadaver, Female, Humans, Joint Capsule injuries, Knee Injuries physiopathology, Knee Joint anatomy & histology, Knee Joint physiopathology, Knee Joint surgery, Medial Collateral Ligament, Knee anatomy & histology, Middle Aged, Osteoarthritis, Knee physiopathology, Osteoarthritis, Knee surgery, Osteoporosis, Range of Motion, Articular, Retrospective Studies, Treatment Outcome, Arthroplasty, Replacement, Knee, Femur pathology, Medial Collateral Ligament, Knee physiopathology
- Abstract
Five revision total knee arthroplasties (TKAs) involving severe femoral bone loss were performed in 1994. Each had sufficiently severe femoral bone loss in which collateral ligament origins and posterior capsular attachments were violated. A paradoxical phenomenon was observed in each case. Unlike primary TKAs, in which larger distal femoral bone resection leads to laxity of the knee joint in extension, these cases with severe distal femoral bone loss, after initial component selection, developed the opposite situation, a flexion contracture. It was hypothesized that femoral bone loss involving collateral ligament origins would permit distraction of the tibia below the femur with the knee held in flexion, but when the knee was brought to full extension, intact posterior structures would maintain a normal tibial position. To investigate this hypothesis, six fresh-frozen cadaveric lower limbs were tested in full extension and 45 degrees and 90 degrees of flexion after release of the femoral attachments of the collateral ligaments and the posterior capsule from the femur. Joint space changes were measured via a motion tracking device. Results showed that with loss of collateral attachments, 17.2+/-8.9 mm of joint space is created in 90 degrees of flexion, whereas the joint space in full extension is conserved (1.5+/-1.7 mm). With additional loss of the posterior capsule, the joint space at 90 degrees of flexion increased to 26.2+/-6.1 mm, with minimal changes in the extension gap (3.4+/-0.8 mm). Distal femoral bone loss was associated with an increase in the flexion gap compared to the extension gap.
- Published
- 2001
- Full Text
- View/download PDF
7. Algorithmic Approach for Reconstruction of Proximal Femoral Bone Loss in Revision Total Hip Arthroplasty
- Published
- 2009
- Full Text
- View/download PDF
8. Recognizing Anterior Metaphyseal Femoral Bone Loss During Uncemented Total Hip Arthroplasty: The Skylight Sign
- Published
- 2007
- Full Text
- View/download PDF
9. Algorithmic Approach for Reconstruction of Proximal Femoral Bone Loss in Revision Total Hip Arthroplasty
- Published
- 2009
- Full Text
- View/download PDF
10. Recognizing Anterior Metaphyseal Femoral Bone Loss During Uncemented Total Hip Arthroplasty: The Skylight Sign.
- Published
- 2007
- Full Text
- View/download PDF
11. Salvage of failed total hip arthroplasty with proximal femoral replacement.
- Author
-
Savvidou, Olga D, Mavrogenis, Andreas F, Sakellariou, Vasilios, Christogiannis, Ioannis, Vottis, Christos, Christodoulou, Michael, Vlasis, Konstantinos, and Papagelopoulos, Panayiotis J
- Abstract
EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Identify the available types of reconstruction for failed total hip arthroplasty. 2. Summarize the preoperative workup of patients with failed total hip arthroplasty and massive proximal femoral bone loss. 3. Assess the surgical technique of proximal femoral replacement for failed total hip arthroplasty. 4. Recognize treatment complications, patient outcomes, and survival of proximal femoral megaprostheses for revision of failed total hip arthroplasty. Despite recent advances in device manufacturing and surgical techniques, the management of proximal femoral bone loss in revision total hip arthroplasty remains challenging. Currently, failed total hip arthroplasty in elderly and less active patients, nonunion of the proximal femur with multiple failed attempts at osteosynthesis, resection arthroplasty, and massive proximal femoral bone loss can be salvaged with proximal femoral replacement using a megaprosthesis. The procedure is technically demanding and requires careful preoperative planning. Instability and aseptic loosening are the major complications, especially in younger and more active patients. The new generation of modular proximal femoral replacement megaprostheses and the increased experience obtained with these surgeries have reduced complication rates and improved outcomes. [Orthopedics. 2014; 37(10):691-698.]. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
12. Short-term Outcomes of 3D-Printed Titanium Metaphyseal Cones in Revision Total Knee Arthroplasty.
- Author
-
Remily, Ethan A., Dávila Castrodad, Iciar M., Mohamed, Nequesha S., Wilkie, Wayne A., Kelemen, Margaret N., and Delanois, Ronald E.
