Aims. Uncemented implants are now commonly used at reimplantation of a two-stage revision total hip arthoplasty (THA) following periprosthetic joint infection (PJI). However, there is a paucity of data on the performance of the most commonly used uncemented femoral implants – modular
Non-modular tapered
Revision total hip arthroplasty (THA) is challenging
when there is severe loss of bone in the proximal femur. The purpose
of this study was to evaluate the clinical and radiographic outcomes
of revision THA in patients with severe proximal femoral bone loss
treated with a
Aims. Revision total hip arthroplasty in patients with Vancouver type B3 fractures with Paprosky type IIIA, IIIB, and IV femoral defects are difficult to treat. One option for Paprovsky type IIIB and IV defects involves modular cementless, tapered, revision femoral components in conjunction with distal interlocking screws. The aim of this study was to analyze the rate of reoperations and complications and union of the fracture, subsidence of the stem, mortality, and the clinical outcomes in these patients. Methods. A total of 46 femoral components in patients with Vancouver B3 fractures (23 with Paprosky type IIIA, 19 with type IIIB, and four with type IV defects) in 46 patients were revised with a transfemoral approach using a modular, tapered, cementless revision Revitan curved femoral component with distal cone-in-cone fixation and prospectively followed for a mean of 48.8 months (SD 23.9; 24 to 112). The mean age of the patients was 80.4 years (66 to 100). Additional distal interlocking was also used in 23 fractures in which distal cone-in-cone fixation in the isthmus was < 3 cm. Results. One patient (2.2%) died during the first postoperative year. After six months, 43 patients (93.5%) had osseous, and three had fibrous consolidation of the fracture and the bony flap, 42 (91.3%) had bony ingrowth and four had stable fibrous fixation of the stem. No patient had radiolucency around the interlocking screws and no screw broke. One patient had non-progressive subsidence and two had a dislocation. The mean Harris Hip Score increased from of 57.8 points (SD 7.9) three months postoperatively to 76.1 points (SD 10.7) 24 months postoperatively. Conclusion. The 2° tapered,
Aims. Although good clinical outcomes have been reported for monolithic tapered,
Aims. Radiostereometric analysis (RSA) allows an extremely accurate
measurement of early micromotion of components following arthroplasty. . Patients and Methods. In this study, RSA was used to measure the migration of 11 partially
cemented
Tapered,
We reviewed 25 patients in whom a MUTARS megaprosthesis with a conical
Tapered,
We report our experience of revision total hip
replacement (THR) using the Revitan curved modular titanium
If a surgeon is faced with altered lesser trochanter
anatomy when revising the femoral component in revision total hip
replacement, a peri-prosthetic fracture, or Paprosky type IIIb or
type IV femoral bone loss, a modular tapered stem offers the advantages
of accurately controlling femoral version and length. The splines
of the taper allow rotational control, and improve the fit in femoral
canals with diaphyseal bone loss. In general, two centimetres of diaphyseal
contact is all that is needed to gain stability with modular tapered
stems. By allowing the proximal body trial to rotate on a well-fixed
distal segment during trial reduction, appropriate anteversion can
be obtained in order to improve intra-operative stability, and decrease
the dislocation risk. However, modular stems should not be used for
all femoral revisions, as implant fracture and corrosion at modular
junctions can still occur. Cite this article:
Aims. The risk of mechanical failure of modular revision hip stems is frequently mentioned in the literature, but little is currently known about the actual clinical failure rates of this type of prosthesis. The current retrospective long-term analysis examines the distal and modular failure patterns of the Prevision hip stem from 18 years of clinical use. A design improvement of the modular taper was introduced in 2008, and the data could also be used to compare the original and the current design of the modular connection. Methods. We performed an analysis of the Prevision modular hip stem using the manufacturer’s vigilance database and investigated different mechanical failure patterns of the hip stem from January 2004 to December 2022. Results. Two mechanical failure patterns were identified: fractures in the area of the distal
Aims. Femoral revision component subsidence has been identified as predicting early failure in revision hip surgery. This comparative cohort study assessed the potential risk factors of subsidence in two commonly used femoral implant designs. Methods. A comparative cohort study was undertaken, analyzing a consecutive series of patients following revision total hip arthroplasties using either a tapered-modular (TM)
Tapered
Revision total hip arthroplasty (THA) is projected
to increase by 137% from the years 2005 to 2030. Reconstruction of
the femur with massive bone loss can be a formidable undertaking.
