Clinical and radiological outcome of hydroxyapatite-coated femoral stem in revision hip arthroplasty

Gosens, Taco; Langelaan, E.J. van

doi:10.1007/s00264-005-0659-1

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…After cementless revisions many patients are able to bear only partial weight for eight weeks or longer. 6,7,10 Dislocation was reported in 14% of our cemented revisions, which appears high, but with extensively-reviewed patients there is a reporting bias for dislocation 41 and so this, combined with the long duration of our study, is relevant. Furthermore, many patients were elderly, a known risk factor for dislocation.…”

Section: Discussionmentioning

confidence: 82%

“…[1][2][3] Initially, cementless femoral revision was also associated with poor results. 4,5 Successful results have been achieved with modern cementless designs, [6][7][8][9][10] but there are concerns which include loosening in the presence of severe metadiaphyseal deficiency, 7,[10][11][12][13] intra-operative fracture, stem subsidence, thigh pain, stress shielding and the need for an extensive femoral osteotomy to fit many of the longer stem cementless designs. [14][15][16][17] A long period of restricted weight-bearing is usually advised after revision to a cementless femoral component, which may hamper rehabilitation.…”

mentioning

confidence: 99%

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Revision total hip replacement using cemented collarless double-taper femoral components

Howie

Wimhurst

McGee

et al. 2007

The Journal of Bone and Joint Surgery. British volume

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We investigated 219 revisions of total hip replacement (THR) in 211 patients using a collarless double-taper cemented femoral component. The mean age of the patients was 72 years (30 to 90). The 137 long and 82 standard length stems were analysed separately. The mean follow-up was six years (2 to 18), and no patient was lost to follow-up. Survival of the long stems to re-revision for aseptic loosening at nine years was 98% (95% confidence interval (CI) 94 to 100), and for the standard stems was 93% (95% CI 85 to 100). At five years, one long stem was definitely loose radiologically and one standard stem was probably loose. Pre-operative femoral bone deficiency did not influence the results for the long stems, and corrective femoral osteotomy was avoided, as were significant subsidence, major stress shielding and persistent thigh pain. Because of these reliable results, cemented long collarless double-taper femoral components are recommended for routine revision THR in older patients.

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Section: Discussionmentioning

confidence: 82%

mentioning

confidence: 99%

Revision total hip replacement using cemented collarless double-taper femoral components

Howie

Wimhurst

McGee

et al. 2007

The Journal of Bone and Joint Surgery. British volume

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“…Cementless revisions are another alternative for which good results have been reported but often require patients to be partial weight bearing for eight weeks or longer (19–21). In elderly patients or those with multi-joint disease the potential to fully weight bear immediately postoperatively is a major advantage.…”

Section: Discussionmentioning

confidence: 99%

Long Stem Cemented Revision Arthroplasty for Aseptic Loosening in Elderly Patients Produces Good Results, despite Significant Bone Loss

et al. 2013

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We assessed the results of long cemented stems in patients over 65 undergoing a first time revision hip arthroplasty for aseptic loosening. 103 patients were followed up for a minimum of five years after revision surgery; 45% had EndoKlinik C grade preoperative bone loss. At final follow-up 31 patients had died, all but one with the prosthesis in situ. There were 71 revisions alive, one had been revised for a peri-prosthetic fracture. Of the 45 that had radiographs at a minimum of five years, three stems were probably or definitely loose according to the Harris classification. There was 92% patient satisfaction and a mean Oxford Hip Score (OHS) of 25/60 in the 59 patients that had not been revised and had full clinical follow-up. Long-stem cemented revisions for aseptic loosening in elderly patients allow immediate postoperative weight bearing and have good radiological and clinical outcomes.

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“…These poor results with cemented revisions have led investigators to explore cementless options [7][8][9]. However, in the revision setting, the proximal femur is often deficient and provides a poor biological and mechanical environment for proximal porous ingrowth; in cases of pronounced bone defect and deficient isthmus, distal fixation of an extensively porouscoated implant is unable to provide primary stability [10].…”

Section: Discussionmentioning

confidence: 99%

Distal locking stem for revision femoral loosening and peri-prosthetic fractures

Mertl

Philippot

Rosset

et al. 2010

International Orthopaedics (SICOT)

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Revision total hip arthroplasty in the setting of a large proximal femoral deficiency or a peri-prosthetic fracture remains a challenging problem. We describe the development, surgical technique and the use of cementless revision stems with distal inter-locking screws to provide immediate stability of the femoral implant. Results were assessed in a large multicentre French study conducted with the french hip and knee surgery society (SFHG). We retrospectively reviewed 725 revisions using interlocking stems from 14 French orthopaedic departments. Seven different stems were used in this series. In-patient records were retrieved, and in addition to demographic data the indication for revision, the preoperative and postoperative PMA and Harris hip scores were documented. The bone deficiency was classified on the basis of the French National Orthopaedic Meeting (SOFCOT) classification. Intraoperative complications and problems if any were retrieved from operative notes. Clinical status and radiographs at the final follow-up were evaluated, paying special attention to the metaphyseal filling index. Average follow-up was 4.5 years. As for the clinical results, the mean Harris hip score at last follow-up was 81. Therefore, it increased by an average of 31 points. Bone reconstruction was assessed on the corticomedullary index in the metaphyseal area and at mid-shaft increasing from 36 to 45 and 54 to 63, respectively. Radiologically, 637 implants were stable, and 40 demonstrated subsidence. Forty-eight implants have been revised. We found a significant relation between the metaphyseal filling index, the stability of the stem and the quality of bone reconstruction. Results were analysed with respect to three groups of stems: group 1 was a straight, partially HA-coated implant; group 2 was a curved, fully HA-coated implant; and group 3 was a curved, partially-coated implant. Group 1 showed a significantly higher rate of failure when compared with the others types of implants. Group 2 had better functional results than group 3, which in turn reported better results than group 1. With regard to implant fixation, group 2 had significantly better results. Both groups 2 and 3 induced less thigh pain than group 1. The distal interlocking stem has shown promising results for femoral revisions. The advantages are initial axial and rotational stability and consistent bony ingrowth owing to hydroxyapatite coating. Distal locked stems are mainly indicated to treat complex femoral revision with severe bone loss and peri-prosthetic fractures.

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Clinical and radiological outcome of hydroxyapatite-coated femoral stem in revision hip arthroplasty

Cited by 8 publications

References 26 publications

Revision total hip replacement using cemented collarless double-taper femoral components

Revision total hip replacement using cemented collarless double-taper femoral components

Long Stem Cemented Revision Arthroplasty for Aseptic Loosening in Elderly Patients Produces Good Results, despite Significant Bone Loss

Distal locking stem for revision femoral loosening and peri-prosthetic fractures

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