Loosening Of Femoral Component Research Articles

No Difference in Revision Rates or Patient Reported Outcome Measures Between Surgical Approaches for Total Hip Arthroplasty Performed for Femoral Neck Fracture: An Analysis of 5,025 Primary Total Hip Arthroplasties from the New Zealand Joint Registry

BackgroundTotal hip arthroplasty (THA) for femoral neck fracture (FNF) can be performed through different surgical approaches. This study compared the revision rates and patient-reported outcome measures (PROM) by surgical approach. MethodsData from the New Zealand Joint Registry (NZJR) were analyzed for patients undergoing primary THA for FNF from January 2000 to December 2021. A total of 5,025 THAs were performed for FNF; the lateral approach was used in 2,499 (49.7%), the posterior in 2,255 (44.9%), and the anterior in 271 (4.3%). The primary outcome measure was the all-cause revision rate. Secondary outcome measures included revision rates for: dislocation, aseptic femoral component loosening, periprosthetic fracture, and infection. Oxford Hip Scores (OHS) were also collected. Age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, femoral head size, dual mobility use, femoral fixation, and surgeon experience were assessed as potential confounding variables. ResultsThere was no difference in the revision rates between lateral and posterior (P = 0.156), lateral and anterior (P = 0.680), or posterior and anterior (P = 0.714) approaches. There was no difference in the reasons for revision between the lateral and posterior approaches or six-month OHS (P = 0.712). There was insufficient data to compare the anterior approach. ConclusionsThere is no difference in the overall revision rates, reasons for revision, or OHS between the lateral and posterior surgical approaches for THA performed for FNF. Insufficient data on the anterior approach is available for an accurate comparison.

A comparison of cemented femoral fixation via anterior versus posterior approach total hip arthroplasty: an analysis of 60,739 total hip arthroplasties.

Anterior approach total hip arthroplasty (THA) decreases the rate of dislocation but increases femoral-sided complications in the way of periprosthetic fractures and component loosening. A cemented prosthesis may reduce femoral-sided complications and improve the risk:benefit profile of anterior approach THA. Data from the Australian National Joint Replacement Registry were analysed for patients undergoing primary THA via the anterior or posterior approach using a cemented polished femoral stem from January 2015 to December 2021. The primary outcome measure was the cumulative percent revision (CPR) for all causes and CPR for femoral component loosening and fracture. The CPR for the primary outcome measures were compared between the anterior and posterior approach and adjusted for age, sex, ASA score, BMI and femoral head size. The study included 60,739 THAs with cemented stems (10,742 anterior, 49,997 posterior). The rate of revision of the anterior versus the posterior approach did not significantly differ (HR 0.87 (95% CI, 0.74-1.03), p = 0.100). Anterior approach THA had a significantly higher rate of revision for femoral component loosening (HR 5.06 [95% CI, 3.08-8.30], p < 0.001); and a decreased rate of revision for infection (HR 0.59 [95% CI, 0.43-0.81], p = 0.001) and dislocation/instability (HR 0-3 months 0.48 [95% CI, 0.27-0.83], p = 0.008; HR >3 months 0.30 [95% CI, 0.15-0.61], p < 0.001). There was no difference in the rate of revision surgery for fracture between the 2 approaches (HR 1.01 [95% CI, 0.71-1.43]), p = 0.975). There is no significant difference in overall revision rates with cemented femoral fixation performed with an anterior or posterior approach. Cemented fixation performed with the anterior approach partly mitigates femoral complications with no difference in the revision rate for fracture but an increased rate of femoral component loosening.

High femoral offset as a risk factor for aseptic femoral component loosening in cementless primary total hip arthroplasty

PurposeLateralized stems in primary cementless total hip arthroplasty (THA) showed to be associated with aseptic femoral loosening. However, femoral head length also affects femoral offset but was not considered so far. This study analyzed the impact of high femoral offset (hFO) combinations, formed by lateralized stems or large femoral head lengths, on aseptic femoral component loosening.MethodsRetrospective cohort study was performed including all patients that underwent primary cementless THA at our institution between July 2004 and December 2016. Patients were screened for aseptic femoral component loosening and grouped in aseptic loosening (AL) and non-aseptic loosening (nAL) group. Medical records were screened; implant details were noted and classified in hFO and standard femoral offset (sFO) combinations. Supposed risk factors for aseptic loosening were analyzed.ResultsTwo thousand four hundred fifty-nine THA could be included, containing 14 THA (0.6%) with aseptic femoral component loosening. The AL group contained 11 hFO combinations (78.6%), whereas in the nAL group, 1315 hFO combinations (53.8%) were used. Subgroup analysis showed significant difference between two groups for hFO combinations (p = 0.014), age (p = 0.002), NSAR (p = 0.001), and bilateral THA on same day (p = 0.001). The multiple logistic regression analysis showed that hFO combination was the only variable for increased probability of aseptic loosening (OR, 3.7; p = 0.04).ConclusionHigh femoral offset combinations, formed by lateralized stems or large femoral head lengths in our collective of standard straight stems implanted by an anterior approach, show a 3.7-fold increased probability for aseptic femoral component loosening. Adjustment of the postoperative protocol may be considered in these cases to ensure proper stem ingrowth.

