The management of proximal femoral bone loss is a significant challenge in revision hip arthroplasty. A possible solution is the use of a modular proximal femur endoprosthesis (EPR). Although the survivorship and functional outcome of megaprostheses used in tumour surgery has been well described, outcome of EPRs used in revision hip surgery has received less attention. The aim of this study was to determine the 5-year outcome following proximal femur EPR and determine factors that influence it. This was a retrospective consecutive case series of all EPRs (n=80) performed for non-neoplastic indications, by 6 surgeons, in our tertiary referral centre, between 2005–2014. Patient demographics and relevant clinical details were determined from notes. The most common indications for the use of EPRs included infection (n=40), peri-prosthetic fracture (n=12) and failed osteosynthesis of proximal femoral fractures/complex trauma (n=11). Outcome measures included complication and re-operation rates, implant survival and assessment of functional outcome using the Oxford-Hip-Score (OHS). The mean age at surgery was 69 years and mean follow-up was 4 (0 – 11) years. The mean number of previous hip operations was 2.4 (range: 0 – 17). Twenty-five patients sustained a complication (31%), the most common being infection (n=9) and dislocation (n=4). By follow-up, further surgery was required in 18 (22%) hips, 9 of which were EPR revisions. 5-yr implant survivorship was 87% (95%CI: 76 – 98%). Mean OHS was 28 (range: 4 – 48). Inferior survival and outcome were seen in EPRs performed for the treatment of infection. Infection eradication was achieved in 34/41 with the index EPR procedure and in 40/41 hips by follow-up. Limb salvage was achieved in all cases and acceptable complication- and re-operation rates were seen. EPRs for periprosthetic fractures and failed osteosynthesis had best outcome. We recommend the continued use of proximal femur EPR in complex revision surgery.
Custom-made partial pelvis replacements (PPRs) are increasingly used in the reconstruction of large acetabular defects and have mainly been designed using a triflange approach, requiring extensive soft-tissue dissection. The monoflange design, where primary intramedullary fixation within the ilium combined with a monoflange for rotational stability, was anticipated to overcome this obstacle. The aim of this study was to evaluate the design with regard to functional outcome, complications, and acetabular reconstruction. Between 2014 and 2023, 79 patients with a mean follow-up of 33 months (SD 22; 9 to 103) were included. Functional outcome was measured using the Harris Hip Score and EuroQol five-dimension questionnaire (EQ-5D). PPR revisions were defined as an endpoint, and subgroups were analyzed to determine risk factors.Aims
Methods
The aim of this study was to examine the implant accuracy of custom-made partial pelvis replacements (PPRs) in revision total hip arthroplasty (rTHA). Custom-made implants offer an option to achieve a reconstruction in cases with severe acetabular bone loss. By analyzing implant deviation in CT and radiograph imaging and correlating early clinical complications, we aimed to optimize the usage of custom-made implants. A consecutive series of 45 (2014 to 2019) PPRs for Paprosky III defects at rTHA were analyzed comparing the preoperative planning CT scans used to manufacture the implants with postoperative CT scans and radiographs. The anteversion (AV), inclination (IC), deviation from the preoperatively planned implant position, and deviation of the centre of rotation (COR) were explored. Early postoperative complications were recorded, and factors for malpositioning were sought. The mean follow-up was 30 months (SD 19; 6 to 74), with four patients lost to follow-up.Aims
Methods
The aim of this study was to compare open reduction and internal fixation (ORIF) with revision surgery for the surgical management of Unified Classification System (UCS) type B periprosthetic femoral fractures around cemented polished taper-slip femoral components following primary total hip arthroplasty (THA). Data were collected for patients admitted to five UK centres. The primary outcome measure was the two-year reoperation rate. Secondary outcomes were time to surgery, transfusion requirements, critical care requirements, length of stay, two-year local complication rates, six-month systemic complication rates, and mortality rates. Comparisons were made by the form of treatment (ORIF vs revision) and UCS type (B1 vs B2/B3). Kaplan-Meier survival analysis was performed with two-year reoperation for any reason as the endpoint.Aims
Methods