The goals of revision surgery are to create a stable construct,
preserve bone and soft tissues, augment deficient host bone, improve
function, provide a foundation for future surgery, and create a
biomechanically restored hip. Options for treatment of the compromised femur
include: resection arthroplasty, allograft prosthetic composite
(APC), proximal femoral replacement, cementless fixation with a
modular tapered
Aims. The goals of this study were to define the risk factors, characteristics,
and chronology of fractures in 5417 revision total hip arthroplasties
(THAs). . Patients and Methods. From our hospital’s prospectively collected database we identified
all patients who had undergone a revision THA between 1969 and 2011
which involved the femoral stem. The patients’ medical records and
radiographs were examined and the relevant data extracted. Post-operative
periprosthetic fractures were classified using the Vancouver system.
A total of 5417 revision THAs were identified. Results. There were 668 intra-operative fractures, giving an incidence
of 12%. Fractures were three times more common with uncemented stems
(19%) than with cemented stems (6%) (p <
0.001). The incidence
of intra-operative femoral fracture varied by uncemented stem type:
fully-coated (20%); proximally-coated (19%); modular
When fracture of an extensively porous-coated
femoral component occurs, its removal at revision total hip arthroplasty
(THA) may require a femoral osteotomy and the use of a trephine.
The remaining cortical bone after using the trephine may develop
thermally induced necrosis. A retrospective review identified 11
fractured, well-fixed, uncemented, extensively porous-coated femoral
components requiring removal using a trephine with a minimum of
two years of follow-up. . The mean time to failure was 4.6 years (1.7 to 9.1, standard
deviation (. sd. ) 2.3). These were revised using a larger extensively
porous coated component,
Aims. To evaluate the hypothesis that failed osteosynthesis of periprosthetic
Vancouver type B1 fractures can be treated successfully with stem
revision using a transfemoral approach and a cementless, modular,
tapered revision stem with reproducible rates of fracture healing,
stability of the revision stem, and clinically good results. Patients and Methods. A total of 14 patients (11 women, three men) with a mean age
of 72.4 years (65 to 90) undergoing revision hip arthroplasty after
failed osteosynthesis of periprosthetic fractures of Vancouver type
B1 were treated using a transfemoral approach to remove the well-fixed
stem before insertion of a modular,
The Unified Classification System (UCS), or Vancouver system, is a validated and widely used classification system to guide the management of periprosthetic femoral fractures. It suggests that well-fixed stems (type B1) can be treated with fixation but that loose stems (types B2 and B3) should be revised. Determining whether a stem is loose can be difficult and some authors have questioned how to apply this classification system to polished taper slip stems which are, by definition, loose within their cement mantle. Recent evidence has challenged the common perception that revision surgery is preferable to fixation surgery for UCS-B periprosthetic fractures around cemented polished taper slip stems. Indications for fixation include an anatomically reducible fracture and cement mantle, a well-fixed femoral bone-cement interface, and a well-functioning acetabular component. However, not all type B fractures can or should be managed with fixation due to the risk of early failure. This annotation details specific fracture patterns that should not be managed with fixation alone. Cite this article:
Periprosthetic femoral fractures are increasing in incidence, and typically occur in frail elderly patients. They are similar to pathological fractures in many ways. The aims of treatment are the same, including 'getting it right first time' with a single operation, which allows immediate unrestricted weightbearing, with a low risk of complications, and one that avoids the creation of stress risers locally that may predispose to further peri-implant fracture. The surgical approach to these fractures, the associated soft-tissue handling, and exposure of the fracture are key elements in minimizing the high rate of complications. This annotation describes the approaches to the femur that can be used to facilitate the surgical management of peri- and interprosthetic fractures of the femur at all levels using either modern methods of fixation or revision arthroplasty. Cite this article:
There are limited long-term studies reporting on outcomes of the Zimmer Modular Revision (ZMR) stem, and concerns remain regarding failure. Our primary aim was to determine long-term survival free from all-cause revision and stem-related failure for this modular revision stem in revision total hip arthroplasty (THA). Secondary aims included evaluating radiological and functional outcomes. We retrospectively identified all patients in our institutional database who underwent revision THA using the ZMR system from January 2000 to December 2007. We included 106 patients (108 hips) with a mean follow-up of 14.5 years (2.3 to 22.3). Mean patient age was 69.2 years (37.0 to 89.4), and 51.9% were female (n = 55). Indications for index revision included aseptic loosening (73.1%), infection (16.7%), fracture (9.3%), and stem fracture (0.9%). Kaplan-Meier analysis was used to determine the all-cause and stem-related failure revision-free survival. At most recent follow-up, Oxford Hip Scores (OHS) were collected, and radiological stem stability was determined using the Engh classification.Aims
Methods
The aim of this study was to evaluate the incidence of liner malseating in two commonly used dual-mobility (DM) designs. Secondary aims included determining the risk of dislocation, survival, and clinical outcomes. We retrospectively identified 256 primary total hip arthroplasties (THAs) that included a DM component (144 Stryker MDM and 112 Zimmer-Biomet G7) in 233 patients, performed between January 2012 and December 2019. Postoperative radiographs were reviewed independently for malseating of the liner by five reviewers. The mean age of the patients at the time of THA was 66 years (18 to 93), 166 (65%) were female, and the mean BMI was 30 kg/m2 (17 to 57). The mean follow-up was 3.5 years (2.0 to 9.2).Aims
Methods
The aim of this study was to determine whether fixation, as opposed to revision arthroplasty, can be safely used to treat reducible Vancouver B type fractures in association with a cemented collarless polished tapered femoral stem (the Exeter). This retrospective cohort study assessed 152 operatively managed consecutive unilateral Vancouver B fractures involving Exeter stems; 130 were managed with open reduction and internal fixation (ORIF) and 22 with revision arthroplasty. Mean follow-up was 6.5 years (SD 2.6; 3.2 to 12.1). The primary outcome measure was revision of at least one component. Kaplan–Meier survival analysis was performed. Regression analysis was used to identify risk factors for revision following ORIF. Secondary outcomes included any reoperation, complications, blood transfusion, length of hospital stay, and mortality.Aims
Methods
We implanted 203 smooth-stemmed femoral components before January 1988. The femoral component used was anatomically shaped,
This aim of this study was to assess the reliability and validity of the Unified Classification System (UCS) for postoperative periprosthetic femoral fractures (PFFs) around cemented polished taper-slip (PTS) stems. Radiographs of 71 patients with a PFF admitted consecutively at two centres between 25 February 2012 and 19 May 2020 were collated by an independent investigator. Six observers (three hip consultants and three trainees) were familiarized with the UCS. Each PFF was classified on two separate occasions, with a mean time between assessments of 22.7 days (16 to 29). Interobserver reliability for more than two observers was assessed using percentage agreement and Fleiss’ kappa statistic. Intraobserver reliability between two observers was calculated with Cohen kappa statistic. Validity was tested on surgically managed UCS type B PFFs where stem stability was documented in operation notes (n = 50). Validity was assessed using percentage agreement and Cohen kappa statistic between radiological assessment and intraoperative findings. Kappa statistics were interpreted using Landis and Koch criteria. All six observers were blinded to operation notes and postoperative radiographs.Aims
Methods
