Revision of hip resurfacing arthroplasty with a bone-conserving short-stem implant: a case report and review of the literature

Abstract

IntroductionSuitable treatment of early failure of total hip replacement is critical in younger patients, as bone stock is lost and the functional outcome is impaired.Case presentationWe report the case of a 56-year-old Caucasian woman with early failure of hip resurfacing arthroplasty. While revision is usually performed with a conventional hip implant, this case report describes for the first time a revision procedure with a bone-conserving short-stem hip implant.ConclusionsOur approach allows further conservation of femoral bone stock and provides a long-term solution to the patient, which maintains the possibility of using a conventional hip implant should a second revision become necessary.

Can hip resurfacing be safely revised with short-stem total hip arthroplasty? A case series of six patients

“…Preservation of bone stock is of utmost importance in modern THA, in particular taking into account that patients become increasingly younger of age, thus most likely experiencing one or more revision surgeries during their lifetime. 13 Although to date the usage of short stems in revision THA is to be considered off-label use, it may, however, offer the opportunity of saving as much femoral bone stock as possible with regards to further future revisions in assorted patients. The present consecutive case series aimed to investigate the outcomes of revision THA using a short stem in patients with failed HRA.…”

“…Given that many patients with a failed HRA are less than 60 years of age, 13 in modern THA a decisive long-term strategy for further revisions, including also contemporary implant designs, seems crucial. In many cases, HRA, given its particular design, primarily preserves the metaphyseal femoral bone stock and thereby, in theory, allows revision surgery with a short-stem design.…”

“…To date, however, almost no data is available regarding revision of HRA with a short stem. Schmidutz et al 13 reported a case report of one patient with failed HRA, which was revised at three years due to a traumatic dislocation of the acetabular component following a falling incident two months earlier. Intraoperatively, a massive metallosis of the periprosthetic tissue was found, and both the femoral and acetabular components were found damaged, making the removal of all components necessary.…”

“…Intraoperatively, a massive metallosis of the periprosthetic tissue was found, and both the femoral and acetabular components were found damaged, making the removal of all components necessary. 13 As the femoral bone was found to be intact, the osteotomy was performed directly below the femoral component and a metaphyseal-anchored short stem (Metha, B. Braun Aesculap, Tuttlingen, Germany) was used as revision implant. At the two year follow up, Schmidutz et al reported a good clinical outcome (HHS 86) and a stable implant position.…”

“…To our best knowledge, only one case report of revision surgery of HRA using a short stem has been published so far. 13 As revision surgery of HRA using a short stem is to be considered off-label use, given the various manufacturers recommendations regarding indications, short stems are not eligible to be used as revision implants. Subsequently, numbers of cases are scarce and clinical outcomes as well as risks and complications of revision surgery using a short stem are unknown.…”