- Subjects
FEMUR surgery ,KNEE surgery ,TIBIA surgery ,PROSTHETICS ,TOTAL knee replacement ,TIME ,RETROSPECTIVE studies ,RADIOGRAPHY ,ARTIFICIAL joints ,REOPERATION ,KAPLAN-Meier estimator ,TITANIUM ,THREE-dimensional printing ,COMPLICATIONS of prosthesis ,KNEE - Abstract
Recently, 3-dimensional (3D) printing technology has been used in the development of titanium metaphyseal cones to manage severe bone loss in revision total knee arthroplasty (rTKA). This study assessed (1) radiographs; (2) functional outcomes; (3) complications; and (4) 2-year implant survivorship in patients receiving 3D-printed titanium metaphyseal cones for moderate-to-severe tibial and femoral bone loss in rTKA. A single institution, retrospective chart review was performed for patients with large bone defects treated with a 3D-printed femoral or tibial titanium metaphyseal cone between 2015 and 2017 during rTKA (N=54). Paired sample t tests analyzed Knee Society Scores (KSS). Kaplan-Meier analyses determined implant survivorship when the endpoint was cone revision for aseptic loosening, cone revision for any reason, and reoperation for any reason. The authors found that 51 (98.1%) of 52 available radiographs demonstrated well-fixed components without any evidence of loosening or migration. Mean postoperative KSS scores were significantly higher when compared with preoperative scores (80.4 vs 52.0; P>.001). One patient experienced aseptic loosening of their cone. Seven additional cones were explanted as a consequence of reinfection, 1 of which was removed prior to arthrodesis. Cone survivorship was 98.5% when the endpoint was cone revision due to aseptic loosening, 88.2% when cone revision was due to any reason, and 77.9% for any reoperation. Metaphyseal cones appear to be well-suited for large bone defects during rTKA and the authors' findings suggest that cones may be a viable option for metaphyseal fixation during rTKA. Future studies should focus on their durability during a longer time period. [Orthopedics. 2021;44(1):43-47.]. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
13. Primary Cementless Femoral Stems in Conversion Hip Arthroplasty After Failed Fixation of Intertrochanteric Fractures.
- Author
-
Thalody, Hope S., Post, Zachary D., Lutz, Rex W., Czymek, Miranda, Ong, Alvin C., and Ponzio, Danielle Y.
- Abstract
Salvage conversion hip arthroplasty is a viable solution to restore function and reduce pain after failed intertrochanteric hip fracture fixation. Our primary objective was to assess early outcomes achieved with primary cementless metaphyseal-engaging femoral stems for conversion hip arthroplasty compared with revision diaphyseal-engaging stems. This was a retrospective review of 70 patients with failed intertrochanteric hip fractures subsequently managed with conversion total hip arthroplasty or hemiarthroplasty. Thirty-five patients who underwent conversion using a primary cementless stem were compared with 35 patients who underwent conversion using a revision stem. The groups were similar regarding sex, body mass index, American Society of Anesthesiologists classification, preoperative diagnosis, and implants removed. Clinical and radiographic outcomes and complications were compared over a mean follow-up of 6 years. The primary stem cohort had a shorter mean hospital stay (3.03 vs 4.34 days, P=.028). There were no significant differences between the primary and revision cohorts regarding mean time to conversion (2.26 vs 1.75 years, P=.671), operative time (127 vs 131 minutes, P=.611), incidence of discharge to home (54.3% vs 37.1%, P=.23), postoperative complications (5.71% vs 5.71%, P=1.0), reoperations (5.71% vs 11.4%, P=.669), leg length discrepancy (5.33 vs 7.38 mm, P=.210), subsidence (20.0% vs 23.3%, P=.981), and Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement (78.6 vs 81.9, P=.723). We report comparable outcomes of conversion hip arthroplasty with the use of primary cementless and revision stems. Current primary cementless femoral stems may be considered for conversion hip arthroplasty for failed intertrochanteric fracture fixation. [Orthopedics. 2024;47(1):e6–e12.] [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
14. Augments and Void Fillers: Metallica.
- Author
-
Rosenberg, Aaron G.
- Subjects
METALS in surgery ,BONE grafting ,FEMUR surgery ,PROSTHETICS ,SURGICAL instruments - Abstract
The article discusses the importance of metal augments and bone graft in reinforcing mechanical support in bone defects. Metal augments provide structural support for the implant. Femoral augments are designed to fit with femoral components to supplements distal femoral bone loss and allow particulate grafting. Clinical results showed that trabecular metal implants allow maximum intraoperative adaptability.
- Published
- 2006
- Full Text
- View/download PDF
15. The multiply operated patient: last resort solutions.
- Author
-
Cuckler, John M.
- Subjects
TOTAL knee replacement ,ARTHROPLASTY ,KNEE surgery ,SOFT tissue injuries ,ORTHOPEDIC surgery - Abstract
Discusses the clinical considerations and solutions for the management of a patient who has failed multiple attempts at total knee arthroplasty. Treatment for chronic infection of the knee; Procedure to salvage femoral bone loss; Solutions for failed attempts at soft-tissue coverage of the knee; Surgical techniques for fusion of a failed total knee arthroplasty.
