Use of an ‘internal proximal femoral replacement’ with distal fixation in revision arthroplasty of the hip

Jaiswal, Parag; Jagiello, Jakub; David, L.; Blunn, Gordon; Carrington, Richard; Skinner, John; Cannon, Stephen R.; Briggs, Timothy

doi:10.1302/0301-620x.90b1.19494

Cited by 11 publications

(6 citation statements)

References 19 publications

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“…This demonstrates that adequate debridement in combination with prolonged targeted antimicrobial therapy can minimise the risk of endoprosthesis infection. Of note, proximal femoral replacements have been used to treat failed hip replacements with severe proximal bone loss, and functional outcomes were similar to those in our study [9].…”

Section: Discussionsupporting

confidence: 82%

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Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma

Dean

Matthews

Price

et al. 2011

International Orthopaedics (SICOT)

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Section: Discussionsupporting

confidence: 82%

“…Mean time from initial injury to EPR was 34 (6-102) months, and median number of previous operations was two (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). All patients had sustained traumatic fractures of the proximal femur-four 31.A2.3, The ultimate failed internal fixation was a dynamic hip screw in three cases (Fig.…”

Section: Resultsmentioning

confidence: 99%

Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma

Dean

Matthews

Price

et al. 2011

International Orthopaedics (SICOT)

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“…The high postoperative deep infection rate (5%) in our series can be explained by multiple previous surgeries that patients had undergone, long operative time, and the large size of cortical strut onlay allografts. Complication and reoperation rates of alternative techniques, including circumferential proximal femoral allograft [30], impaction bone grafting [20,31], proximal femoral allograft-prosthesis composites [2], proximal femur replacements [21], and modular fluted tapered stems [1,8] appear to be greater than in the current study despite that the durations of followup were substantially shorter in those series (Table 4). Head and Malinin [18] reported the survival rate of revision cementless stems with structural onlay allografts was 97% at 9.5 years followup.…”

Section: Discussioncontrasting

confidence: 58%

High Survivorship With Cementless Stems and Cortical Strut Allografts for Large Femoral Bone Defects in Revision THA

Kim

Park

Kim

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Numerous studies have investigated the clinical and radiographic results of revision THAs with use of cementless stems and cortical strut allografts. However, to our knowledge, no long-term followup studies have evaluated patients undergoing revision THA with use of cortical strut allografts where the allografts provided the primary stability for extensively coated femoral stems in the presence of extensive femoral diaphyseal bone defects. Question/purposes We performed this study to determine (1) validated outcomes scores; (2) radiographic signs of fixation and allograft healing; (3) frequency of complications; and (4) survivorship of the components after use of cortical strut onlay allografts in Types IIIB and IV femoral diaphyseal bone defects.Methods Between 1994 and 2003, we performed 140 revision THAs in 130 patients with Paprosky Types IIIB and IV femoral diaphyseal defects. The patients were treated using extensively coated femoral stems and cortical strut allografts because primary axial or rotational stability could not be achieved without grafting. Ten of the patients (10 hips; 7.7%) were lost to followup or died before 10 years; the remaining 120 patients (130 hips) represent the study group in this retrospective study. There were 66 men and 54 women. Their mean age at the time of index surgery was 59 ± 18 years (range, 36-67 years). The primary diagnosis was predominantly osteonecrosis of the femoral head (53%). The most common reason for revision was aseptic loosening (97%), followed by periprosthetic fracture (3%). The mean time from primary to revision THA was 12 years (range, 8-27 years). The mean duration of followup was 16.1 years (range, 12-20 years). Results The mean Harris hip score was 39 ± 10 points before revision and improved to 86 ± 14 points at 16 years followup (p = 0.02). The mean preoperative WOMAC score was 62 ± 29 (41-91) points and improved to 22 ± 19 (11-51) points at 16 years followup (p = 0.003). Of the 130 stems, 113 (87%) had bone ingrowth, five (4%) had stable fibrous ingrowth, and 12 (9%) were unstable. All allografts were incorporated. Four hips (3%) had a displaced femoral shaft fracture at the stem tip; four (3%) had a postoperative dislocation; and six (5%) had early postoperative infection. Kaplan-Meier survivorship analysis, with revision or radiographic failure as the endpoint, revealed that the 16-year rate of survival of the components was 91% (95% CI, 0.88%-0.96%).

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“…Methicillin-resistant Staphylococcus aureus (MRSA) has become an important pathogen in orthopedic infections in many parts of the world (Stefani and Varaldo 2003, Giannoudis et al 2005, Patel et al 2008). The situation in Swedish hospitals is more favorable (Stenhem et al 2006), but the prevalence of MRSA in the Swedish community is unknown, and there is limited information from other countries (Gorwitz et al 2008, Donker et al 2009).…”

mentioning

confidence: 99%

Bacterial colonization and resistance patterns in 133 patients undergoing a primary hip- or knee replacement in Southern Sweden

Stefánsdóttir¹,

Johansson²,

Lidgren³

et al. 2013

Acta Orthopaedica

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Background and purpose Prosthetic joint infections can be caused by bacteria derived from the patient’s skin. The aim of the study was: (1) to determine which bacteria colonize the nose and groin in patients planned for primary hip or knee arthroplasty, (2) to determine the antimicrobial resistance patterns, and (3) to monitor changes in bacterial colonization and resistance patterns connected to surgery.Patients and methods 2 weeks before scheduled primary hip or knee arthroplasty, culture samples were taken from the anterior nares and from the groin of 133 consecutive patients. At surgery, cloxacillin was given prophylactically and cement with gentamicin was used. 2 weeks after surgery, another set of samples were taken from 120 of these patients. Bacterial findings and resistance patterns were analyzed.Results Preoperatively, 95% of the patients had coagulase-negative staphylococci (CNS) in the groin and 77% in the nose. The proportion of patients with a methicillin-resistant CNS in the groin increased from 20% preoperatively to 50% postoperatively (p < 0.001), and the proportion of patients with a gentamicin-resistant CNS in the groin increased from 5% to 45% (p < 0.001). 28% of the patients had Staphylococcus aureus in the nose preoperatively, and 7% in the groin. Methicillin-resistant Staphylococcus aureus (MRSA) was found in the nose of 1 patient.Interpretation In southern Sweden, beta-lactams were effective against 99% of the Staphylococcus aureus strains and 80% of the CNS strains colonizing the patients undergoing primary hip or knee arthroplasty. Gentamicin protects against most CNS strains in cemented primary joint replacements.

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Use of an ‘internal proximal femoral replacement’ with distal fixation in revision arthroplasty of the hip

Cited by 11 publications

References 19 publications

Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma

Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma

High Survivorship With Cementless Stems and Cortical Strut Allografts for Large Femoral Bone Defects in Revision THA

Bacterial colonization and resistance patterns in 133 patients undergoing a primary hip- or knee replacement in Southern Sweden

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