Revision of failed hemiarthroplasty for fractures at the hip

Warwick, David; Hubble, M; Sarris, Ioannis; Strange, Julian

doi:10.1007/s002640050233

Cited by 30 publications

(19 citation statements)

References 19 publications

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“…At present, hemiarthroplasty is the preferred treatment for this group, but the outcome can be unsatisfac-tory, particularly for the more active patient. Warwick et al 12 reported acetabular erosion in 31 of 56 patients requiring revision of a hemiarthroplasty, with a median interval following implantation of 12 months to the onset of symptoms and 33 months to revision. Squires and Bannister 13 reported a 38% revision rate at four years in previously mobile, independent patients whose displaced subcapital fractures were treated by hemiarthroplasty.…”

mentioning

confidence: 99%

Five-year clinical, radiological and postmortem results of the Cambridge Cup in patients with displaced fractures of the neck of the femur

Field

Rushton

2005

The Journal of Bone and Joint Surgery. British volume

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The Cambridge Cup has been designed to replace the horseshoe-shaped articular cartilage of the acetabulum and the underlying subchondral bone. It is intended to provide physiological loading with minimal resection of healthy bone. The cup has been used in 50 women with displaced, subcapital fractures of the neck of the femur. In 24 cases, the cup was coated with hydroxyapatite. In 26, the coating was removed before implantation in order to simulate the effect of long-term resorption. The mean Barthel index and the Charnley-modified Merle d'Aubigné scores recovered to their levels before fracture. We reviewed 30 women at two years, 21 were asymptomatic and nine reported minimal pain. The mean scores deteriorated slightly after five years reflecting the comorbidity of advancing age. Patients with the hydroxyapatite-coated components remained asymptomatic, with no wear or loosening. The uncoated components migrated after four years and three required revision. This trial shows good early results using a novel, hydroxyapatite-coated, physiological acetabular component.

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confidence: 99%

Five-year clinical, radiological and postmortem results of the Cambridge Cup in patients with displaced fractures of the neck of the femur

Field

Rushton

2005

The Journal of Bone and Joint Surgery. British volume

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“…Failure of a unipolar endoprosthesis is most commonly the result of stem loosening or acetabular erosion from the large femoral head articulating on the host acetabular cartilage [1,9,17,24,26,27]. Our two cases illustrate a new and potentially destructive long-term complication of the articulation between a large-diameter unipolar femoral head and a contemporary femoral stem.…”

Section: Discussionmentioning

confidence: 90%

“…Although some surgeons provide long-term followup for patients with THAs, they often are not as arduous in following patients with endoprostheses and our two patients emphasize the importance of doing so. Although postoperative erosion of the acetabulum is most commonly the result of wear of the cartilage and bone by the large metal unipolar head [10,17,24,26,27], special attention should be directed to detect superior migration of the implant and erosion of the greater trochanter. These findings may herald the need for a complex revision with removal of a well-fixed stem and a constrained liner or dualmobility cup to deal with the abductor erosion, rather than just placement of an acetabular cup and a femoral head exchange.…”

Section: Discussionmentioning

confidence: 99%

“…Complications of this modular junction include fretting [6-8, 12, 16, 23], crevice corrosion [6-8, 12, 13, 16, 23], and fracture of the trunnion [2,4,13,15,19,28]. The most common reason for revision of a unipolar endoprosthesis is stem loosening [1,10,27] or acetabular erosion from the large femoral head articulating on the host acetabular cartilage and not from complications of the trunnion [10,17,24,26,27]. Recent reports of large diameter heads in metal-on-metal THA have shown increased rates of trunnion corrosion [3,11,20], increased serum metal ion levels [3,11,20,21], Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.…”

Section: Introductionmentioning

confidence: 99%

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Severe Metal-induced Osteolysis Many Years After Unipolar Hip Endoprosthesis

Mann

Tanzer

Tänzer

2013

Clinical Orthopaedics &Amp; Related Research

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Background Modularity of the femoral head-neck junction provides increased intraoperative flexibility to the surgeon. Complications of this modularity include damage to the trunnion, with subsequent bone and/or soft tissue loss from adverse reactions to metal debris. Case Description We describe two cases of severe metalinduced osteolysis and soft tissue damage requiring revision 10 and 13 years following implantation of a unipolar endoprosthesis. Damage to the trunnion resulted in severe acetabular and trochanteric osteolysis and soft tissue loss requiring complex revision surgery. Literature Review Several reports have shown the trunnion, the head-neck interface, and the neck-stem couple as the causes of this early failure secondary to metal ion release from mechanical fretting corrosion or from crevice corrosion at these modular interfaces. These reports have been in association with a total hip prosthesis rather than a unipolar endoprosthesis. Revision of a unipolar endoprosthesis is most commonly attributable to stem loosening or acetabular erosion from the large femoral head articulating on the host acetabular cartilage and not owing to failure of the trunnion. Purposes and Clinical Relevance Trunnion damage resulting in a severe reaction to metal debris with acetabular osteolysis, erosion of the greater trochanter, and loss of the abductor mechanism can occur years after implantation of a cementless unipolar endoprosthesis. This raises questions regarding long-term safety of the modular interface of a contemporary cementless stem and a large-diameter unipolar head. We recommend long-term followup of patients with a unipolar endoprosthesis as early recognition and treatment are required to avoid a potentially complex revision.

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“…With the aging society in most developed countries, the increased number of elderly patients with osteoporosis is expected to result in a gradual increase of patients with femoral neck fracture 1–3. Elderly patients with displaced femoral neck fracture generally undergo hemiarthroplasty for early rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Effect of a prostaglandin EP4 receptor agonist on early fixation of hydroxyapatite/titanium composite‐ and titanium‐coated rough‐surfaced implants in ovariectomized rats

Hayashi

Fotovati

Ali

et al. 2009

J Biomedical Materials Res

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The agonist of the prostaglandin EP4 receptor can increase bone density in osteoporosis. Using ovariectomized (OVX) and sham-operated (SO) rats, the effects of the EP4 receptor agonist, ONO-4819, and hydroxyapatite (HA) on implant-bone fixation in implants with a rough surface were investigated. Female Wistar rats (12 weeks old) were divided into either SO or bilateral OVX groups. Twenty four weeks later, either hydroxyapatite/titanium (HA/Ti) composite-coated or Ti-coated implants were implanted into the femora, and the animals were treated with either ONO-4819 or saline for 4 weeks. The fixation strength of the HA/Ti-coated implants was higher than that of the Ti-coated implants in the saline-treated OVX rats. In the OVX rats, ONO-4819 enhanced fixation of the rough Ti-coated implants to levels similar to that of HA/Ti-coated implants. These data suggest that a combination of treatment with an EP4 receptor agonist and a rough-surfaced implant might be useful in increasing the early fixation of cement-less arthroplasty, particularly in elderly patients with osteoporosis.

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Revision of failed hemiarthroplasty for fractures at the hip

Cited by 30 publications

References 19 publications

Five-year clinical, radiological and postmortem results of the Cambridge Cup in patients with displaced fractures of the neck of the femur

Five-year clinical, radiological and postmortem results of the Cambridge Cup in patients with displaced fractures of the neck of the femur

Severe Metal-induced Osteolysis Many Years After Unipolar Hip Endoprosthesis

Effect of a prostaglandin EP4 receptor agonist on early fixation of hydroxyapatite/titanium composite‐ and titanium‐coated rough‐surfaced implants in ovariectomized rats

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