- Published
- 2004
- Full Text
- View/download PDF
16. Consistent New Bone Formation in 95 Revisions: Average 9-Year Follow-up.
- Author
-
Mantelos, George, Koulouvaris, Panagiotis, Kotsovolos, Hlias, and Xenakis, Theodoros
- Published
- 2008
- Full Text
- View/download PDF
17. Proximal Fixation With a Modular Stem in Complex Revision THA.
- Author
-
McCarthy, Joseph C. and Lee, Jo-Ann
- Subjects
FRACTURE fixation ,TITANIUM ,FEMUR ,BONE injuries ,POROUS materials - Abstract
The article presents the results of a study which analyzed the outcome of femoral fixation using a modular, proximally coated titanium femoral component in patients with proximal femoral bone loss. The study found that maximum contact and in-growth between host bone and porous coating is needed with cementless fixation to prevent micromotion.
- Published
- 2006
18. The Role of Stem Modularity in the Failure of Internal Fixation in Geriatric Patients With Distally Fixed Hemiarthroplasty.
- Author
-
Çiloglu, Osman and Karaali, Evren
- Subjects
PROSTHETICS ,TOTAL hip replacement ,HEMIARTHROPLASTY ,HIP fractures ,RADIOGRAPHY ,RETROSPECTIVE studies ,EVALUATION research ,ARTIFICIAL joints ,COMPARATIVE studies ,FRACTURE fixation ,BONE regeneration ,COMPLICATIONS of prosthesis - Abstract
The aim of this study was to compare the radiological and clinical outcomes of the same make of modular and monoblock tapered fluted stems in patients with failure of internal fixation following osteoporotic intertrochanteric fracture. This retrospective, comparative study included patients older than 65 years who underwent hemiarthroplasty with a modular or monoblock distally fixed fluted stem and had failed treatment with proximal femoral nailing between 2012 and 2017, with at least a 2-year follow-up period. Radiographic and clinical evaluations of the groups were compared. The modular group comprised 22 males and 18 females with a mean age of 85.05±7.1 years, and the monoblock group comprised 27 males and 17 females with a mean age of 83.27±7.0 years. No significant difference was observed between the groups regarding the preoperative and final-visit Harris Hip Score and Parker and Palmer Mobility Score values (P>.05 for both). More patients showed osseous restoration in the monoblock group, but not to a significant level. The groups were similar regarding mortality rates. Stem length was greater in the modular group, but the proximal femoral part and stem size were similar in the groups (P<.05 for all). Canal filling at levels A, B, and C was negatively correlated (weak) with the proximal femoral bone restoration (P<.001 for all). Canal filling at level B was negatively correlated (weak) with the stress shielding of the femur (P<.05 for all). When comparing the modularity of the stem by minimizing the variations of both prostheses, such as brand and geometric design, there was no significant difference in either clinical or radiological evaluations. [Orthopedics. 2021;44(1):e119-e124.]. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
19. Gluteus Maximus Transfer as an Augmentation Technique for Patients With Severe Abductor Deficiency of the Hip.
- Author
-
Quisquater, Laurent, Timmermans, Annick, Vandenabeele, Frank, Driesen, Ronald, and Corten, Kristoff
- Subjects
MUSCULOSKELETAL system diseases ,BUTTOCKS ,SURGICAL flaps ,SKELETAL muscle ,ORTHOPEDIC surgery ,HIP joint ,GAIT in humans ,PLASTIC surgery ,TREATMENT effectiveness ,QUALITY of life ,LONGITUDINAL method - Abstract
Impaired abductor function of the hip following severe abductor deficiencies can be devastating for functionality and quality of life. Recently, gluteus maximus transfer has been proposed as a solution to these difficult problems. However, outcome results are sparse. The aim of this study was to evaluate the effects of gluteus maximus transfer on improvement of pain, disability, and quality of life in patients with severe hip abductor deficiencies. Gluteus maximus transfer was performed in 16 patients with severe disruption of the abductor muscles of the hip. Data were collected preoperatively and at 6 weeks, 3 and 6 months, and 1 to 2 years after surgery. The measurements pertained to complications, healing of the flap based on magnetic resonance imaging (MRI) findings (in 10 patients), evaluation of Trendelenburg gait and sign, and patient-reported outcome measures of pain, disability, and quality of life. Preoperatively, all patients had a positive Trendelenburg sign and reported severe pain at the level of the greater trochanter. At a mean follow-up of 20 months, the Trendelenburg sign was negative in 7 patients and the Trendelenburg gait had disappeared in 7 patients. There was an improvement in patient-reported outcome measures but not to a significant level except for the pain subscores. Two patients had a postoperative seroma that resulted in a visible bump on the lateral side. Seven of 10 repairs with MRI follow-up showed perfect ingrowth on MRI without signs of rerupture. Gluteus maximus transfer for abductor deficiency of the hip may be effective for pain relief and functional improvements. Most patients showed an improved quality of life but were not completely pain free. [Orthopedics. 2020;43(4):e299-e305.]. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
20. Survivorship of the Modular Femoral Revision Stem.
- Author
-
Shah, Ritesh R., Cipparrone, Nancy E., Parilla, Frank W., Robinson, Matthew G., Gordon, Alexander C., and Goldstein, Wayne M.
