Aims. To clarify the mid-term results of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, combined with
Purpose. Cementless cup with
Acetabular bone defects are common in revision total hip arthroplasty and are usually worse than depicted on routine radiographs. These defects may be cavitary, segmental or both. For cavitary and segmental defects with more than 50% host support, our preference is to use a cementless revision acetabular component, supplemented by the use of screw fixation and morselised bone graft. For cavitary and segmental defects with less than 50% host support, the use of an anti-protrusio cage, morselised bone graft and a cemented all polyethylene socket is preferred. Our use of
Bone loss options in revision total knee replacement include prevention (earlier revision before extensive osteolysis, tedious prosthesis removal), prosthetic substitution, and bone grafting. Massive bone loss options include arthrodesis, custom total knee replacement, amputation, or revision with structural allograft-prosthesis composites. Advantages of
Introduction: Treatment of acetabular defects can be difficult, especially in case of roof destruction. Since 9 years, we use a variant of Paprosky’s technique which consists in rebuilding the roof by
We report 11 patients having revision of total hip arthroplasty using massive
In this report, porous tantalum was used to achieve abductor tendon reattachment to
Purpose of the Study: The outcome after revision knee arthroplasty with structural distal femoral allograft augmentation for major bone loss has been rarely reported in the literature. The aim of this study was to assess the outcome for patients managed with such a procedure in our hospital. Materials and Methods: Since 2001, ten revision knee arthroplasties requiring structural distal femoral allograft for major bone loss were performed in nine patients who underwent surgery at mean age of 68.1±9.8 years and prospectively followed. All patients were operated by the same surgical team. The first assessment was completed for the patients during August 2005 for radiographic and clinical evaluation. The mean follow up time was 22.2±15.1 months. Results: On radiographic analysis none of the allografts had resorbtion. Implant position. Was preserved in all patients. Two patients had postoperative complications: one had superficial wound infection without need of surgical revision, another patient needed angioplasty because of pseudoaneurisma of popliteal artery and temporary using of knee brace for mild medial instability. Clinical evaluation revealed that mean “Hospital for Special Surgery Score” had improved from 39.8 to 84.1 points and mean range of motions improved from 75.0±42.0 to 103.5±12.5 (p=0.05, paired t-test). Before the surgery all patients used a walker or a crutch, while only one of them used a cane and the remaining patients walked without any support after the operation. Conclusions: Our preliminary results demonstrate that
Introduction and Objectives: The treatment of choice in periprosthetic Vancouver B1 fractures is open reduction and fixation with an osteosynthesis plate. There is a certain amount of controversy as to the need to also use a cortical allograft plate. Materials and Methods: We carried out a revision of periprosthetic fractures Vancouver type B1 treated with Dall-Milles (Styker) plates with and without an additional cortical allograft. Results: We included a total of 12 patients operated between March 2003 and July 2207, 6 of them had a plate and also an allograft plate (AP) and 6 only had a DM plate alone (DMP). There was one case of superficial infection of the surgical wound in the AP group in the only case of an open fracture (grade 1) in the series. No osteosynthesis failures were seen in either of the groups. Mean age (4 years more), mean hospital stay (4 days more), need for transfusion (33% more) and mortality (16% more) were all greater in the AP group; whereas the size of the DM plate and operation time (30 minutes less) were less. The EQ-5D health scale was one tenth better in the DMP group, but, curiously, the Oxford Hip Score was 9 points lower. Discussion and Conclusions: Not all patients with periprosthetic fractures Vancouver type B1 treated with a DM plate need the addition of a
Cancellous and cortical bone used as a delivery vehicle for antibiotics. Recent studies with cancellous bone as an antibiotic carrier in vitro and in vivo showed high initial peak concentrations of antibiotics in the surrounding medium. However, high concentrations of antibiotics can substantially reduce osteoblast replication and even cause cell death. To determine whether impregnation with gentamycine impair the incorporation of bone allografts, as compared to allografts without antibiotic.Introduction
Objectives