We studied the various drill bits available for engineering purposes, and compared them with standard orthopaedic drill bits, using continuous temperature recording at 0.5 mm, 1.0 mm and 1.5 mm from the edge of a 2.5 mm hole as it was drilled in fresh cadaver human tibia. We found that some commercially available drill bits performed better than their orthopaedic equivalents, producing significantly less thermal injury to the surrounding bone and halving the force required for cortical penetration. Our work suggests that the optimal bit for orthopaedic purposes should have a split point and a quick helix. Theoretical knowledge of cutting technology predicts that the addition of a parabolic
We aimed to report the mid- to long-term rates of septic and aseptic failure after two-stage revision surgery for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). We retrospectively reviewed 96 cases which met the Musculoskeletal Infection Society criteria for PJI. The mean follow-up was 90 months (SD 32). Septic failure was assessed using a Delphi-based consensus definition. Any further surgery undertaken for aseptic mechanical causes was considered as aseptic failure. The cumulative incidence with competing risk analysis was used to predict the risk of septic failure. A regression model was used to evaluate factors associated with septic failure. The cumulative incidence of aseptic failure was also analyzed.Aims
Methods
There is a paucity of long-term studies analyzing risk factors for failure after single-stage revision for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). We report the mid- to long-term septic and non-septic failure rate of single-stage revision for PJI after THA. We retrospectively reviewed 88 cases which met the Musculoskeletal Infection Society (MSIS) criteria for PJI. Mean follow-up was seven years (1 to 14). Septic failure was diagnosed with a Delphi-based consensus definition. Any reoperation for mechanical causes in the absence of evidence of infection was considered as non-septic failure. A competing risk regression model was used to evaluate factors associated with septic and non-septic failures. A Kaplan-Meier estimate was used to analyze mortality.Aims
Methods
We evaluated a large database with mechanical failure of a single uncemented modular femoral component, used in revision hip arthroplasty, as the end point and compared them to a control group treated with the same implant. Patient- and implant-specific risk factors for implant failure were analyzed. All cases of a fractured uncemented modular revision femoral component from one manufacturer until April 2017 were identified and the total number of implants sold until April 2017 was used to calculate the fracture rate. The manufacturer provided data on patient demographics, time to failure, and implant details for all notified fractured devices. Patient- and implant-specific risk factors were evaluated using a logistic regression model with multiple imputations and compared to data from a previously published reference group, where no fractures had been observed. The results of a retrieval analysis of the fractured implants, performed by the manufacturer, were available for evaluation.Aims
Methods
The Fassier Duval (FD) rod is a third-generation telescopic implant for children with osteogenesis imperfecta (OI). Threaded fixation enables proximal insertion without opening the knee or ankle joint. We have reviewed our combined two-centre experience with this implant. In total, 34 children with a mean age of five years (1 to 14) with severe OI have undergone rodding of 72 lower limb long bones (27 tibial, 45 femoral) for recurrent fractures with progressive deformity despite optimized bone health and bisphosphonate therapy. Data were collected prospectively, with 1.5 to 11 years follow-up.Aims
Methods