- Subjects
ARTIFICIAL joints ,FEMUR ,BONE fractures ,PROSTHETICS ,COMPLICATIONS of prosthesis ,REOPERATION ,TIME ,TOTAL hip replacement ,RETROSPECTIVE studies ,KAPLAN-Meier estimator - Abstract
The geriatric population represents a rapidly growing segment of society with prolonged life expectancies and more active lifestyles. Many of these patients have already undergone primary total hip arthroplasty (THA) and are presenting with aseptic loosening, polyethylene wear, osteolysis, or periprosthetic fractures. Therefore, the demand for hip revision procedures is expected to grow. Currently, there are many modular implant options available for use in complicated revision THA. Early results of modular femoral revision systems are promising for the treatment of the deficient femur in complex revision THA. The objective of this study was to evaluate component survivorship of a modular femoral revision system in revision THA. A retrospective review was conducted using electronic health records of patients who underwent revision THA performed by 1 of 3 surgeon investigators from 2010 through 2014. The authors included all patients who underwent a revision THA using a specific modular femoral revision system. The authors evaluated component survivorship and time to re-revision THA. Fifty-one revision THAs were included. Seven patients required a second revision THA (13.7%; 95% confidence interval, 4%-23%). Mean time to re-revision THA was 4.88±3.9 months. Kaplan-Meier survivorship using re-revision for any reason was 86.3% at 60 months. This study showed excellent component survivorship of the specific modular femoral revision system in revision THA. [Orthopedics. 2019; 42(5):294-298.]. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
21. Salvage of failed total hip arthroplasty with proximal femoral replacement
- Author
-
Andreas F. Mavrogenis, Christos Vottis, Panayiotis J. Papagelopoulos, Vasilios Sakellariou, Olga D. Savvidou, Michael Christodoulou, Konstantinos Vlasis, and Ioannis Christogiannis
- Subjects
musculoskeletal diseases ,Male ,Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Nonunion ,Salvage therapy ,Pain ,Thigh ,Resection arthroplasty ,medicine ,Humans ,Orthopedics and Sports Medicine ,Femur ,Treatment Failure ,Bone Resorption ,Aged ,Salvage Therapy ,Osteosynthesis ,business.industry ,Plastic Surgery Procedures ,medicine.disease ,Arthroplasty ,Surgery ,Prosthesis Failure ,medicine.anatomical_structure ,Complication ,business ,Total hip arthroplasty - Abstract
Educational Objectives As a result of reading this article, physicians should be able to: 1. Identify the available types of reconstruction for failed total hip arthroplasty. 2. Summarize the preoperative workup of patients with failed total hip arthroplasty and massive proximal femoral bone loss. 3. Assess the surgical technique of proximal femoral replacement for failed total hip arthroplasty. 4. Recognize treatment complications, patient outcomes, and survival of proximal femoral megaprostheses for revision of failed total hip arthroplasty. Despite recent advances in device manufacturing and surgical techniques, the management of proximal femoral bone loss in revision total hip arthroplasty remains challenging. Currently, failed total hip arthroplasty in elderly and less active patients, nonunion of the proximal femur with multiple failed attempts at osteosynthesis, resection arthroplasty, and massive proximal femoral bone loss can be salvaged with proximal femoral replacement using a megaprosthesis. The procedure is technically demanding and requires careful preoperative planning. Instability and aseptic loosening are the major complications, especially in younger and more active patients. The new generation of modular proximal femoral replacement megaprostheses and the increased experience obtained with these surgeries have reduced complication rates and improved outcomes. [ Orthopedics. 2014; 37(10):691–698.]
- Published
- 2013
22. Short-term Outcomes of 3D-Printed Titanium Metaphyseal Cones in Revision Total Knee Arthroplasty
- Author
-
Iciar M. Dávila Castrodad, Ronald E. Delanois, Margaret N Kelemen, Nequesha S. Mohamed, Ethan A. Remily, and Wayne A. Wilkie
- Subjects
Male ,Reoperation ,musculoskeletal diseases ,3d printed ,medicine.medical_specialty ,Time Factors ,Knee Joint ,Radiography ,Arthrodesis ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Prosthesis Design ,03 medical and health sciences ,0302 clinical medicine ,Chart review ,medicine ,Humans ,Orthopedics and Sports Medicine ,Femur ,030212 general & internal medicine ,Arthroplasty, Replacement, Knee ,Aged ,Retrospective Studies ,Fixation (histology) ,Aged, 80 and over ,Titanium ,030222 orthopedics ,Tibia ,business.industry ,Middle Aged ,Prosthesis Failure ,Surgery ,Printing, Three-Dimensional ,Orthopedic surgery ,Female ,sense organs ,Implant ,Knee Prosthesis ,business ,Revision total knee arthroplasty - Abstract
Recently, 3-dimensional (3D) printing technology has been used in the development of titanium metaphyseal cones to manage severe bone loss in revision total knee arthroplasty (rTKA). This study assessed (1) radiographs; (2) functional outcomes; (3) complications; and (4) 2-year implant survivorship in patients receiving 3D-printed titanium metaphyseal cones for moderate-to-severe tibial and femoral bone loss in rTKA. A single institution, retrospective chart review was performed for patients with large bone defects treated with a 3D-printed femoral or tibial titanium metaphyseal cone between 2015 and 2017 during rTKA (N=54). Paired sample t tests analyzed Knee Society Scores (KSS). Kaplan–Meier analyses determined implant survivorship when the endpoint was cone revision for aseptic loosening, cone revision for any reason, and reoperation for any reason. The authors found that 51 (98.1%) of 52 available radiographs demonstrated well-fixed components without any evidence of loosening or migration. Mean postoperative KSS scores were significantly higher when compared with preoperative scores (80.4 vs 52.0; P >.001). One patient experienced aseptic loosening of their cone. Seven additional cones were explanted as a consequence of reinfection, 1 of which was removed prior to arthrodesis. Cone survivorship was 98.5% when the endpoint was cone revision due to aseptic loosening, 88.2% when cone revision was due to any reason, and 77.9% for any reoperation. Metaphyseal cones appear to be well-suited for large bone defects during rTKA and the authors' findings suggest that cones may be a viable option for metaphyseal fixation during rTKA. Future studies should focus on their durability during a longer time period. [ Orthopedics . 2021;44(1):43–47.]
