Failed Total Hip Replacement Research Articles

The fate of femoral windows in revision joint arthroplasty.

We retrospectively reviewed the radiographs of twenty patients in whom a window in the femoral cortex had been created to facilitate revision of a failed total hip replacement with a non-cemented prosthesis, to determine if the window had healed and, if so, how long it had taken. All but three windows showed clear evidence of healing three months postoperatively. At six months, only two windows remained radiographically visible, and at eight months, all of the windows had healed. We concluded that when the section of cortical bone that is removed to create the window is replaced with an uncemented femoral component, the window heals by bone within three to eight months.

Prosthetic hip failure: preliminary findings of retrospective radiograph image analysis.

We present the results of a retrospective study based on radiographs of 75 successful total hip replacements, and 103 which involved failure of the femoral component of the prosthesis. The failures were selected to exclude cases in which infection was implicated. Success was defined as absence of adverse clinical or radiological symptoms for at least 12 years after surgery. A failure was either obvious, for example, stem fracture, or defined as one which showed progressive radiological and clinical degeneration resulting in the need for revision surgery. Measurements were made on radiographs which had been obtained immediately post-operatively, so that the features measured would depend on surgical procedure rather than on any subsequent biological response. Computer image analysis has been used to make precisely defined, reproducible measurements of 58 parameters characterising the insertion of the femoral component of a standard Charnley prosthesis. These parameters include geometry of insertion, distribution of cement, surrounding bone thickness, and so on. Clinical findings, including patient weight, were also recorded with the measurements on computer disc. Preliminary statistical comparisons indicate that several of the measured parameters are of predictive value for determining the long-term success or failure of total hip replacements.

ＴＨＲ再置換術におけるＡｌｌｏｇｒａｆｔの経験

We presented a case, sixty-six-year-old woman, who had been treated with large allograft for severe structural deficiency about the hip joint associated with prior failed total hip replacement. The acetabulum and a part of the femoral neck were reconstructed with frozen massive allografts. Partial weight bearing was started at three months postoperatively. A year after surgery loosening and proximal migration of the acetabular component were revealed radiografically. We are considering the additional operation for her hip pain.

Total Hip Reconstruction Using Frozen Femoral Head Allografts in Patients with Acetabular Bone Loss

Major acetabular bone loss associated with failed total hip replacements can be managed successfully using frozen femoral heads as structural allografts during revision surgery. In 29 cases followed for an average period of 3.9 years, all of the grafts showed radiographic evidence of union. Five hips showed clinical or radiographic evidence for acetabular loosening. Three of these hips required reoperations for symptomatic loosening. In two of these, sufficient bone stock was present to permit another revision without further bone grafting. Twenty-five of the remaining 26 hips were functioning satisfactorily with a mean Harris score of 84 points. In view of the major bone loss following multiple previous operative procedures in these young patients, the results of revisions using structural femoral head allografts were clearly superior to those with resection arthroplasty, the most likely alternate solution. Graft resorption, lack of posterior coverage, and incomplete cement mantle contributed to the failures.

Massive allografting for severe failed total hip replacement.

We are presenting the cases of five patients that illustrate the uses of large, frozen bone and osteoarticular allografts in dealing with severe structural deficiency about the hip joint associated with prior failed total hip replacement. The status of the grafts was assessed at a minimum follow-up of twenty-four months (average, thirty months). In four patients extensive grafts in the proximal part of the femur in conjunction with total hip-replacement components were used, and in the fifth patient a matched whole-joint transplant of the proximal part of the femur and the acetabulum was employed. The short-term clinical advantage of these massive grafts is clear, but the long-term results are uncertain.

Revision of Total Hip Replacement with Solid Cortico-spongious Bone Graft for Medial Acetabular Disruption

In revision of failed total hip replacements with disruption of the medial acetabular wall the use of autogenous solid cortico-spongious bone graft proved to be a successful surgical procedure. In 7/8 revisions followed for 2-3 years, the bone grafts healed, as seen radiographically on plain film or by conventional tomography and no further acetabular protrusion occurred. Two of these seven hips had a radiolucent zone of 2-5 mm at the bone-cement interface at the inferior part of the cup. In the eighth hip the bone graft was resorbed/eroded and the cup had migrated 4 mm in the mediocranial direction.

A Case of Double Fracture in Total Hip Replacement

Femoral stem failure in total hip replacement is uncommon. It tends to occur predominantly in males over 1.8 m in height and over 76 kg in weight. Poor or inadequate cementing technique may lead to cement failure, which may be seen as roentgenographic lucencies present by as much as 12 months prior to actual stem failure. This article reports on a case of double stem failure, together with a full metallurgical examination, which indicated loosening of the implant prior to eventual failure from overload. Although one of the fractures occurred across an area of relative weakness in the stem material, this was not felt to be the principal cause of failure.

A New Power Tool for Removal of Methylmethacrylate from the Femur

An air turbine drill will remove methylmethacrylate from the medullary canal of the proximal femur in cases of failed total hip replacement and from the distal femur in cases of failed long stem total knee replacement. This power tool is expensive, but the high cost is partially offset by multiple other uses: cutting burr holes in the skull, doing osteotomies, cutting bone grafts and making windows in the femur. The power of the instrument and effectiveness of the burrs make it important to have instruction and direct experience in its proper use prior to use in the operating room.

Femoral stem failure in total hip replacement

Reported here are four fractured femoral components from a consecutive series of 200 total hip reconstructions. All four had been placed in patients who weighed ninety-one kilograms or more and who were more than 1.8 meters tall. In each patient, roentgenograms made prior to the time of failure of the prosthesis revealed roentgenographic lucency, which was interpreted as cement failure. Metallurgical examination revealed fatigue failure and some abnormality in each prosthetic stem. Review of all 200 total hip replacements suggested that there was failure to position the prosthesis in strong valgus in there four hips and in thirty others. In the four failures, the contributing influences of large size of patients, inadequate valgus positioning of the prosthesis, inadequate support by cement, and metallurgical inadequacies of the prosthesis used are discussed.

Articular Interposition of Trochanteric Wires in a Failed Total Hip Replacement

This is a case report of a previously unrecorded complication of trochanteric osteomy in a total hip arthroplasty. The trochanteric wire fixation failed and wire fragments migrated from the osteotomy site into the joint space. Revision total arthroplasty was elected. An additional potential complication of trochanteric osteotomy is noted.