Modular dual-mobility constructs reduce the risk of dislocation after revision total hip arthroplasty (THA). However, questions about metal ions from the cobalt-chromium (CoCr) liner persist, and are particularly germane to patients being revised for adverse local tissue reactions (ALTR) to metal. We determined the early- to mid-term serum Co and Cr levels after modular dual-mobility components were used in revision and complex primary THAs, and specifically included patients revised for ALTR. Serum Co and Cr levels were measured prospectively in 24 patients with a modular dual-mobility construct and a ceramic femoral head. Patients with CoCr heads or contralateral THAs with CoCr heads were excluded. The mean age was 63 years (35 to 83), with 13 patients (54%) being female. The mean follow-up was four years (2 to 7). Indications for modular dual-mobility were prosthetic joint infection treated with two-stage exchange and subsequent reimplantation (n = 8), ALTR revision (n = 7), complex primary THA (n = 7), recurrent instability (n = 1), and periprosthetic femoral fracture (n = 1). The mean preoperative Co and Cr in patients revised for an ALTR were 29.7 μg/l (2 to 146) and 21.5 μg/l (1 to 113), respectively.Aims
Patients and Methods
A number of methods have been described to remove a well-fixed humeral implant as part of revision shoulder arthroplasty. These include the use of cortical windows and humeral osteotomies. The router bit extraction technique uses a high-speed router bit to disrupt the bone-implant interface. The implant is then struck in a retrograde fashion with a square-tip impactor and mallet. The purpose of this study was to determine the characteristics and frequency of the different techniques needed for the removal of a well-fixed humeral stem in revision shoulder arthroplasty. Between 2010 and 2018, 288 revision shoulder arthroplasty procedures requiring removal of a well-fixed humeral component were carried out at a tertiary referral centre by a single surgeon. The patient demographics, indications for surgery, and method of extraction were collected.Aims
Patients and Methods
This aim of this study was to assess the feasibility of designing and introducing generic 3D-printed instrumentation for routine use in total knee arthroplasty. Instruments were designed to take advantage of 3D-printing technology, particularly ensuring that all parts were pre-assembled, to theoretically reduce the time and skill required during surgery. Concerning functionality, ranges of resection angle and distance were restricted within a safe zone, while accommodating either mechanical or anatomical alignment goals. To identify the most suitable biocompatible materials, typical instrument shapes and mating parts, such as dovetails and screws, were designed and produced.Aims
Materials and Methods
Vancouver type B periprosthetic femoral fractures (PFF) are challenging complications after total hip arthroplasty (THA), and some treatment controversies remain. The objectives of this study were: to evaluate the short-to-mid-term clinical outcomes after treatment of Vancouver type B PFF and to compare postoperative outcome in subgroups according to classifications and treatments; to report the clinical outcomes after conservative treatment; and to identify risk factors for postoperative complications in Vancouver type B PFF. A total of 97 consecutive PPFs (49 males and 48 females) were included with a mean age of 66 years (standard deviation (SD) 14.9). Of these, 86 patients were treated with surgery and 11 were treated conservatively. All living patients had a minimum two-year follow-up. Patient demographics details, fracture healing, functional scores, and complications were assessed. Clinical outcomes between internal fixation and revisions in patients with or without a stable femoral component were compared. Conservatively treated PPFs were evaluated in terms of mortality and healing status. A logistic regression analysis was performed to identify risk factors for complications.Aims
Methods
Currently, periprosthetic fractures are excluded from the American Society for Bone and Mineral Research (ASBMR) definition of atypical femoral fracture (AFFs). This study aims to report on a series of periprosthetic femoral fractures (PFFs) that otherwise meet the criteria for AFFs. Secondary aims were to identify predictors of periprosthetic atypical femoral fractures (PAFFs) and quantify the complications of treatment. This was a retrospective case control study of consecutive patients with periprosthetic femoral fractures between 2007 and 2017. Two observers identified 16 PAFF cases (mean age 73.9 years (44 to 88), 14 female patients) and 17 typical periprosthetic fractures in patients on bisphosphonate therapy as controls (mean age 80.7 years (60 to 86, 13 female patients). Univariate and multivariate analysis was performed to identify predictors of PAFF. Management and complications were recorded.Aims