A 15-YEAR SURVIVAL ANALYSIS OF OXIDIZED ZIRCONIUM TOTAL KNEE ARTHROPLASTY

AbstractBackgroundOxidized zirconium (OxZr) has been introduced as an alternative bearing for femoral components in Total Knee Arthroplasty (TKA). It has a ceramic-like zirconium oxide outer layer with a low coefficient of friction. Early studies have found OxZr TKA to have a low incidence of early failure in young high demand patients. Currently no study has reported on the outcome of these implants beyond ten years.ObjectivesThe purpose of our study was to present an in-depth 15-year survival analysis of cemented Profix II OxZr TKA.Study Design &amp; MethodsData was collected prospectively and survival analysis undertaken with multiple strict end points. Complication rates were recorded and patient reported outcomes were measured.Results617 Profix II OxZr TKAs were performed over four years. Forty-nine patients underwent reoperation. Aseptic tibial loosening was the most common cause of failure (32.7%) on average occurring 2.8 years post primary procedure. There was one recorded failure due to loosening of the zirconium femoral component. Revision rate at 15-years was 6.38%. Cumulative survivorship was 91.52% with failure considered to be reoperation for any reason. WOMAC score improved in 86% of patients by year 1. The average score improved by 21.2 points and met the standard for minimum clinically important difference.ConclusionsThis study presents the first 15-year survival analysis of cemented Profix II OxZr TKA. Our data supports current literature on the long-term survivorship of oxidised zirconium total knee replacements.

High Rates of Aseptic Loosening in Modern Posterior-stabilized Femoral Components From a Single Manufacturer.

Total knee arthroplasty (TKA) is one of the most commonly performed surgical procedures in the United States. There are concerns and reports of early aseptic loosening due to debonding at the cement-implant interface in a specific posterior-stabilized femoral design. This study describes failure at the cement-implant interface with 2 femoral implant designs produced by a single manufacturer. This is a review of failed primary total knee arthroplasties performed with Optetrak Logic and Truliant posterior-stabilized femoral components between 2010 and 2020. Cases with revision surgery performed for femoral component loosening were reviewed. Seventeen of 896 knees were revised for femoral component loosening. The mean time from index arthroplasty to revision was 73 months. Patients presented with knee pain and recurrent aseptic effusions. More than half of patients had no evidence of component loosening on plain radiographs. Bone scans were positive in 77% of patients with loosening. Femoral components were easily disimpacted from the cement mantle at the time of revision surgery. Patients were treated with femoral only revision or femoral and tibial revision. Two complications occurred in this series. Providers should maintain vigilance in the surveillance of patients with these implants. Clinicians should have a low threshold for additional diagnostic testing if these patients develop pain and/or recurrent effusions. Isolated femoral or complete revision both seem to be acceptable treatment strategies for this failure mechanism.

Ceramic-on-Ceramic Total Hip Arthroplasty for Avascular Necrosis: 13-Year Average Follow-Up of Patients Under 50 Years Old