Introduction. Large acetabular bone defects caused by aseptic loosening are common. Reconstruction of large segmental defects can be challenging. Various implants and operative techniques have been developed to allow further acetabular revision in cases where bone stock is poor. Reconstitution of bone stock is desirable especially in younger patients. The aim of the study was to review the clinical and radiological results of hip revision with structural acetabular bone grafts using fresh frozen allograft and cemented components. Method. Between 1990 and 2014, 151 first time revisions for aseptic acetabular loosening with acetabular reconstruction with a fresh frozen
INTRODUCTION. Allograft reconstruction after resection of primary bone sarcomas has a non-union rate of approximately 20%. Achieving a wide surface area of contact between host and allograft bone is one of the most important factors to help reduce the non-union rate. We developed a novel technique of haptic robot-assisted surgery to reconstruct bone defects left after primary bone sarcoma resection with
We evaluated 38 hip reconstructions in 36 patients at a mean follow-up of 5.9 years (range 4 to 9.1) after femoral head allografts had been used to augment severely deficient acetabular bone stock. The patients were all relatively young and had many previous operations. Their pre-operative Harris hip rating averaged 46 points (range 18 to 73). All the allografts united and there were no infections. However, 12 acetabular components (32%) became loose; six of these had needed revision using the healed allograft, and two hips had required resection arthroplasty. The 30 surviving hips had a mean Harris hip score of 82 points. Some radiographic evidence of graft resorption was seen in 23 hips, though this was mild in 17. The extent of cover provided by the allograft and the severity of graft resorption both correlated with acetabular loosening. Although
We investigated the radiographic and clinical course of 31 patients in whom a bulk acetabular allograft had been used during the cementless revision of a total hip replacement. Two patients died and two were lost to follow-up within 24 months, but of the remaining 27 acetabular components, 12 (44%) showed radiographic evidence of instability at a mean of 46 months. Five of these have been revised. In the 12 failures, signs of instability had been noted at an average of 29 months (1 to 60). Failures during the first 24 months were usually due to technical errors, later failures to gradual migration of the cup into the graft. The cups with the greatest amount of their surface supported by grafts were most likely to migrate, but this migration was usually asymptomatic. Screw fixation of the cup, used in 24 cases, appeared to control the mechanism of failure. Femoral head allografts and distal femoral allografts had been used, with failure in 6 of 16, and 6 of 11 respectively; distal femoral allografts were used only for large defects. The insidious course of late cup migration and graft failure necessitates close radiographic follow-up of patients treated with bulk allografts.
We evaluated the use of a hemipelvic acetabular transplant in twenty revision hip arthroplasties with massive acetabular bone defects (Paprosky IIIB) at a mean follow-up of 5-years (4–10 years). These defects were initially trimmed to as geometric a shape as possible by the surgeon. The hemipelvic allografts were then cut to a geometric shape to match the acetabular defects and to allow tight stable positioning of the graft between the host ilium ischium and pubis. The graft was further stabilised with screw fixation. A cemented cup (without a reinforcement ring) was entirely supported by the allograft in all procedures. We report 65% good intermediate-term results. There were seven failures (five aseptic loosening and two deep infections). Radiographic bone bridging between the graft and host was evident in only one of these cases. Aseptic graft osteolysis began radiographically at a mean of 14 months and revision occurred at a mean of 2 years in the 5 aseptic failure cases. All 5 cases could be reconstructed again due to the restoration of bone stock provided by the hemipelvic graft. One infected case was able to be reconstructed using impaction allografting and the other was converted to a Girdlestone hip. Thirteen of twenty acetabular reconstructions did not require revision. Radiographic bone bridging between the graft and host was evident in 12 cases. In 2 cases, ace-tabular migration began early (at 5 and 27 months) but stopped (at 35 and 55 months). These 2 cases have been followed for 6 and 9 years respectively, with no further migration. Two dislocations occurred but did not require acetabular revision. The function of these hips is good with a mean Postel Merle D’Aubigne score of 16.5. We feel that these are satisfactory intermediate term results for massive acetabular defects too large for reconstruction with other standard techniques.
An uncemented hemispherical acetabular component
is the mainstay of acetabular revision and gives excellent long-term
results. Occasionally, the degree of acetabular bone loss means that a
hemispherical component will be unstable when sited in the correct
anatomical location or there is minimal bleeding host bone left
for biological fixation. On these occasions an alternative method
of reconstruction has to be used. A major column
Background. Ankle and hindfoot fusion in the presence of large bony defects represents a challenging problem. Treatment options include acute shortening and fusion or void filling with metal cages or
Aims. Although internal hemipelvectomy is associated with a high incidence of morbidity, especially wound complications, few studies have examined rates of wound complications in these patients or have identified factors associated with the consequences. The present study aimed to: 1) determine the rate of wound and other complications requiring surgery after internal hemipelvectomy; and 2) identify factors that affect the rate of wound complications and can be used to stratify patients by risk of wound complications. Methods. The medical records of 123 patients undergoing internal hemipelvectomy were retrospectively reviewed, with a focus on both overall complications and wound complications. Logistic regression analyses were performed to examine the association between host, tumour, and surgical factors and rates of postoperative wound complications. Results. The overall rate of postoperative complications requiring surgery was 49.6%. Wound complications were observed in 34.1% of patients, hardware-related complications in 13.2%, graft-related complications in 9.1%, and local recurrence in 5.7%. On multivariate analysis, extrapelvic tumour extension (odds ratio (OR) 23.28; 95% confidence interval (CI), 1.97 to 274.67; p = 0.012), both intra- and extrapelvic tumour extension (OR 46.48; 95% CI, 3.50 to 617.77; p = 0.004), blood transfusion ≥ 20 units (OR 50.28; 95% CI, 1.63 to 1550.32; p = 0.025), vascular sacrifice of the internal iliac artery (OR 64.56; 95% CI, 6.33 to 658.43; p < 0.001), and use of a
Background. Revision total hip arthroplasty (THA) is a challenging scenario following complex primary THA for developmental dysplasia of hip (DDH). This study envisages the long-term outcomes of revision DDH and the role of lateral structural support in socket fixation in these young patients who may require multiple revisions in their life-time. Materials and methods. Hundred and eighteen consecutive cemented revision THAs with minimum follow up of 5 years following primary diagnosis of DDH operated by a single unit between January 1974 and December 2012 were analysed for their clinical and radiological outcomes. Results. The mean follow-up of 118 patients was 11.0 years (5.1–39.6 years). At 11 years, the cumulative survivorship with revision as the endpoint was 89.8%. Amongst the 88 acetabular revisions for aseptic loosening, 21 had pre-existing autologous lateral structural bone graft from the primary THA (group A). Only 3 (14%) of them required lateral structural re-grafting using allograft at revision. With the remaining 18 hips, the lateral support from the previous graft facilitated revision with no requirement of additional structural graft. Sixty-seven hips did not have lateral structural autograft during primary operation (group B). Amongst them, 18 (27%) required lateral
Introduction:. We report the outcomes of salvage procedures in total ankle replacement (TAR) in a single surgeon series. Methods:. This study was a retrospective review of patients who had undergone salvage procedures with tibio-talo-calcaneal (TTC) fusion for failed TAR over a period from 1999–2013 in a single centre. In this period, 317 TAR were performed of which 11 have failed necessitating conversion to TTC fusion. Clinical documentation and radiographs were reviewed for cause of failure, type of graft for fusion, time to radiological/clinical union and complications including further surgeries. Results:. The causes of failure of the TAR were pain from instability/impingement in 8, fracture in one, subsidence of the talar component in one and infection in one. From the group of 11 patients, 8 patients went onto union at a mean of 10 months (7–14). All 8 patients had femoral head