Late Hematogenous Infection of Prosthetic Joint

Jahoda, D; Nyc, O; Šimša, Jaromír; Kucera, E; Hanek, P.; Chrz, P; Pokorný, D; Tawa, Nicholas E.; Landor, I; Sosna, A

doi:10.55095/achot2008/015

Cited by 19 publications

(2 citation statements)

References 25 publications

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“…Dle studie Weinraucha nemá použití cementu s antibiotikem statisticky významný vliv na adhezi (23). Proto používáme kostní cement s antibiotikem, který snižuje možnost postoperační infekce lokální oblasti operovaného kloubu (5)(6)(7)(8)10).…”

Section: Tab 3 Indikace K Použití Metody Docementování Dříku Do Původ...unclassified

Cement-within-Cement Femoral Stem Reimplantation Technique

Judl¹,

Jahoda²,

Landor³

et al. 2011

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PURPOSE OF THE STUDYThe reimplantation of a cemented femoral component at revision is always a challenge for the orthopaedic surgeon, particularly when the cement mantle is intact. The aim of this study was to provide evidence that the recementing of a femoral stem into the original cement mantle can be included in routine surgical procedures. MATERIAL AND METHODSA group of 104 patients with femoral stem revision, followed-up for an average of 50.2 months, were retrospectively reviewed. The outcome evaluation was focused, in the first place, on survivorship of the femoral component, acetabular migration, and dislocation and infection after revision arthroplasty. Hip function evaluation was based on the Harris hip scores before surgery and at the latest follow-up. On radiographs Gruen zones were assessed pre-operatively and at the latest follow-up. The results were statistically evaluated using the Kaplan-Meier survival analysis (Statistica 8.0). RESULTSOf the 104 patients, only three (2.9 %) had stem re-revision due to its loosening. Further 16 patients underwent revi sion for other post-operative complications. The success rate of reimplantation in our group including all post-operative complications was 81.7 %. The average Harris scores were 56 before surgery and 87 at the latest follow-up. Radiolucent lines in Gruen zones were on average 0.45 mm in width before revision and 0.15 mm at the latest follow-up. Fourteen patients had second revision within 20 months of the first and only five were revised after a long period. DISCUSSIONThe cement-within-cement exchange of a femoral component is a relatively frequent orthopaedic procedure. Despite this frequency, however, there have not been enough literature reports based on large patient groups to give support to its routine use. The aim of this study was to demonstrate on a large patient group that recementing a femoral stem into the original intact cement mantle can be considered an established operative technique. Our results suggest that the list of indications for this technique, as described by Lieberman and Nelson, can be extended by the following: broken stem with an intact distal cement mantle, replacement of a monoblock femoral component due to severe head damage, loosening of the femoral component without impairment of the distal cement mantle, conversion of a cervico-capital to a total hip replacement and the need of removing all bone cement. No risk is associated with reimplantation of the original component if there is no need for a different implant to correct angle or length stability. A new implant is always used when any part of the femoral component has been damaged mechanically. If only the proximal stem requires recementing, the use of the original component is preferred because of absolute cement/stem cohesion. The number of our patients in which the technique failed was generally in agreement with the results of other authors. CONCLUSIONSUtilisation of the original cement mantle of a femoral component is one of the options at revision arthrop...

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Section: Tab 3 Indikace K Použití Metody Docementování Dříku Do Původ...unclassified

Cement-within-Cement Femoral Stem Reimplantation Technique

Judl¹,

Jahoda²,

Landor³

et al. 2011

ACHOT

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“…Hlavní příčiny selhání revizní totální endoprotézy (TEP) kolenního kloubu jsou stejné jako u primární náhrady, tj. aseptické uvolnění, osteolýza a infekce, mohou se však lišit relativním zastoupením (10,14,17). Kromě toho může docházet ke komplikacím, které přímo souvisí s revizním implantátem.…”

Section: úVodunclassified

Fracture of Tibial Stem in Revision Total Knee Arthroplasty

Smizanský¹,

Gallo²,

Florian³

et al. 2009

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An unusual case of implant failure after revision total knee arthroplasty (TKA) is presented and the case report is completed with the results of an ensuing biomechanical study made to explain possible causes leading to a fracture of the tibial stem. For this we used electron microscopic and biomechanical analyses. There was no material defect found at the site of fracture. By computerized modelling of the clinical situation, however, we found out that asymmetrical progressive osteolysis of the proximal tibia could have caused significant changes in mechanical straining associated with qualitative alterations in the process of degradation and erosion of the implant, eventually leading to a fracture of the tibial stem. In this way mechanical straining at the site of fracture could have exceeded the failure threshold of titanium alloy. Stem fracture of a current tibial component design has not yet been described in the literature. The only failure so far reported concerns the stem of a femoral component, and this has also been explained by biomechanical reasons. It follows from this study that patients with progressive osteolysis around the TKA should be followed up more frequently. The conclusions of this biomechanical analysis emphasize the importance of a thorough reconstruction of bone defects in order to improve long-term survival of the implant.

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