Anterior Windowing of the Femur Diaphysis for Cement Removal in Revision Surgery

Zweymüller, K.; Steindl, Martin; Melmer, Thomas

doi:10.1097/01.blo.0000192042.05584.9c

Cited by 29 publications

(19 citation statements)

References 39 publications

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“…Löhr et al reported a 10% subsidence rate with no value greater than 3 or 4 mm for axial migration [13]. Zweymüller et al [14] observed massive subsidence was occurring when postoperative trauma-associated severe bone loss was present. Neither author provided details Fig.…”

Section: Discussionmentioning

confidence: 97%

“…Zweymüller et al [14] has reported that initial stability of SLR implant permits the windowing of the femur with no concerns for the level of femoral fenestration. In this series, we successfully used the SLR implant in femurs with a cortical index < 0.3 because the broaching allowed us to firmly seat the prosthesis through an extensive press-fitting preparation achieved by a truly synergistic preparation of the proximal regions of the femur provided by the rasps.…”

Section: Discussionmentioning

confidence: 98%

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Pneumatic broaching may prevent massive stem subsidence in femoral revision hip replacement

Hourlier¹,

Fennema

2008

Interact Surg

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Massive postoperative subsidence of the prosthesis is a major failure concern in revision hip replacement, as it can potentially provoke recurrent dislocation, secondary femoral fracture, and discrepancies in leg length. In this study, we aimed to evaluate whether the use of vibration-assisted broaching would offer the requisite control and reproducibility necessary to achieve axial stability for a tapered, rectangular revision stem in patients undergoing hip revision surgery. We evaluated the performance of the Zweymüller femoral revision stem implanted following pneumatic rasping in 61 patients (62 hips). There were 39 females and 22 males with a mean age of 72 years. Aseptic loosening was the indication for revision in most cases. According to the Paprosky classification, defects of the femur were grade 2 in 14 hips, grade 3 in 44 hips, and grade 4 in four hips. Ninety percent of the surgeries were first revisions. In the majority of procedures (58 procedures), we utilized anterolateral abductor splitting with the patient in the lateral position as our surgical approach. In six cases, we performed windowing of the femur diaphysis to facilitate cement removal. An extended trochanteric osteotomy was performed in two cases. In all cases, the femoral bed of the implant was modelled at the time of operation using progressively larger pneumatic broaches of 18-22 cm in length. The mean preoperative Postel Merle d'Aubigné (PMA) score was 9, which improved to 16.4 at the time of the last follow-up (mean: 4.8 years; range 3-7 years). No implant showed evidence of significant migration or loosening. During the operation, the specific use of the pneumatic hammer did not cause any complications. In conclusion, the use of the Zweymü ller femoral revision stem implanted following pneumatic rasping potentially minimizes complications and maximizes benefits. An extended follow-up is required to better understand the potential long-term benefits of this approach.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Pneumatic broaching may prevent massive stem subsidence in femoral revision hip replacement

Hourlier¹,

Fennema

2008

Interact Surg

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“…Stability of that design has been shown to be reliable as long as its distal third is safely anchored in healthy own bone while eventual removal usually is achievable without major difficulties [54]. The most common defects up to Paprosky type 3 such can be supplied favourably [55,56]. Other uncemented designs may provide comparable results as long as a safe distal fixation can be obtained [57][58][59].…”

Section: Discussionmentioning

confidence: 98%

One-stage revision of septic hip prosthesis with antibiotic-loaded bone grafts and cementless implants

Winkler¹

2009

LO SCAL

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Infection of total hip replacement (THR) is a serious complication, necessitating its complete removal and thorough debridement of the site. Usually long-term antibiotic treatment and a multitude of surgical interventions within a period of several months are required until a definitive supply can be achieved. One-stage exchange using antibiotic containing cement did not gain widespread use because of several risks, although the possible clinical and economic advantages are evident. Allograft bone may be impregnated with high loads of antibiotics using a special technique and acts as a carrier, avoiding the disadvantages of cement. Based on this technology 37 exchange procedures of infected THR were performed in a single stage, all of them without the use of bone cement. Three hips required re-revision because of re-infection, the remaining 34 hips (92%) stayed infection-free and stable for a period between 2 and 8 years after surgery. No adverse side effects could be found. Incorporation appeared as after grafting with unimpregnated grafts. Antibiotic impregnated allograft bone may enable reconstruction of bone stock, insertion of an uncemented implant and control of infection in a single operation.

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“…Extended trochanteric osteotomies were performed in nine hips, and anterior fenestrations [4] for cement and cement stopper removal were done in 13 cases. Bone grafting was not involved in any procedure.…”

Section: Methodsmentioning

confidence: 99%

“…The SLR-Plus stem (Smith and Nephew, UK) was introduced as a design modification of the uncemented SL-Plus stem to provide enhanced load transfer from the proximal to the distal femur [4]. It basically is a longer version of the primary SL-Plus [5] stem featuring a rectangular cross section for primary stability in the affected and unaffected areas of the diaphysis.…”

Section: Introductionmentioning

confidence: 99%

Revision total hip arthroplasty using a cementless tapered revision stem in patients with a mean age of 82 years

Neumann¹,

Dueckelmann²,

Thaler³

et al. 2011

International Orthopaedics (SICOT)

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Purpose A tapered straight cementless stem was used for revision in a group of old and very old patients. We wanted to know whether the use of this implant could achieve satisfactory results despite age and osteoporosis. Methods We retrospectively analysed data of 77 elderly patients (77 hips) who underwent revision in cemented and uncemented primary total hip arthroplasties (THA). The patients had a mean age of 82.2 years (range, 75-92 years) at revision surgery. They were monitored for a mean follow up of 7.1 years (range, 5.0-10.2 years). During the minimum follow-up period 11 patients died of unrelated causes, leaving 66 patients (66 hips) for evaluation. Results During the period of study three stems failed due to aseptic loosening, three hips dislocated and were successfully treated by closed reduction and bracing. No infection, osteolysis or significant stress shielding around the stems was observed. The survivorship at an average of 7.1-year follow-up was 95.5%. Conclusions These results indicate that this stem is an excellent alternative in revision THA in patients of 75 years or older.

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Anterior Windowing of the Femur Diaphysis for Cement Removal in Revision Surgery

Abstract: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 29 publications

References 39 publications

Pneumatic broaching may prevent massive stem subsidence in femoral revision hip replacement

Pneumatic broaching may prevent massive stem subsidence in femoral revision hip replacement

One-stage revision of septic hip prosthesis with antibiotic-loaded bone grafts and cementless implants

Revision total hip arthroplasty using a cementless tapered revision stem in patients with a mean age of 82 years

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