- Published
- 2021
23. Femoral Component Revision of Total Hip Arthroplasty.
- Author
-
Brown, Jonathon M., Mistry, Jaydev B., Cherian, Jeffrey J., Elmallah, Randa K., Chughtai, Morad, Harwin, Steven F., and Mont, Michael A.
- Subjects
TOTAL hip replacement ,TREATMENT effectiveness ,HIP osteoarthritis ,BONE resorption ,PERIPROSTHETIC fractures - Abstract
Modern primary total hip arthroplasty (THA) is among the most successful operations in medicine. It has been a consistently effective treatment for end-stage osteoarthritis of the hip. With the increasing number of primary THA procedures being performed and the decreasing age of patients undergoing the procedure, there is an inevitable associated increase in revision burden for arthroplasty surgeons. Revision THA is most often indicated for instability, aseptic loosening, osteolysis, infection, periprosthetic fracture, component malposition, and catastrophic implant failure. Understanding the etiology of THA failure is essential for guiding clinical decision making. Femoral component revision presents a complex challenge to the arthroplasty surgeon because of modern implant design as well as bone loss in the proximal femur. Thorough patient evaluation, defect classification, and well-executed surgical reconstruction based on comprehensive preoperative planning may determine the postoperative results. Knowledge of various reconstructive options and the indications for each is necessary to achieve a successful outcome. This article highlights the most common indications for revision after THA and offers recommendations for how to approach revision of the femoral component. Specifically, the authors review preoperative assessment, common classification systems for femoral deficiency, techniques for component extraction, and modalities of femoral component fixation. [Modern primary total hip arthroplasty (THA) is among the most successful operations in medicine. It has been a consistently effective treatment for end-stage osteoarthritis of the hip. With the increasing number of primary THA procedures being performed and the decreasing age of patients undergoing the procedure, there is an inevitable associated increase in revision burden for arthroplasty surgeons. Revision THA is most often indicated for instability, aseptic loosening, osteolysis, infection, periprosthetic fracture, component malposition, and catastrophic implant failure. Understanding the etiology of THA failure is essential for guiding clinical decision making. Femoral component revision presents a complex challenge to the arthroplasty surgeon because of modern implant design as well as bone loss in the proximal femur. Thorough patient evaluation, defect classification, and well-executed surgical reconstruction based on comprehensive preoperative planning may determine the postoperative results. Knowledge of various reconstructive options and the indications for each is necessary to achieve a successful outcome. This article highlights the most common indications for revision after THA and offers recommendations for how to approach revision of the femoral component. Specifically, the authors review preoperative assessment, common classification systems for femoral deficiency, techniques for component extraction, and modalities of femoral component fixation. [Orthopedics. 2016; 39(6):e1129–e1139.] [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
24. This month's module: Hip and Knee Arthroplasty.
- Subjects
ARTHROPLASTY ,TOTAL hip replacement - Abstract
Presents a quiz about hip and knee arthroplasty.
- Published
- 2004
25. Revision Total Knee Arthroplasty Using Metaphyseal Sleeves at Short-term Follow-up.
- Author
-
Huang, Ronald, Barrazueta, Gustavo, Ong, Alvin, Orozco, Fabio, Jafari, Mehdi, Coyle, Catelyn, and Austin, Matthew
- Abstract
The treatment of bone loss in revision total knee arthroplasty (TKA) has involved using revision implants in association with cement, augments, particulate, and structural allograft. Newer metaphyseal augments were introduced to allow for metaphyseal fixation of the prosthesis while managing significant bone loss. The purpose of the current study was to evaluate the outcome of revision TKA using metaphyseal sleeves. The authors prospectively followed 96 knees that underwent revision TKA with metaphyseal sleeves. Eighty-three knees met the minimum 2-year criteria for follow-up. Thirty-six sleeves were used in femoral revisions and 83 sleeves were used in tibial revisions. The defects were classified according to the Anderson Orthopaedic Research Institute classification. Femoral defects were classified as type I in 4 knees, type IIb in 25 knees, and type III in 7 knees. Tibial defects were classified as type I in 9 knees, type IIa in 1 knee, type IIb in 68 knees, and type III in 5 knees. The patients were followed for an average of 2.4 years (range, 2.0-3.7 years). Mean Knee Society function score improved from 47.9 to 61.1 points. Mean Short Form 36 physical score improved from 43.3 to 56.3 points. Mean Western Ontario and McMaster Universities Arthritis Index improved from 55.3 to 25.9 points. None of the implants demonstrated progressive radiolucent lines around the metaphyseal sleeves. At final follow-up, only 2 (2.7%) tibial components required revision for aseptic loosening. At short-term follow-up, revision TKA with metaphyseal sleeves provided reliable fixation. This is especially encouraging given the severe nature of bone loss in the majority of patients in whom a metaphyseal sleeve was used. Long-term follow-up is needed to demonstrate the true effectiveness of these devices. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
26. Effect of Medial Epicondylar Osteotomy on Soft Tissue Balancing in Total Knee Arthroplasty.
- Author
-
Mihalko, William M., SAEKI, KAZUHIKO, and WHITESIDE, LEO A.
- Abstract
Balancing and surgical exposure of a severe varus knee during total knee arthroplasty (TKA) can be difficult. Use of a medial epicondylar osteotomy to solve these problems has been reported. This study compared knee stability in cadaveric specimens afterTKA, after medial epicondylar osteotomy, and after conventional subperiosteal release of the medial collateral ligament (MCL). Five cadaveric knees were tested after TKA, after medial epicondylar osteotomy, and after repair of the osteotomy to compare the results to 5 cadaveric knees that underwent complete subperiosteal release of the MCL. A retrospective review of clinical cases also was performed of 118 varus knees exposed using the standard medial parapatellar approach and subperiosteal release of the MCL to compare results to the literature using a medial epicondylar osteotomy. Coronal and transverse plane laxity increased significantly at 60° and 90° flexion in the knees after medial epicondylar osteotomy. Suture repair of the osteotomy did not affect stability. The knees with MCL release had a significantly lower degree of coronal and transverse plane laxity at 60° and 90° than knees with an epicondylar osteotomy. The retrospective case review found satisfactory exposure and correct ligament balance was achieved in all cases. The findings of this study question the need for an epicondylar osteotomy in severe varus osteoarthritic knees. Because the knee remains unstable in flexion after this technique, an implant with higher constraint should be used. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
27. Endo-Modell Rotating-hinge Total Knee for Revision Total Knee Arthroplasty.
- Author
-
Bistolfi, Alessandro, ROSSO, FEDERICA, CROYA, MAURIZIO, and MASSAZZA, GIUSEPPE
- Published
- 2013
- Full Text
- View/download PDF
28. Outcome and Complications of Constrained Acetabular Components.
- Author
-
YANG, CAO and GOODMAN, STUART B.
- Published
- 2009
- Full Text
- View/download PDF
29. Histologic Analysis of Allograft Mixed With Hydroxyapatite-Tricalcium Phosphate Used in Revision Femoral Impaction Bone Grafting.
- Author
-
Fujishiro, Takkaki, Nishikawa, Tetsuo, Takahiro, Niikura, Takikawa, Satoshi, Saegusa, Yasuhiro, Kurosaka, Masahiro, and Bauer, Thomas W.
- Published
- 2008
- Full Text
- View/download PDF
30. The Effect of a Collared Prosthesis on Aseptic Loosening and Proximal Femoral Bone Resorption in Hybrid Total Hip Arthroplasty.
- Author
-
Caglar, Omur, Atilla, Bulent, Tokgozoglu, Mazhar, and Alpaslan, Mumtaz
- Published
- 2008
- Full Text
- View/download PDF
31. Periprosthetic fractures in total hip arthroplasty.
- Author
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Van Flandern, Geoffrey J.
- Subjects
BONE fractures ,HIP joint injuries ,TOTAL hip replacement ,PROSTHETICS ,JOINT surgery ,ARTHROPLASTY - Abstract
Periprosthetic fractures can be discussed in many formats. In this article, epidemiology, classification, and treatment are divided into the following three categories of periprosthetic fracture: intraoperative fractures detected at the time of surgery; intraoperative fractures undetected at the time of surgery, but detected postoperatively; and postoperative fractures occurring late after the arthroplasty procedure. [ABSTRACT FROM AUTHOR]
- Published
- 2005
32. Preventing and managing intraoperative fractures and perforations in hip arthroplasty.
- Author
-
Talmo, Carl T. and Bono, James V.
- Subjects
BONE fracture prevention ,BONE injuries ,SURGICAL complications ,TOTAL hip replacement ,ARTIFICIAL joints ,PROSTHETICS - Abstract
Intraoperative perforation of the femur, a serious complication of hip arthroplasty, encompasses a broad spectrum--from a simple hole in the bone to a displaced fracture with an unstable prosthesis. Although some intraoperative perforations are managed routinely, others are disastrous and often associated with greater morbidity, mortality, increased blood loss, and poor clinical outcome. Appropriate recognition, including an awareness of preoperative risk factors, is paramount to the successful management of these complications. We have found the S-ROM (DePuy Orthopaedics Inc., Warsaw, Ind) prosthesis safe in the prevention of cortical perforation in high-risk patients and effective in managing intraoperative perforation and fracture when it occurs. [ABSTRACT FROM AUTHOR]
- Published
- 2005
33. Histologic and mechanical evaluation of impaction grafting for femoral component revision in a goat model.
- Author
-
Malkani, Arthur L., Voor, Michael J., Hellman, Edward J., Khalily, Cyna, Capello, William, Mei Wang, Bauer, Thomas W., Crawford, Charles H., and Wang, Mei
- Subjects
TOTAL hip replacement ,GOATS as laboratory animals ,HISTOLOGY ,HOMOGRAFTS ,BONE grafting - Abstract
A goat model of revision hip arthroplasty was used to examine the histology and mechanical performance of impaction grafting using two femoral stems varying in stem surface finish. There were no significant mechanical or qualitative histologic differences between smooth, tapered, polished stems and step-cut, grit-blasted stems. Allograft distribution, bone incorporation, and cement mantle thickness were not uniform within the femoral canal. Efforts to improve the impaction grafting technique may be more important than stem design. [ABSTRACT FROM AUTHOR]
- Published
- 2005
34. Preservation of bone mineral density of the proximal femur following hemisurface arthroplasty.
- Author
-
Amstutz, Harlan C., Ebramzadeh, Edward, Sarkany, Akos, Le Duff, Michel, and Rude, Robert
- Subjects
OSTEONECROSIS ,FEMUR surgery ,BONES ,DENSITY ,ARTHROPLASTY - Abstract
Bone mineral density of the proximal femur was measured in six patients who underwent hemisurface replacement for osteonecrosis of the femoral head. Bone mineral density values in operated and contralateral nonoperated hips were compared. In four patients who had sequential examinations, bone mineral density was compared over time. Average patient age was 34.6 years, average follow-up was 9.1 years, and mean follow-up of bone mineral density measurements was 6.6 years. Average bone mineral density variation was 0.0048 to -0.0264 g/cm2 per year in all five regions in nonoperated hips and -0.012 to -0.0300 g/cm2 in operated hips. These results support bone conservation and preservation with hemiresurfacing arthroplasty in young patients with osteonecrosis of the femoral head. [ABSTRACT FROM AUTHOR]
- Published
- 2004
- Full Text
- View/download PDF
35. The Joint Reduction Method of Revision Total Knee Arthroplasty.
- Published
- 2004
- Full Text
- View/download PDF
36. Bipolar reconstruction for recurrent instability of the hip.
- Author
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Nadaud, Matthew C., Fehring, Thomas K., Odum, Susan, Mason, J. Bohannon, Griffin, William L., and McCoy, Thomas H.
- Subjects
TOTAL hip replacement ,HIP surgery ,ARTHROPLASTY ,BIOMEDICAL materials ,PROSTHETICS ,ARTIFICIAL implants ,PLASTIC surgery - Abstract
Between 1986 and 1998, 81 total hip revisions were performed for recurrent instability. Twenty-three revisions were fixed cups to bipolars. Average follow-up was 50 months. Radiographic evaluation showed no significant osteolysis and average migration of 1.7 mm. The average postoperative Harris hip score was 74. All patients who underwent revision to a bipolar prosthesis had no further instability. Acetabular revision to a bipolar prosthesis provides stability in recurrent prosthetic hip instability. [ABSTRACT FROM AUTHOR]
- Published
- 2004
- Full Text
- View/download PDF
37. The Use of Hydroxyapatite on Press-fit Tapered Femoral Stems.
- Author
-
Maheshwari, Aditya V., Ranawat, Amar S., and Ranawat, Chitranjan S.
- Published
- 2008
- Full Text
- View/download PDF
38. The structural allograft composite in revision total knee arthroplasty.
- Author
-
Dennis, Douglas A. and Little, Lance R.
- Subjects
HOMOGRAFTS ,TOTAL knee replacement ,ARTHROPLASTY ,KNEE surgery ,ORTHOPEDIC surgery ,ORTHOPEDICS - Abstract
Although morselized cancellous autograft or allograft has been shown to be highly successful for management of smaller cavitary defects in revision TKA, structural allografts often are required for large, contained, or uncontained osseous defects. Early clinical results of revision TKA using structural allografts have been encouraging with high allograft-host union rates, as long as adequate fixation is obtained. The use of intramedullary stems with sufficient length to engage diaphyseal bone is recommended to lessen load transmission to the structural allograft and to reduce the risk of late allograft collapse or fracture. Extensive preoperative planning, meticulous operative technique, and an extended period of postoperative rehabilitation are required for optimal [ABSTRACT FROM AUTHOR]
- Published
- 2005
- Full Text
- View/download PDF
39. The Short Stem: A Thinking Man's Alternative to Surface Replacement.
- Author
-
Stulberg, S. David and Dolan, Mark
- Published
- 2008
- Full Text
- View/download PDF
40. Extensively Porous-coated Stems: Avoiding Modularity.
- Author
-
Engh Sr, Charles A. and Fenwick, James A.
