Endoscopy for Cement Removal in Revision Arthroplasty of the Hip

Govaers, Kris; Meermans, Geert; Stuyck, Jos; Deprez, Patrick; Bortier, Hilde; Roels, J

doi:10.2106/jbjs.f.00699

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…Extraction techniques of well-fixed cemented or uncemented RTKA implants can be challenging and are linked with increased risks for complication [40][41][42][43][44][45][46][47]. Ultrasonic methods [48], pneumatic shock wave technology and intramedullary endoscopy (mostly for hip procedures but also for the knee) [49,50] customized guides [51], highpowered drills with centralizers [52], and computer assisted freehand navigations [53] are new technologies and methods for implant removal in revision total knee and hip arthroplasties that aim to reduce complication risks and possibly the need for osteotomies. However, due to several limitations and still missing reliable evidence for the superiority of one or another method, these techniques rely mostly on the individual preference of the surgeon and have not gained enough acceptance until now to prevail on the daily praxis in RTKA.…”

Section: Discussionmentioning

confidence: 99%

Impact of stem profile on the revisability and the need for osteotomy in well-fixed cemented revision total knee arthroplasty implants

Maslaris

Spyrou

Schoeneberg

et al. 2022

Arch Orthop Trauma Surg

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Introduction While re-revision total knee arthroplasty (ReRTKA) steadily increases, the ease and bone-sparing removal of RTKA implants is gaining more and more in importance. Biomechanical data suggest that cemented conical stems can be removed significantly easier than cylindrical stems. However, no clinical evidence exists supporting this observation. Aim of this study was to compare the revisability and need for osteotomy (OT) between removals of well-fixed cemented conical vs. cylindrical RTKA stems. Materials and methods 55 removals of well-fixed full-cemented RTKA stems (29 knees) performed between 2016 and 2018 were retrospectively analyzed. Main outcome variables were: bone loss, fractures, osteotomy incidence, surgery duration, early postoperative complications (EPC), hemoglobin drop and blood transfusion. SPSS was used for the statistical analysis. Results 44.8% were conical, 48.3% cylindrical, and 6.9% combined stem designs. Causes for re-revision were PJI (75.9%), malposition (17.2%) and persistent pain (6.9%). 10 stem removals (18.2%) required an OT (four femoral, six tibial): eight stems (14.5%) had cylindrical and two (3.6%) conical designs (P = 0.041). Fractures were noted solely in removals without OT (11.1% vs. 0%,). There was a tendency to more bone loss in cylindrical stem revisions (53.8% vs. 32%, P = 0.24). A longer overall surgery time was observed in revisions of cylindrical stems (+ 37 min, P = 0.05). There was higher hemoglobin drop and need for blood transfusion in revisions of cylindrical stems or after OT but without reaching statistical significance. The EPC rates were slightly higher in ReRTKA on cylindrical stems (P = 0.28). Conclusion Well-fixed cemented conical stems may be revision friendlier with less demands on OT and shorter overall surgery time than cemented cylindrical stems.

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Section: Discussionmentioning

confidence: 99%

Impact of stem profile on the revisability and the need for osteotomy in well-fixed cemented revision total knee arthroplasty implants

Maslaris

Spyrou

Schoeneberg

et al. 2022

Arch Orthop Trauma Surg

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“…7 The cystoscope offers zero-degree vision whereas our standard scope offers 30 degrees however our vision was satisfactory without any distortion. Govaers et al 8 in their multicentre prospective study of 107 cases evaluated the usefulness of endoscopy in the reduction of complications during cement removal in revision hip arthroplasty. After extraction of the implanted stem using standard extraction instruments they removed all the accessible proximal cement using various narrow osteotomes and chisels.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopically-assisted removal of distal centraliser of an MS-30 femoral stem using a cannulated reamer in revision hip arthroplasty

Papachristos

Acton

2019

HIP International

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Background: Revision hip arthroplasty can be challenging especially when difficulties to remove distal centralisers arise. Case: We report a case where we removed a well-fixed 1st-generation solid MS-30 distal centraliser combining standard cannulated trauma reamers and arthroscopical guidance. Such case has not been reported in the past and this technical tip can be useful in revision procedures of the specific implant.

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“…A surgical robot using a flexible drill and a visualization system have been tested [19], having the same negative impact on the THA workflow. A study on the use of endoscopes during femoral drilling remained inconclusive about the potential lower complication rates [20].…”

Section: Introductionmentioning

confidence: 99%

Design and In Vitro Validation of an Orthopaedic Drill Guide for Femoral Stem Revision in Total Hip Arthroplasty

Klok,

Groenewegen,

Temmerman

et al. 2024

IEEE J. Transl. Eng. Health Med.

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Objective: Cemented total hip arthroplasty (THA) demonstrates superior survival rates compared to uncemented procedures. Nevertheless, most younger patients opt for uncemented THA, as removing well-fixed bone cement in the femur during revisions is complex, particularly the distal cement plug. This removal procedure often increases the risk of femoral fracture or perforation, haemorrhage and weakening bone due to poor drill control and positioning. Aim of this study was to design a novel drill guide to improve drill positioning. Methods and procedures: A novel orthopaedic drill guide was developed, featuring a compliant centralizer activated by a drill guide actuator. Bone models were prepared to assess centralizing performance. Three conditions were tested: drilling without guidance, guided drilling with centralizer activation held, and guided drilling with centralizer activation released. Deviations from the bone centre were measured at the entry and exit point of the drill. Results: In the centralizing performance test, the drill guide significantly reduced drill hole deviations in both entry and exit points compared to the control ( \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} $p < 0.05$\end{document} ). The absolute deviation on the exit side of the cement plug was 10.59mm (SD 1.56) for the ‘No drill guide‘ condition, 3.02mm (SD 2.09) for ‘Drill guide – hold‘ and 2.12mm (SD 1.71) for ‘Drill guide – release‘. The compliant drill guide centralizer significantly lowered the risk of cortical bone perforation during intramedullary canal drilling in the bone models due to better control of the cement drill position. Clinical and Translational Impact Statement: The drill guide potentially reduces perioperative risks in cemented femoral stem revision. Future research should identify optimal scenarios for its application.

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Endoscopy for Cement Removal in Revision Arthroplasty of the Hip

Cited by 8 publications

References 18 publications

Impact of stem profile on the revisability and the need for osteotomy in well-fixed cemented revision total knee arthroplasty implants

Impact of stem profile on the revisability and the need for osteotomy in well-fixed cemented revision total knee arthroplasty implants

Arthroscopically-assisted removal of distal centraliser of an MS-30 femoral stem using a cannulated reamer in revision hip arthroplasty

Design and In Vitro Validation of an Orthopaedic Drill Guide for Femoral Stem Revision in Total Hip Arthroplasty

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