Patients and Methods
There is insufficient evidence to recommend the use of alternative polyethylene bearings in modular, fixed-bearing total knee arthroplasty (TKA). The purpose of this study was to compare standard polyethylene (SP) and highly crosslinked polyethylene (XLP) tibial liners in posterior-stabilized TKA, with osteolysis as the primary outcome and clinical results and the rate of re-operation as the secondary outcomes. This is a single-surgeon, prospective randomized study involving one design of modular posterior-stabilized TKA. An analysis of 122 TKAs with an SP compression moulded liner and 123 with an XLP liner was performed, with a mean follow-up of six years (2 to 11). Patients were evaluated clinically using the Knee Society score, Lower Extremity Activity Score (LEAS), and the presence of an effusion, and standard radiographs were assessed for radiolucent lines and osteolytic lesions.Aims
Patients and Methods
The aim of this study was to investigate the outcomes of Vancouver
type B2 and B3 fractures by performing a systematic review of the
methods of surgical treatment which have been reported. A systematic search was performed in Ovid MEDLINE, Embase and
the Cochrane Central Register of Controlled Trials. For inclusion,
studies required a minimum of ten patients with a Vancouver type
B2 and/or ten patients with a Vancouver type B3 fracture, a minimum
mean follow-up of two years and outcomes which were matched to the type
of fracture. Studies were also required to report the rate of re-operation
as an outcome measure. The protocol was registered in the PROSPERO
database. Aims
Materials and Methods
Loss or absence of proximal femoral bone in revision total hip
arthroplasty (THA) remains a significant challenge. While the main
indication for the use of proximal femoral replacements (PFRs) is
in the treatment of malignant disease, they have a valuable role
in revision THA for loosening, fracture and infection in patients
with bone loss. Our aim was to determine the clinical outcomes,
implant survivorship, and complications of PFRs used in revision
THA for indications other than malignancy. A retrospective review of 44 patients who underwent revision
THA using a PFR between 2000 and 2013 was undertaken. Their mean
age was 79 years (53 to 97); 31 (70%) were women. The bone loss
was classified as Paprosky IIIB or IV in all patients. The mean
follow-up was six years (2 to 12), at which time 22 patients had
died and five were lost to follow-up.Aims
Patients and Methods
Recurrent infection following two-stage revision total hip arthroplasty
(THA) for prosthetic joint infection (PJI) is a devastating complication.
The purpose of this study was to report the survival of repeat two-stage
revision hip arthroplasty, describe complications, and identify
risk factors for failure. We retrospectively identified 19 hips (19 patients) that had
undergone repeat two-stage revision THA for infection between 2000
to 2013. There were seven female patients (37%) and the mean age
was 60 years (30 to 85). Survival free from revision was assessed
via Kaplan–Meier analysis. The patients were classified according
to the Musculoskeletal Infection Society (MSIS) system, and risk
factors for failure were identified. Mean follow-up was four years
(2 to 11).Aims
Patients and Methods
Periprosthetic femoral fracture (PFF) is a potentially
devastating complication after total hip arthroplasty, with historically
high rates of complication and failure because of the technical
challenges of surgery, as well as the prevalence of advanced age
and comorbidity in the patients at risk. This study describes the short-term outcome after revision arthroplasty
using a modular, titanium, tapered, conical stem for PFF in a series
of 38 fractures in 37 patients. The mean age of the cohort was 77 years (47 to 96). A total of
27 patients had an American Society of Anesthesiologists grade of
at least 3. At a mean follow-up of 35 months (4 to 66) the mean
Oxford Hip Score (OHS) was 35 (15 to 48) and comorbidity was significantly
associated with a poorer OHS. All fractures united and no stem needed
to be revised. Three hips in three patients required further surgery
for infection, recurrent PFF and recurrent dislocation and three
other patients required closed manipulation for a single dislocation.