AbstractThe long-term survival of ceramic-on-ceramic bearings in young, active patients with osteonecrosis undergoing total hip arthroplasty (THA) is unknown. A previously published study demonstrated a high activity level in these young patients at 5-year follow-up, and this is a second follow-up report on this previously reported series. The purpose of this study is to determine whether high activity level is associated with ceramic-on-ceramic THA failure at long-term follow-up. This is a retrospective review of a single-surgeon consecutive series of index cases performed between 2003 and 2010. Inclusion criteria were ceramic-on-ceramic THA articulations in patients younger than 50 with a diagnosis of osteonecrosis. Mean follow-up was 12.5 years (range 9–17). Data were collected by survey via mail, telephone, e-mail, and social media. Preoperative and postoperative Western Ontario and McMaster University (WOMAC) Arthritis Index and University of California at Los Angeles (UCLA) activity scores were collected. Student t-tests were used as appropriate. There were 97 patients in this series. Mean age at THA was 36 (range 14–50). Since the prior report, four more patients have been confirmed deceased, and four more have been lost to follow-up. We confirmed that six patients were deceased and 42 were otherwise lost to follow-up. The response rate was 54%. The vast majority of patients were highly active at latest follow-up (73% with UCLA scores between 7 and 10). UCLA scores (1–10 scale) improved from a preoperative mean of 3.4 to postoperative 7.1 (p &lt; 0.001). WOMAC scores (1–100 scale) increased from preoperative mean of 38.7 to postoperative 86.1 (p &lt; 0.001). At latest follow-up, four patients had undergone revision surgery. There were no ceramic component failures. One patient underwent early revision for femoral component loosening, one was revised for chronic pain at another institution. Since the prior report there have been two additional revisions; one patient was revised for instability at 5-year postop, and one patient was revised for periprosthetic fracture at 10 years. Despite additional loss to follow-up and lack of clinical and radiographic measures, this survey study suggests that at long-term follow-up ceramic bearings accommodate high activity level with excellent component survivorship (93%) in young patients undergoing THA.

Cementless and Cemented Dual-Pivot Total Knee Arthroplasty: A Matched Comparison With a Minimum Two-Year Follow-Up

BackgroundWith the use of newer biomaterials, many authors have reported similar results between cementless and cemented total knee arthroplasty (TKA). The purpose of this study was to compare the early clinical and radiographic outcomes of cementless and cemented TKA using the same dual-pivot articulation. MethodsA consecutive series of 806 TKAs were implanted by a single surgeon using the same dual-pivot articulation. There were 634 TKAs (79%) cemented and 172 (21%) uncemented. One patient in the cementless group was lost before two years. The remaining 171 cementless TKAs were matched 1:1 with cemented TKAs with respect to age, sex, and body mass index. All patients were followed for a minimum of two years (range, 24-66 months) using the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement , and Knee Society clinical and radiographic evaluation. The average follow-up was 3.8 years (range, 24-66 months) in the cemented group and 3.4 years (range, 24-56 months) in the cementless group. ResultsAt final follow-up, the average Knee Injury and Osteoarthritis Outcome Score for Joint Replacement was higher in the cementless group (86 points (range, 64-100) versus 80 points (range, 57-100). Postoperative Knee Society scores (including pain and function) were similar. There was one deep infection (cemented TKA). The manipulation rate was 1.2% in the cementless group and 2.4% in the cemented TKA group. Excluding infection, two knees (1.2%) were revised in each group. No cases of femoral or tibial component loosening were identified. ConclusionPatients implanted with either a cemented or cementless TKA using the same conforming dual-pivot articulation design had similar early outcomes and functional improvements. The type of fixation did not appear to influence the early clinical results.

The clinical effect of trochanteric slide osteotomy combined with a cementless femoral conical stem in total hip replacement for the treatment of Crowe type IV developmental dysplasia of the hip.

Total hip replacement (THR) for Crowe type IV developmental dysplasia of the hip (DDH) is still challenging due to specific joint deformities and the high incidence of post-operative complications. This study aimed to evaluate the clinical effect of trochanteric slide osteotomy (TSO) combined with a cementless femoral conical stem in THR for the treatment of Crowe type IV DDH. Thirty-one total hip replacements (26 patients) with Crowe type IV DDH were performed using TSO combined with a cementless femoral conical stem. Surgical outcomes were evaluated using leg length discrepancy (LLD), Harris hip score, and post-operative complications. The average pre-operative LLD was 51mm (range 46-58mm), decreasing to an average of 10mm (range 8-12mm) post-operatively. As a result, the post-operative incidence of the Trendelenburg sign significantly decreased compared with the pre-operative incidence (P< 0.05). Bony union was identified in 26 hips (83.9%), fibrous union in four (12.9%), and non-union in one (3.2%). No acetabular or femoral component loosening, dislocation, or deep infection around the component was found in any of the patients during the follow-up period (27 to 39 months). The average Harris hip score improved from 63.0 ± 3.0 (range 58-69) to 93.3 ± 2.0 (range 91-96). TSO combined with a cementless conical stem in THR is an appropriate option for patients with high congenital hip dislocation.

