Survivorship and Radiological Analysis of a Monoblock, Hydroxyapatite-Coated Titanium Stem in Revision Hip Arthroplasty

Saunders, P. R.; Shaw, Debbie A.; Sidharthan, Sijin K.; Siney, Paul D.; Young, Stephen K.; Board, Tim

doi:10.1016/j.arth.2020.01.081

Cited by 8 publications

(8 citation statements)

References 39 publications

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“…We investigated the ability to restore offset and LL using a revision stem with good mid-term survivorship. 19 We report that FO and LL can be restored within ±5 mm in over 50% of cases and to within ±10 mm in over 80% of cases. These results demonstrate adequate reproduction of biomechanics can be achieved using a monoblock, fully HA-coated titanium stem.…”

Section: Discussionmentioning

confidence: 65%

“…18 The stem has a reported aseptic survivorship of 97.33% at 6 years with low complication rates and evidence of proximal bone loading. 19 Initially the stem was available with a single offset (135° neck shaft angle), the only modifiable aspect being neck length. In 2012, additional stem sizes (11, 13 and 15) and a high off-set version (135° neck shaft angle with 7 mm of lateralisation) were introduced; 11 cases in the series had a high off-set version.…”

Section: Methodsmentioning

confidence: 99%

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Hip offset and leg-length restoration in revision hip arthroplasty with a monoblock, hydroxyapatite-coated stem

et al. 2022

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Aims: Restoration of normal hip biomechanics in arthroplasty surgery is important in order to achieve good muscle function and joint stability. Methods: In this retrospective cohort study, we examined the postoperative radiographs of 131 femoral revision arthroplasty procedures using a monoblock, fully hydroxyapatite (HA)-coated titanium stem. Femoral offset, modified-global offset and leg length were measured of the operated and contralateral hips. Results: Femoral offset was restored to ±10 mm in 108 cases (82%), modified-global offset was restored ±10 mm in 93 cases (71%) and leg length was restored to ±10 mm in 102 cases (81%). There were 4 dislocations with a mean follow-up period of 38 months. Conclusions: Restoration of hip biomechanics is achievable with a monoblock stem and thus is a viable option in revision hip arthroplasty.

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Section: Discussionmentioning

confidence: 65%

Section: Methodsmentioning

confidence: 99%

Hip offset and leg-length restoration in revision hip arthroplasty with a monoblock, hydroxyapatite-coated stem

et al. 2022

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“…2020 [ 23 ] 157 Periprothetische Frakturen (22,9 %) I bis IV 1 0 % 11,87 % 3,8 % 0 % 96,2 % Saunders et al. 2020 [ 55 ] 254 Aseptische Lockerung (75 %) I bis IIIb 5,2 1,2 % 11 % 11,4 % 0,3 % 94,8 % Modulare Revisionsschäfte Wirtz et al. 2014 [ 66 ] 163 Aseptische Lockerung (95 %) I bis III 5,7 0 % 12 % 3 % 0 % 97 % Schnurr et al.…”

Section: Komplikationen Und Ergebnisseunclassified

Strategien für die Schaftrevision

2022

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Zusammenfassung Hintergrund und Planung Die Schaftrevision stellt in ihrer Operationsvorbereitung und technischen Durchführung eine große Herausforderung dar. Die Ergebnisse sind maßgeblich von der Defektsituation, der Qualität der Implantatentfernung sowie der Wahl des Revisionsimplantates abhängig. Patientenspezifische Faktoren wie das Alter, die Komorbiditäten, die Knochenqualität oder auch die Lokalisation des Zementes haben entscheidenden Einfluss auf die operative Strategie. Eine entsprechende präoperative Vorbereitung inklusive des Vorhandenseins von notwendigen Spezialinstrumenten, die essenziell für die schonende Implantatentfernung sind, ist unabdingbar, um das bestmögliche Ergebnis zu erzielen. Therapie Die knochenschonende Explantation stellt gerade bei festsitzenden Schäften und Zementresten, die ggf. weit über den Isthmus reichen können, eine besondere Herausforderung dar. In solchen Situationen sollte ein transfemoraler Zugang erwogen werden. Die zementfreie Reimplantation unter Verwendung von modularen oder nichtmodularen Titanschäften ist für die meisten Revisionen die derzeit bevorzugte Therapie der Wahl. Bei älteren Patienten mit niedrigem Leistungsanspruch oder schlechter Knochenqualität bleibt die zementierte Versorgung eine gute alternative Therapieoption.

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“…[1][2][3] Many of these revision indications are associated with varying amounts of femoral bone loss. 4 Several studies on titanium tapered stems (TTS) have reported excellent implant survivorship with relatively low rates of stem subsidence; [5][6][7] for this reason, the TTS is now the workhorse implant design used in contemporary femoral component revision.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic cable prevents tapered titanium stem subsidence with 2 cm of stem-cortical engagement in a cadaveric model

et al. 2023

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AimsWhen performing revision total hip arthroplasty using diaphyseal-engaging titanium tapered stems (TTS), the recommended 3 to 4 cm of stem-cortical diaphyseal contact may not be available. In challenging cases such as these with only 2 cm of contact, can sufficient axial stability be achieved and what is the benefit of a prophylactic cable? This study sought to determine, first, whether a prophylactic cable allows for sufficient axial stability when the contact length is 2 cm, and second, if differing TTS taper angles (2° vs 3.5°) impact these results.MethodsA biomechanical matched-pair cadaveric study was designed using six matched pairs of human fresh cadaveric femora prepared so that 2 cm of diaphyseal bone engaged with 2° (right femora) or 3.5° (left femora) TTS. Before impaction, three matched pairs received a single 100 lb-tensioned prophylactic beaded cable; the remaining three matched pairs received no cable adjuncts. Specimens underwent stepwise axial loading to 2600 N or until failure, defined as stem subsidence > 5 mm.ResultsAll specimens without cable adjuncts (6/6 femora) failed during axial testing, while all specimens with a prophylactic cable (6/6) successfully resisted axial load, regardless of taper angle. In total, four of the failed specimens experienced proximal longitudinal fractures, three of which occurred with the higher 3.5° TTS. One fracture occurred in a 3.5° TTS with a prophylactic cable yet passed axial testing, subsiding < 5 mm. Among specimens with a prophylactic cable, the 3.5° TTS resulted in lower mean subsidence (0.5 mm (SD 0.8)) compared with the 2° TTS (2.4 mm (SD 1.8)).ConclusionA single prophylactic beaded cable dramatically improved initial axial stability when stem-cortex contact length was 2 cm. All implants failed secondary to fracture or subsidence > 5 mm when a prophylactic cable was not used. A higher taper angle appears to decrease the magnitude of subsidence but increased the fracture risk. The fracture risk was mitigated by the use of a prophylactic cable.Cite this article: Bone Jt Open 2023;4(7):472–477.

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Survivorship and Radiological Analysis of a Monoblock, Hydroxyapatite-Coated Titanium Stem in Revision Hip Arthroplasty

Cited by 8 publications

References 39 publications

Hip offset and leg-length restoration in revision hip arthroplasty with a monoblock, hydroxyapatite-coated stem

Hip offset and leg-length restoration in revision hip arthroplasty with a monoblock, hydroxyapatite-coated stem

Strategien für die Schaftrevision

Prophylactic cable prevents tapered titanium stem subsidence with 2 cm of stem-cortical engagement in a cadaveric model

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