Large femoral bone loss after hip revision using the uncemented proximally porous-coated Bi-Metric prosthesis

Background and purposeTotal hip replacement (THR) is not recommended for children and very young teenagers because early and repetitive revisions are likely. We investigated the clinical and radiographic outcomes of THR performed in children and teenage patients.Patients and methodsWe included 111 patients (132 hips) who underwent THR before 20 years of age. They were identified in the Norwegian Arthroplasty Register, together with information on the primary diagnosis, types of implants, and any revisions that required implant change. Radiographs and Harris hip score (HHS) were also evaluated.ResultsThe mean age at primary THR was 17 (11–19) years and the mean follow-up time was 14 (3–26) years. The 10-year survival rate after primary THR (with the endpoint being any revision) was 70%. 39 patients had at least 1 revision and 16 patients had 2 or more revisions. In the latest radiographs, osteolysis and atrophy were observed in 19% and 27% of the acetabulae and 21% and 62% of the femurs, respectively. The mean HHS at the final follow-up was 83 (15–100).InterpretationThe clinical score after THR in these young patients was acceptable, but many revisions had been performed. However, young patients with developmental dysplasia of the hip had lower implant survival. Moreover, the bone stock in these patients was poor, which could complicate future revisions.

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“… 2006 , Adolphson et al. 2009 ) is also a concern for future revisions. We observed a high incidence of atrophy in the proximal femur (62%).…”

Section: Discussionmentioning

confidence: 99%

Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old

Tsukanaka¹,

Halvorsen²,

Nordsletten³

et al. 2016

Acta Orthopaedica

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“…In addition, functional evaluation of bone metabolism surround metallic implants with 18 F-fluoride PET is a technology under development and more validating studies in different patient groups are warranted. In summary, we found that before revision of a loose fem-gions 2, 3 and 6 between six months and 2 years (27). Adolphson et al (28) compared BMD around Bimetric stems at a mean of 6 years after revision.…”

Section: Discussionmentioning

confidence: 59%

Bone Metabolism Analyzed by Pet and Dxa following Revision tha Using A Distally Fixed Stem. A Pilot Study

2011

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In a pilot study we analyzed bone remodeling using ¹⁸F-PET (positron emission tomography) scanning or DXA (dual-energy x-ray absorptiometry) in 3 patient groups, one with a loose femoral stem and 2 after revision using a modular stem (MP). In loose implants (group 1), bone formation activity compared to the contralateral healthy femur was 261 %. In the proximal part of the femur bone formation was increased by 253 % one week after revision (group 2) and did not normalize within 1 year. In the distal region it decreased to normal after one year. In the second revision group DXA showed decreased bone mineral density at 6 and 24 months (group 3). The PET technique provided evidence of bone healing despite osteolysis and prosthetic loosening which continued after revision. Decreasing BMD after revision in the third group is multifactorial, but suggests that despite intensive bone formation resorption was still higher.

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“…During a minimum two-year follow-up, Teratani et al noted a mean HHS score that improved from 69.6 preoperatively to 90.9 postoperatively [20]. Compared to the result of hip revision in literature, which was not encouraging in the past [22] but clinically and radiographically improved in recent studies [23,24], the functional outcome and survivorship of PAO in this cohort and others [2,9,20,21] were comparable. Therefore, we prudently suggest PAO as an alternative strategy for treating DDH in middle aged Chinese patients.…”

Section: Discussionmentioning

confidence: 73%

Mid-term results of Bernese periacetabular osteotomy for developmental dysplasia of hip in middle aged patients

Zhu

Chen

Cui

et al. 2013

International Orthopaedics (SICOT)

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Purpose To address the question, compared to having hip replacement with latent revision, does Bernese periacetabular osteotomy (PAO) before primary hip replacement occupy a preferable treatment strategy for middle aged (aged 35-54 years) hip dysplasia patients? We assessed the mid-term functional outcome and survivorship of PAO in those patients. Methods Forty-one hips in 36 patients at middle age at the time of surgery (mean age, 39.5 years; range, 35-47 years) were retrospectively identified out of a total PAO cohort of 315 patients. Eleven of the 41 PAO hips also underwent osteochondroplasty at the femoral head-neck junction. Radiographic parameters of lateral centre edge angle, anterior centre edge angle and hip joint medialisation were investigated using the Harris Hip Score (HHS). Results The average follow-up was 5.1 years (range, two to ten years). Radiographic parameters postoperatively improved into the normal range, whereas no progression was found from preoperative Tonnis osteoarthritis score. Forty hips survived at the last follow-up, with HHS Score improved from 63.7 to 88.4. Compared to the sole PAO group, both postoperative alpha angle and range of joint motion improved in the PAO combined with osteochondroplasty group. However, no difference in HHS score was found. Conclusions Good survivorship and improved joint function were identified in middle-aged Chinese patients following PAO with or without osteochondroplasty. We prudently suggest PAO as an alternative strategy for treating DDH in those patients.

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Large femoral bone loss after hip revision using the uncemented proximally porous-coated Bi-Metric prosthesis

Cited by 8 publications

References 34 publications

Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old

Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old

Bone Metabolism Analyzed by Pet and Dxa following Revision tha Using A Distally Fixed Stem. A Pilot Study

Mid-term results of Bernese periacetabular osteotomy for developmental dysplasia of hip in middle aged patients

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