POSITIONING OF ACETABULAR AND FEMORAL COMPONENT IN PRIMARY TOTAL HIP ARTHROPLASTY USING CT EVALUATED PATIENT NATIVE ANATOMY

In total hip arthroplasty, component orientation is an important task for stability. Acetabular and femoral component orientation is the key factor for outcome of total hip arthroplasty. The aim of this study is to assess the clinical and radiological effectiveness of positioning of acetabulum and femoral components in primary total hip replacement using CT evaluated patient native anatomy. Subjects of this study were 36 patients with nonunion neck of femur fractures or arthritic hip based on inclusion and exclusion criteria and treated with cemented or uncemented total hip arthroplasty. Pre operative CT scan with 3D reconstruction was done for all patients and the acetabular inclination and version was measured in coronal and axial planes. Femoral anteversion was measured in mid axial image. Transverse acetabular notch (TAN) and anterior acetabular notch (AAN) were identied intra operatively to reproduce the pre operative angles. Post operatively CT scan was done and all angles were measured as before. All patients were followed up and analyzed using Harris Hip Score. The mean preoperative Harris Hip Score is 34.5. The mean postoperative Harris Hip Score is 88.19. Mean acetabular cup inclination is 39.80°, Mean cup anteversion is 15.1° and mean femoral anteversion is 14.75°. No Dislocation was noted during follow up. No hips show clinical and radiological evidence of femoral and acetabular component loosening. All Postoperative CT measurements of angles are within the safe zone by Lewinnek et al. Preoperative CT guided parameters, intra operative anatomical landmarks (TAN&amp;AAN) and the digital protractor device can aid better positioning of the acetabular and femoral component of THA and is independent of the position of the patient. It also provides a precise planning for component placement resulting in less intra operative time thereby reducing the chances of infection and decreases the dislocation rate and wear and tear and improves the functional outcome

The influence of radiologic bone transparency after hybrid total knee arthroplasty on clinical outcomes: Minimum 6-year follow up of 214 cases

BackgroundThis study aimed to investigate how bone transparency affects loosening of the cementless femoral component by serially analyzing radiologic images in hybrid total knee arthroplasty (TKA). MethodsA total of 214 cases of TKA performed using the hybrid technique that were followed up for at least 6 years were retrospectively investigated. Bone transparency around the femoral component during the follow up period was evaluated. All TKA cases were divided into two groups and compared: those with radiologic bone transparency (bone transparency group, n = 51) and those without radiologic bone transparency (no bone transparency group, n = 163). ResultsThe incidence of revision TKA in all patients was 6.1%, and obesity, preoperative and postoperative mechanical alignment did not affect surgical outcomes. All bone transparency cases were asymptomatic, and only 8/51 cases (15.7%) of bone transparency spontaneously resolved. Between the bone transparency and no bone transparency groups, there was no difference found in the preoperative and postoperative radiologic parameters and clinical outcomes. During the follow up period, there were four (1.9%) cases with a definite radiolucent line in the femoral component, all of which belonged to the bone transparency group. ConclusionsThe bone transparency around the femoral component that appears on radiography after hybrid TKA could be an early sign of aseptic loosening; therefore, follow up serial radiography is essential.

New polyethylenes in total hip arthroplasty : a 20- to 22-year follow-up study.

A significant reduction in wear at five and ten years was previously reported when comparing Durasul highly cross-linked polyethylene with nitrogen-sterilized Sulene polyethylene in total hip arthroplasty (THA). We investigated whether the improvement observed at the earlier follow-up continued, resulting in decreased osteolysis and revision surgery rates over the second decade. Between January 1999 and December 2001, 90 patients underwent surgery using the same acetabular and femoral components with a 28 mm metallic femoral head and either a Durasul or Sulene liner. A total of 66 hips of this prospective randomized study were available for a minimum follow-up of 20 years. The linear femoral head penetration rate was measured at six weeks, one year, and annually thereafter, using the Dorr method on digitized radiographs with a software package. In the Durasul group, no patients underwent revision due to loosening or showed radiological evidence of osteolysis. In the Sulene group, four patients (four hips) were revised due to femoral component loosening. The 20-year cumulative failure incidence in the presence of the competing event of death for revision surgery was 4.5% (95% confidence interval (CI) 0.8 to 13.6) in the Durasul group, and 8.9% (95% CI 2.8 to 19.5) in the Sulene group. The mean wear one year after surgery was 0.09 mm (SD 0.007) in the Durasul group and 0.24 (SD 0.015) in the Sulene group (p < 0.001). From one to 20 years after surgery, the mean total penetration was 0.32 mm (SD 0.045) in the Durasul group and 1.07 mm (SD 0.13) in the Sulene group (p < 0.001). Mean femoral head penetration at 20 years was approximately 70.0% less in the Durasul group than the Sulene group. The significant reduction in femoral head penetration obtained with the Durasul compared with Sulene in uncemented THA resulted in lower osteolysis and revision rates after 20 years.Cite this article: Bone Joint J2022;104-B(9):1032-1038.

Radiographic and clinical analysis of a Porous-coated metaphyseal cone for revision total Knee arthroplasty

BackgroundThe aim of this study was to evaluate the radiographic and clinical outcomes of a recently introduced metaphyseal cone system for revision TKA. Methods73 revision TKAs in 72 patients were retrospectively reviewed. All patients had a minimum of 2-year clinical follow-up (mean 34.1 months; range 24.0 to 50.3 months). 114 Metaphyseal cones (64 tibial and 50 femoral) of a single manufacturer were implanted. The most common indications for revision were aseptic loosening (56.9%), second stage reimplantation for periprosthetic joint infection (PJI; 26.4%), and instability (12.5%). All femoral and tibial stems were press-fit cementless stems. ResultsTen of 72 patients underwent re-revision: six for infection (8.3%), two for instability (2.8%), one (1.4%) for patellar tendon rupture and one (1.4%) for femoral component loosening (a cone was not utilized at index revision). Two patients had loose cones (one with an isolated tibial cone and one with both femoral and tibial cones) associated with loose implants but declined re-revision. Aseptic survivorship of our patient cohort free from any re-revision surgery was 95.9% at 2 years (95% CI 87.4–98.7%) and 96.5% of cones demonstrated radiographic evidence of osseointegration. At 2-years, the Knee Society Score (KSS) improved from a mean of 17.2 points preoperatively to 57.8 points (p <.0001). ConclusionsPorous-coated metaphyseal cones from this manufacturer demonstrate excellent aseptic survivorship and radiographic evidence of osseointegration similar to prior designs when used with cementless stems.

Modular dual-mobility articulations in patients with adverse spinopelvic mobility

Aims Adverse spinal motion or balance (spine mobility) and adverse pelvic mobility, in combination, are often referred to as adverse spinopelvic mobility (SPM). A stiff lumbar spine, large posterior standing pelvic tilt, and severe sagittal spinal deformity have been identified as risk factors for increased hip instability. Adverse SPM can create functional malposition of the acetabular components and hence is an instability risk. Adverse pelvic mobility is often, but not always, associated with abnormal spinal motion parameters. Dislocation rates for dual-mobility articulations (DMAs) have been reported to be between 0% and 1.1%. The aim of this study was to determine the early survivorship from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of patients with adverse SPM who received a DMA. Methods A multicentre study was performed using data from 227 patients undergoing primary total hip arthroplasty (THA), enrolled consecutively. All the patients who had one or more adverse spine or pelvic mobility parameter had a DMA inserted at the time of their surgery. The mean age was 76 years (22 to 93) and 63% were female (n = 145). At a mean of 14 months (5 to 31) postoperatively, the AOANJRR was analyzed for follow-up information. Reasons for revision and types of revision were identified. Results The AOANJRR reported two revisions: one due to infection, and the second due to femoral component loosening. No revisions for dislocation were reported. One patient died with the prosthesis in situ. Kaplan-Meier survival rate was 99.1% (95% confidence interval 98.3 to 100) at 14 months (number at risk 104). Conclusion In our cohort of patients undergoing primary THA with one or more factor associated with adverse SPM, DM bearings conferred stability at two years’ follow-up. Cite this article: Bone Joint J 2022;104-B(7):820–825.