One stem subsided more than 5 mm but then stabilised and required
no further intervention. In this series, a modular, tapered, conical stem provided a versatile
reconstruction solution with a low rate of complications. Cite this article:
Total hip replacement for developmental hip dysplasia
is challenging. The anatomical deformities on the acetabular and
femoral sides are difficult to predict. The Crowe classification
is usually used to describe these cases – however, it is not a very
helpful tool for pre-operative planning. Small acetabular components,
acetabular augments, and modular femoral components should be available
for all cases. Regardless of the Crowe classification, the surgeon must
be prepared to perform a femoral osteotomy for shortening, or to
correct rotation, and/or angulation. Cite this article:
Revision after failed femoral components may
be technically demanding due to loss of peri-prosthetic bone. This retrospective
study evaluated the long-term results of femoral revision using
the cementless Wagner Self-Locking stem. Between 1992 and 1998,
68 consecutive hips in 66 patients underwent femoral revision using
this implant. A total of 25 patients died from unrelated causes
without further revision; the remaining 41 hips in 41 patients (12 men
and 29 women) with a mean age of 61 years (29 to 80) were reviewed
at a mean follow-up of 13.9 years (10.4 to 15.8). A transfemoral
approach was used in 32 hips. A total of five stems required further
revision because of infection in two, progressive subsidence in
two and recurrent dislocation in one. Four hips had dislocated and
eight stems had subsided ≥ 10 mm. The mean Harris hip score improved
from 33 points pre-operatively to 75 points at final follow-up (p
<
0.001). In all, 33 stems (91.7%) showed radiological signs
of stable bone fixation. The cumulative survival rates at 15.8 years
with femoral revision for any reason and for stem failure as the
endpoints were 92.0% (95% confidence interval (CI) 86.0% to 98.4%)
and 96.6% (95% CI 92.2% to 100%), respectively. The survivorship
with revision and ≥ 10 mm migration of the stem as the endpoint
was 83.6% (95% CI 76.6% to 91.4%). This study shows quite good survival and moderate clinical outcome
when using a monoblock tapered titanium stem for supporting the
regeneration of bone in complex revision hip surgery.
We are currently facing an epidemic of periprosthetic
fractures around the hip. They may occur either during surgery or
post-operatively. Although the acetabulum may be involved, the femur
is most commonly affected. We are being presented with new, difficult
fracture patterns around cemented and cementless implants, and we
face the challenge of an elderly population who may have grossly
deficient bone and may struggle to rehabilitate after such injuries.
The correct surgical management of these fractures is challenging.
This article will review the current choices of implants and techniques
available to deal with periprosthetic fractures of the femur. Cite this article:
We prospectively evaluated the long-term outcome of 158 consecutive patients who underwent revision total hip replacement using uncemented computer-assisted design-computer-assisted manufacture femoral components. There were 97 men and 61 women. Their mean age was 63.1 years (34.6 to 85.9). The mean follow-up was 10.8 years (10 to 12). The mean Oxford, Harris and Western Ontario and McMaster hip scores improved from 41.1, 44.2 and 52.4 pre-operatively to 18.2, 89.3 and 12.3, respectively (p <
0.0001, for each). Six patients required further surgery. The overall survival of the femoral component was 97% (95% confidence interval 94.5 to 99.7). These results are comparable to those of previously published reports for revision total hip replacement using either cemented or uncemented components.
Periprosthetic femoral fractures (PFF) following total hip arthroplasty
(THA) are devastating complications that are associated with functional
limitations and increased overall mortality. Although cementless
implants have been associated with an increased risk of PFF, the
precise contribution of implant geometry and design on the risk
of both intra-operative and post-operative PFF remains poorly investigated.
A systematic review was performed to aggregate all of the PFF literature
with specific attention to the femoral implant used. A systematic search strategy of several journal databases and
recent proceedings from the American Academy of Orthopaedic Surgeons
was performed. Clinical articles were included for analysis if sufficient
implant description was provided. All articles were reviewed by
two reviewers. A review of fundamental investigations of implant
load-to-failure was performed, with the intent of identifying similar
conclusions from the clinical and fundamental literature.Aims
Patients and Methods
Given the increasing number of total hip arthroplasty
procedures being performed annually, it is imperative that orthopaedic
surgeons understand factors responsible for instability. In order
to treat this potentially complex problem, we recommend correctly
classifying the type of instability present based on component position, abductor
function, impingement, and polyethylene wear. Correct classification
allows the treating surgeon to choose the appropriate revision option
that ultimately will allow for the best potential outcome. Cite this article:
Stems may improve fixation and stability of components
during revision total knee replacement. However, the choice between
cemented and cementless stems is not a clear one. Cemented stems
offer several advantages in terms of versatility, mechanical stability, surgical
technique and clinical outcome over their cementless counterpart. Cite this article: