Conversion of failed internal fixation in proximal femur fractures using calcar-guided short-stem total hip arthroplasty

Afghanyar, Yama; Coutandin, M.; Schneider, Michael; Drees, Philipp; Kutzner, Karl Philipp

doi:10.1186/s10195-022-00655-6

Cited by 3 publications

(1 citation statement)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the past two decades, short stem THA has been introduced [12,13]. Several short stems have been designed, including mid-short stem (engaging metaphysis and junction of the metaphysis and diaphysis), and ultra-short stem (engaging only metaphysis) [14,15]. The classification of short stems is controversial, and several classifications have been developed, considering the length, location of loading, osteotomy level, and implant fixation [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Revision of Failed Short Stems in Total Hip Arthroplasty

Migliorini,

Coppola,

D’Addona

et al. 2024

JCM

View full text Add to dashboard Cite

Background: The current literature lacks studies which evaluate the failure of short stems in total hip arthroplasty (THA). Therefore, the present clinical investigation reported our experience with the failure of short stems in THA, evaluating the causes of failure, survivorship, and the clinical outcomes of revision arthroplasty. Methods: The present study was performed according to the STROBE guidelines. This study was conducted at the Department of Orthopaedic Surgery of the Humanitas Clinical Institute, Milan, Italy, between 2017 and 2022. All patients who underwent revision surgery of a previously implanted THA using a short stem were prospectively included in the present study. Surgeries were performed with patients in lateral position, using a minimally invasive posterolateral approach. The outcomes of interest were to report information on the type and survivorship of implants used for the revision surgery and evaluate the clinical outcomes and the rate of complications. The following patient-reported outcome measures (PROMs) used for the clinical assessment were the Western Ontario McMaster Osteo-Arthritis Index (WOMAC) and related subscales of pain, stiffness, and function, and the visual analogue scale (VAS). Results: Data from 45 patients were retrieved. Of them, 31% (14 of 45 patients) were women. The mean age was 63.7 ± 13.9 years. The mean length of the implant survivorship was 6.2 ± 5.7 years. In total, 58% (26 of 45 patients) underwent revision of all components, 36% (16 of 45 patients) revised only the stem, and 1% (3 of 45 patients) received a two-stage revision. The mean length of the follow-up was 4.4 ± 1.5 years. The cup was revised in 58% (26 of 45) of patients. At 4.4 ± 1.5 years of follow-up, the WOMAC score was 3.5 ± 1.3 and the VAS was 1.2 ± 1.3. In total, 9% (4 of 45) of patients experienced minor complications. One patient used a walking aid because of reduced function. One patient evidenced muscular hypotrophy. Two patients experienced hip dislocations. All two dislocations were managed conservatively with repositioning in the emergency room under fluoroscopy. No patient needed additional revision surgery or experienced further dislocations. Conclusions: Revision surgery is effective and safe when a short stem THA fails. At approximately four years of follow-up, all patients were highly satisfied with their clinical outcomes. Despite the relatively high number (9%), complications were of a minor entity and were successfully managed conservatively.

show abstract

Section: Introductionmentioning

confidence: 99%

Revision of Failed Short Stems in Total Hip Arthroplasty

Migliorini,

Coppola,

D’Addona

et al. 2024

JCM

View full text Add to dashboard Cite

show abstract

Calcar-guided short-stem total hip arthroplasty in fractures of the femoral neck: a prospective observational study of 68 hips

Kutzner,

Walz,

Afghanyar

et al. 2024

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection

Huang,

Ding

et al. 2024

Orthopaedic Surgery

View full text Add to dashboard Cite

PurposeFollowing failed internal fixation of intertrochanteric fractures (FIF‐ITF), the decision to use a long‐stem or standard‐stem femoral implant in hip arthroplasty is still debated. This study aimed to explore how the healing status of fractures after FIF‐ITF failure affects the choice of femoral stem and clinical outcomes.MethodsOur retrospective cohort study reviewed 105 cases of patients with FIF‐ITF who underwent hip arthroplasty at three tertiary Grade A hospitals between December 2012 and December 2022. We compared the clinical outcomes between patients with healed and unhealed fractures, focusing on the selection of femoral stems in relation to proximal medial support and the healing status of the greater trochanter. The primary outcomes measured were functional results, operative time, blood loss, and incidence of complications. A subgroup analysis was conducted to further evaluate the influence of the proximal medial buttress and greater trochanteric healing on femoral stem selection. Statistical analysis included binary and ordinal logistic regression to identify factors influencing the choice of femoral stems. Additionally, a decision tree model was developed to visually represent and explore the relationship between fracture healing status and the selection of femoral components.ResultsThe study included 38 patients with healed fractures and 67 patients with unhealed fractures. Patients in the healed group predominantly chose standard stems and experienced better functional outcomes (p < 0.001, p = 0.002). In contrast, the unhealed group preferred long stems, resulting in longer surgical durations and increased blood loss (p = 0.008, p < 0.001). Binary logistic regression analysis revealed that nonunion of the proximal femoral medial buttress was an independent risk factor for long stems (p < 0.0001, OR = 10.402).ConclusionThe selection of femoral prostheses following FIF‐ITF is influenced by the fracture healing status, particularly the presence of proximal femoral medial buttress. The decision tree model suggested that long‐stem prostheses are more appropriate when there is inadequate fracture healing and the proximal femoral medial buttress is absent.

show abstract

Conversion of failed internal fixation in proximal femur fractures using calcar-guided short-stem total hip arthroplasty

Cited by 3 publications

References 38 publications

Revision of Failed Short Stems in Total Hip Arthroplasty

Revision of Failed Short Stems in Total Hip Arthroplasty

Calcar-guided short-stem total hip arthroplasty in fractures of the femoral neck: a prospective observational study of 68 hips

Key Decision‐Making in Post‐Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection

Contact Info

Product

Resources

About