Subtrochanteric Fracture in a Patient With Trabecular Metal Osteonecrosis Intervention Implant

Fung, Daniel A.; Frey, Steven; Menkowitz, Marc; Mark, Arthur

doi:10.3928/01477447-20080601-09

Cited by 9 publications

(5 citation statements)

References 9 publications

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“…Comparing the complications after insertion of the TI with previous literature, Nadeau et al determined one subtrochanteric fracture four weeks postoperatively within a group of 18 ONFH [15]. A similar case of a subtrochanteric fracture after insertion of the TI was described by Fung et al [9]. Two other studies analysing the treatment of TI revealed no fracture [17,21].…”

Section: Load Bearingmentioning

confidence: 83%

Core decompression and osteonecrosis intervention rod in osteonecrosis of the femoral head: clinical outcome and finite element analysis

Floerkemeier

Lutz

Nackenhorst

et al. 2010

International Orthopaedics (SICOT)

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The osteonecrosis of the femoral head implies significant disability partly due to pain. After conventional core decompression using a 10-mm drill, patients normally are requested to be non-weight bearing for several weeks due to the risk of fracture. After core decompression using multiple small drillings, patients were allowed 50% weight bearing. The alternative of simultaneous implantation of a tantalum implant has the supposed advantage of unrestricted load bearing postoperatively. However, these recommendations are mainly based on clinical experience. The aim of this study was to perform a finite element analysis and confirm the results by clinical data after core decompression and after treatment using a tantalum implant. Postoperatively, the risk of fracture is lower after core decompression using multiple small drillings and after the implantation of a tantalum rod according to finite element analysis compared to core decompression of one 10-mm drill hole. According to the results of this study, a risk of fracture exists only during extreme loading. The long-term results reveal a superior performance for core decompression presumably due to the lack of complete bone ingrowth of the tantalum implant. In conclusion, core decompression using small drill holes seems to be superior compared to the tantalum implant and to conventional core decompression.

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Section: Load Bearingmentioning

confidence: 83%

Core decompression and osteonecrosis intervention rod in osteonecrosis of the femoral head: clinical outcome and finite element analysis

Floerkemeier

Lutz

Nackenhorst

et al. 2010

International Orthopaedics (SICOT)

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“…Metal trabecular material positively affected bone ingrowth for stability of secondary implant (Spinato et al, 2014). As a fairly novel and special material, metal trabecular is reported to resemble bone more than any other prosthesis physically and mechanically, and no major complications were uncovered after treatment (Fung, Frey, Menkowitz, & Mark, 2008). Studies focusing on ONFH suggested that metal trabecular rods implantation, and metal-onmetal total hip resurfacing arthroplasty can serve as advisable options for treating ONFH and severe femoral bone defects (Mont, Seyler, Marker, Marulanda, & Delanois, 2006;Tischler, Hansen, & Austin, 2014).…”

Section: Discussionmentioning

confidence: 99%

Metal trabecular bone reconstruction system better improves clinical efficacy and biomechanical repair of osteonecrosis of the femoral head than free vascularized fibular graft: A case–control study

