Management of Severe Femoral Bone Loss in Revision Total Hip Arthroplasty

Sheth, Neil P.; Melnic, Christopher M.; Rozell, Joshua C.; Paprosky, Wayne G.

doi:10.1016/j.ocl.2015.02.002

Cited by 25 publications

(30 citation statements)

References 60 publications

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“…The Paprosky classification can help surgeonsparticularly more-experienced surgeons-approach these complex procedures in a thoughtful way, in that it can help guide the implant choices that surgeons make at the time of revision THA [8,30,36]. The Paprosky classification offers a simple categorization of proximal femoral bone loss founded on clinical and biomechanical evidence.…”

Section: Discussionmentioning

confidence: 99%

Classifications In Brief: The Paprosky Classification of Femoral Bone Loss

Ibrahim

Fernando

2017

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 99%

Classifications In Brief: The Paprosky Classification of Femoral Bone Loss

Ibrahim

Fernando

2017

Clinical Orthopaedics &Amp; Related Research

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“…The biologic fixation of porous implants used in reconstructive procedures is not always reliable, especially in circumstances in which native bone stock and/or healing capacity is suboptimum [1,6,21,28]. Using the implant to deliver a bisphosphonate compound to surrounding bone has been shown in animal studies to enhance local bone formation [4,5,8,24], but questions regarding the optimum dose remain.…”

Section: Discussionmentioning

confidence: 99%

“…The reliability of cementless implant fixation can be improved, especially in revision hip surgery or in patients whose potential for bone healing may be less than ideal [6,21]. One approach to enhance fixation is to use bisphosphonates to modulate the bone healing response at the implant-bone interface and the surrounding region.…”

Section: Introductionmentioning

confidence: 99%

Implant-delivered Alendronate Causes a Dose-dependent Response on Net Bone Formation Around Porous Titanium Implants in Canines

Pura

Bobyn

Tänzer

2016

Clinical Orthopaedics &Amp; Related Research

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Background Bony fixation of cementless orthopaedic implants is not always achieved, particularly in challenging scenarios such as revision surgery, trauma, and tumor reconstruction. An adjunct therapy for improving porous implant fixation could improve the reliability and durability of these reconstructive procedures. Questions/purposes In this study, we asked whether there is a positive and dose-dependent effect of the local release of the bisphosphonate alendronate from (1) alendronate/ hydroxyapatite (HA) porous-coated titanium implants compared with bare metal porous controls; and (2) alendronate/HA on porous-coated titanium implants compared with HA-coated porous controls with respect to extent of bone ingrowth, bone apposition, and periimplant bone formation in a canine model? Methods Three-dimensional printed porous-coated cylindrical implants coated with three different doses (0.02, 0.06, and 0.18 mg/cm 2 ) of alendronate were inserted bilaterally in the intramedullary canal of the proximal femora of 15 adult mongrel dogs (age range, 3-9 years; mean, 5 years) weighing between 36 kg and 60 kg (mean, 43 kg). In each dog, an implant coated with HA and one of three different doses of alendronate was inserted on one side while the contralateral femur had a bare metal porous control implant and an identical control implant with a coating of HA. The dose effect of locally released alendronate on the extent of bone ingrowth, bone apposition, and periimplant bone was assessed by backscattered electron microscopy of three pairs of crosssections taken from each implant at 12 weeks after surgery. A linear mixed model was used to perform the statistical analyses to account for the correlation in the data resulting from the multiple measures performed on each dog. Results Compared with paired bare metal controls, periimplant bone increased by 92% (p = 0.007), and 114% (p\ 0.001) in the femora with the alendronate implants with a dose of 0.06 mg/cm 2 , or 0.18 mg/cm 2 , respectively. At a dose of 0.02 mg/cm 2 , there was no difference (46% change; p = 0.184, with the numbers available). The comparison of the alendronate-dosed implants with their HA-coated controls showed that the intermediate dose of 0.06 mg/cm 2 alendronate had the greatest effect on net bone formation. Bone apposition was enhanced with the 0.06-mg/cm 2 alendronate femoral implants (82%; p = 0.008), although there was no change in bone ingrowth Two of the authors certify that they (JDB, MT), or a member of their immediate families, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Pipeline Biotechnology (Cedar Knolls, NJ, USA). (37% change; p = 0.902, with the numbers available). When compared with the HA-coated control implants, the greatest effect of the alendronate-dosed implants was the increased amount of periimplant bone at the intermediate dose of 0.06-mg/cm 2 (108%, p = 0.009). There was no effect of the low (0.02-mg/cm 2 ) and high (0.18-mg/cm 2 ) alendronate-dosed implants (...

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“…Traditional reconstructive options include the use of a fully cemented implant with or without impaction bone grafting, allograft prosthesis composite reconstruction, or the use of a megaprosthesis proximal femoral replacement. 2,3,28 Allograft prosthesis composite (APC) reconstruction utilizes a full proximal allograft femoral segment to replace proximal femoral bone loss. The stem is cemented to proximal allograft but may be press fit into the remaining distal femur, leaving the interface between interposed step-cut segments free of cement to allow for graft incorporation.…”

Section: Type IV Femoral Bone Lossmentioning

confidence: 99%

“…For these reasons, the most commonly used, well-described, and successfully implemented classifications for periprosthetic bone loss are the Paprosky femoral and acetabular bone loss classifications. 3,4 Focusing on the femoral side, the Paprosky femoral bone loss classification may be used to describe the location of proximal femoral bone loss, characterize the degree of remaining supportive bone, and imply reconstructive options. 6 Radiographic evaluation for this classification system is performed using plain radiographs to include an AP view of the pelvis, and AP and lateral views of the hip.…”

Section: Introductionmentioning

confidence: 99%

Classifying femoral bone deficiency: Picking the right tool for the job

Balkissoon

Sershon

Paprosky

et al. 2015

Seminars in Arthroplasty

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The number of total hip arthroplasties continues to increase each year, and with it grows the demand for surgeons prepared to manage complicated revisions. To date, the Paprosky classification system is the most commonly used, well-described, and successfully implemented classification system for periprosthetic femoral bone loss. In this review, the Paprosky femoral bone loss classification is presented in detail, using illustrative examples of cases encountered by the contributing authors.

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Management of Severe Femoral Bone Loss in Revision Total Hip Arthroplasty

Cited by 25 publications

References 60 publications

Classifications In Brief: The Paprosky Classification of Femoral Bone Loss

Classifications In Brief: The Paprosky Classification of Femoral Bone Loss

Implant-delivered Alendronate Causes a Dose-dependent Response on Net Bone Formation Around Porous Titanium Implants in Canines

Classifying femoral bone deficiency: Picking the right tool for the job

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