- Published
- 2008
- Full Text
- View/download PDF
41. The Consequences of Malalignment: Are There Any?
- Author
-
Alden, Kris J. and Pagnano, Mark W.
- Published
- 2008
- Full Text
- View/download PDF
42. Extensively porous coated stems: Res Ipsa Loquitur.
- Author
-
Moreland, John R.
- Subjects
ORTHOPEDIC implants ,HIP surgery ,ARTHROPLASTY ,ARTIFICIAL implants ,ORTHOPEDIC surgery - Abstract
Presents the results of a study on the use of extensively porous coated cobalt-chrome stem for the revision of the femoral component in a failed hip arthroplasty. Durability of the fixation technique; Percentage of bone ingrowth stems that achieved significant thigh pain; Advantages of using extensively porous coated stems.
- Published
- 2005
- Full Text
- View/download PDF
43. The use of extensively coated stems in femoral revision surgery.
- Author
-
Fehring, Thomas K.
- Subjects
CLASSIFICATION ,FEMUR surgery ,FEMUR diseases ,ARTHROPLASTY ,JOINT surgery ,REOPERATION - Abstract
The article presents an evaluation of a classification system for femoral defects and discusses options for surgery. It discusses the femoral revision surgery with the use of extensively coated stems. It enumerates techniques for femoral revision and cites clinical results of revisions with extensively coated stems. It concludes that extensively coated stems is the type to be considered as the gold standard in femoral revision surgery.
- Published
- 2003
- Full Text
- View/download PDF
44. Cemented stem failure requires extended trochanteric osteotomy.
- Author
-
Paprosky, Wayne G. and Martin, Eric L.
- Subjects
BONE cements ,ADHESIVES in surgery ,OSTEOTOMY ,BONE surgery ,ORTHOPEDIC surgery ,FEMUR surgery ,ARTIFICIAL joints ,REOPERATION ,COMPLICATIONS of prosthesis - Abstract
Argues that cemented stem failure requires extended trochanteric osteotomy. Reasons cemented femoral stems may need to be revised; Indications for using an extended trochanteric osteotomy; Belief of critics of the extended trochanteric osteotomy.
- Published
- 2003
- Full Text
- View/download PDF
45. Treating abductor deficiency: a transference technique.
- Author
-
Whiteside, Leo A
- Abstract
Loss of abduction power is a common problem after total hip arthroplasty (THA) and may lead to severe limp and instability. A surgical reconstruction technique using a gluteus maximus flap transfer was developed to repair deficient abductor muscles and capsule. The gluteus maximus muscle was split as in a posterior approach to the hip, and the anterior portion of the muscle was elevated as a flap, separating it from the fascia lata and fashioning a triangular distal fascial end. The lateral surface of the greater trochanter was decorticated, and the anterior half of the gluteus maximus was sutured to the greater trochanter with multiple nonabsorbable sutures through drill holes in the bone. The distal fascial end was sutured beneath the vastus lateralis muscle with heavy absorbable sutures. The posterior portion of the gluteus maximus (approximately one-sixth of the muscle body and half the length) was passed beneath the primary flap to substitute for the gluteus minimus and capsule. The tensioning of the flap was done with the hip in 15° to 20° abduction to ensure adequate tension in the transferred muscle. The lower half of the gluteus maximus muscle and fascia lata were also closed over the greater trochanter and transferred muscle flap with the hip abducted and then closed proximally, leaving the anterior edge of the gluteus maximus flap unsutured so that the transferred muscle would be allowed to pull directly on the greater trochanter. Gradual rehabilitation included 2-handed support for 8 weeks and careful gradual abduction exercises beginning 4 weeks postoperatively. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
46. The effect of collar on aseptic loosening and proximal femoral bone resorption in hybrid total hip arthroplasty.
- Author
-
Caglar O, Atilla B, Tokguzoglu M, Alpaslan M, Caglar, Omur, Atilla, Bulent, Tokgozoglu, Mazhar, and Alpaslan, Mumtaz
- Abstract
This study compared proximal femoral bone resorption in hybrid total hip arthroplasty cases that had poor or good contact between the collar and proximal medial femoral neck. A total of 94 patients (102 hips) comprised the study group. Mean patient age was 52 years, and mean follow-up was 4.86 years. Bone resorption of the proximal femur was evaluated with immediate postoperative and follow-up anteroposterior and lateral radiographs. Statistical analysis using the Mann-Whitney test showed no significant difference between the groups that had good or poor contact. The collar did not prevent calcar resorption even when ideal contact was achieved. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
- View/download PDF
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