Chen

Zhu

Liu

et al. 2019

Journal Cellular Physiology

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In this study, we aim to compare and analyze the biomechanical repair and clinical efficacy of osteonecrosis of the femoral head (ONFH) with the use of metal trabecular bone reconstruction system and free vascularized fibular graft. The study enrolled 66 adult patients from medical records of nontraumatic ARCO 2A-3B stage ONFH. A simple ONFH model without surgical treatment was established in 13 cases, 29 cases were treated with metal trabecular bone reconstruction system, and 24 cases were treated with free vascularized fibular graft. Computer-recognized and extracted femur outlines were imported, and three-dimensional reconstructions were performed. The stress concentration and stress peak value were analyzed, and the Harris score, visual analog scale pain score, and operation status of the above patients were compared. Finally, quality of life assessment was performed using SF-36 scale. Metal trabecular bone reconstruction system provided less operation time, blood loss, and the total length of postoperative hospital stay than free vascularized fibular graft. Metal trabecular bone reconstruction system promoted bone reconstruction, increased bone mineral density and Harris score. The total clinical effective rate of young patients (20-40 years) was higher than that of older patients (41-60 years). Metal trabecular bone reconstruction system provided higher physical component summary, mental component summary, and role/social component summary than free vascularized fibular graft. This study demonstrates that both metal trabecular bone reconstruction system and free vascularized fibular graft can prevent or delay the progression of ONFH, while metal trabecular bone reconstruction system is a better choice because of better short-term clinical efficacy. K E Y W O R D S finite-element analysis, free vascularized fibular flap, metal trabecular bone reconstruction system, osteonecrosis of the femoral head *Xian-Tao Chen and Ying-Jie Zhu are cofirst authors.

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“…36,37 Concerns over weakening the femoral neck by drilling of the lateral cortex for insertion of a 10 mm tantalum rod are well founded with reports of five patients having sustained a subtrochanteric fracture post-operatively after a fall. 13,17,18,38 Since the length and diameter of the pegs are small and they do not engage the lateral cortex, and the two or three drillholes of 4 mm (or 4.5 mm) are dispersed, less stress might be generated at the lateral cortex compared with a single hole of more than 10 mm. Moreover, the small length of the pegs eliminates the need to cut the metal and disperse metallic debris, in case of a possible future conversion to a THR.…”

Section: Discussionmentioning

confidence: 99%

Early results of a novel technique using multiple small tantalum pegs for the treatment of osteonecrosis of the femoral head

Malizos

Papasoulis²,

Dailiana³

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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The introduction of a trabecular tantalum rod has been proposed for the management of early-stage osteonecrosis of the femoral head but serves as a single-point of support of the necrotic lesion. We describe a technique using two or three 4.2 mm (or later 4.7 mm) tantalum pegs for the prevention of collapse of the necrotic lesion. We prospectively studied 21 patients (26 hips) with non-traumatic osteonecrosis of the femoral head treated in this manner. Of these, 21 patients (24 hips) were available for radiological and clinical evaluation at a mean follow-up of 46 months (18 to 67). Radiological assessment showed that only eight hips deteriorated according to the Association Research Circulation Osseous classification, and four hips according to the Classification of the Japanese Investigation Committee of Health and Welfare. Functional improvement was obtained with an improvement in the mean Harris hip score from 65.2 (33.67 to 95) to 88.1 (51.72 to 100), the mean Merle D'Aubigné-Postel score from 13 (6 to 18) to 16 (11 to 18), a mean visual analogue score for pain from 5.2 (0 to 9.5) to 2.6 (0 to 7), and the mean Short-Form 36 score from 80.4 (56.8 to 107.1) to 92.4 (67.5 to 115.7). Of these 24 hips followed for a minimum of 18 months, three were considered as failures at the final follow-up, having required total hip replacement. One of the hips without full follow-up was also considered to be a failure. In more than two-thirds of the surviving hips a satisfactory clinical outcome was achieved with promising radiological findings. The estimated mean implant survival was 60 months (95% confidence interval 53.7 to 66.3).

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Subtrochanteric Fracture in a Patient With Trabecular Metal Osteonecrosis Intervention Implant

Cited by 9 publications

References 9 publications

Core decompression and osteonecrosis intervention rod in osteonecrosis of the femoral head: clinical outcome and finite element analysis

Core decompression and osteonecrosis intervention rod in osteonecrosis of the femoral head: clinical outcome and finite element analysis

Metal trabecular bone reconstruction system better improves clinical efficacy and biomechanical repair of osteonecrosis of the femoral head than free vascularized fibular graft: A case–control study

Early results of a novel technique using multiple small tantalum pegs for the treatment of osteonecrosis of the femoral head

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