Collarless Taper Slip and Collared Composite Beam Stems Differ in Failure Modes and Reoperation Rates

Cemented femoral components are used in older patients based on lower risk of periprosthetic fracture and implant loosening. This study reports the survivorship free of periprosthetic femoral fracture (PPFX), femoral loosening, all-cause revision, and reoperation between 2 philosophies of cemented stems. In total, 1,306 primary hybrid total hip arthroplasties were performed for osteoarthritis between 2000 and 2018 in a retrospective single center study. Cemented stems included 798 EON composite beam (CB) and 508 Exeter collarless taper slip (CTS) stems. Mean age was 77 years. An inverse treated probability weighted model was utilized to control for risk factors including age, gender, body mass index, year, and surgeon. There was no difference in risk of PPFX at 10 years (CTS 9% vs CB 5%; hazard ratio [HR] 1.4, P= .47). There was an increased risk of intraoperative fractures requiring fixation in the CB cohort (7/798 [5 calcar, 2 greater trochanter] vs 0/508, P < .001), while there was an increased risk of Vancouver B2 PPFX in the CTS cohort (7/508 vs 0/798; P < 001). There was a higher risk of femoral loosening in the CB cohort (6/798 vs 0/508; P < .0001). Higher survivorship free of revision (98% vs 91%; HR 4, P= .001) and free of reoperation (96% vs 88%; HR 2.5, P= .002) was seen at 10 years in the CB cohort. The risk of PPFX requiring implant revision was increased in the CTS cohort, while there was an increased risk of femoral component loosening and intraoperative fractures seen in the CB cohort. Surgeons should be aware of the different failure modes when choosing implant design for their patient.

Press-Fit Dual-Pivot Total Knee Arthroplasty: Early Results With aMinimum 2-Year Follow-Up.

Ultracongruent (UC) tibial bearings are being used with increasing frequency in the United States. Evidence suggests that the use of certain UC bearings may lead to improved patient satisfaction when compared with using conventional inserts. However, little is known as to what effect the use of UC tibial inserts has on bone ingrowth in uncemented total knee arthroplasty (TKA). The purpose of this study was to determine the early clinical and radiographic results of TKA using a press-fit dual-pivot design. Between 2017 and 2019, a consecutive series of 232 TKAs were implanted using a press-fit tibial and femoral component and a UC dual-pivot tibial insert. Sixty-two percent of patients were male. The average age was 56 years. Patients were followed for a minimum of 2 years (range, 24-42 months) using KOOS-JR and Knee Society clinical and radiographic evaluation. No patient had more than mild knee stiffness at the final follow-up. Two patients reported moderate knee pain with stair climbing. All other patients reported either mild or no pain with activity. Knee Society pain scores averaged 42 points. Flexion averaged 118 degrees. Three knees (1.3%) were revised (one each for flexion instability, tibial plateau fracture, and suspected femoral component loosening). No other cases of femoral or tibial loosening were identified. Although the success of uncemented TKA is determined by a variety of factors, the use of this dual-pivot knee design did not appear to influence tibial or femoral component fixation at early follow-up, yielding acceptable clinical and radiographic outcomes.

Outcomes After Operative Fixation of Vancouver B2 and B3 Type Periprosthetic Fractures

The incidence of periprosthetic femur fracture in the setting of total hip arthroplasty is steadily increasing. Although the traditional dogma is that loose femoral components must be revised, we propose that in a frail geriatric population, anatomic reduction and fixation of Vancouver B2 and B3 periprosthetic fracture variants can restore stem stability and provide similar outcomes as revision arthroplasty. Retrospective cohort study. Level 1 trauma center, tertiary academic medical center. We identified 94 patients over 65 years of age with Vancouver B2 and B3 fractures sustained between 2005 and 2019. Patients were treated by either open reduction and internal fixation (ORIF) or revision arthroplasty (RA) with or without fixation. Outcomes were mortality, time to full weight-bearing after surgery, intraoperative estimated blood loss, perioperative complications, reoperation, subsidence rate, and Patient-Reported Outcomes Measurement Information System pain and physical function scores. A total of 75 (79.8%) ORIF and 19 (20.2%) RA patients were reviewed. One-year mortality for our cohort was 26.3%, and there was no significant difference between groups. Mean time to weight bear and surgical complication rates were similar between groups. The ORIF group had a significantly shorter time to surgery than the RA group. The RA group had greater incidence and amount of subsidence as well as estimated blood loss than the ORIF group. In geriatric patients with Vancouver B2 and B3 type periprosthetic fractures with known loose stems, ORIF may offer a similarly safe method of treatment than revision arthroplasty. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Survivorship and Outcomes of Femoral Neck Preserving Stems in Primary Total Hip Arthroplasty

BackgroundShort-stem femoral implants (SSFIs) promote the preservation of bone in the femoral neck, reduce soft tissue disruption, and facilitate minimally invasive surgical techniques. The purpose of this study was to report the revision rate, complication rate, patient satisfaction, patient-reported outcomes, and radiographic outcomes of patients who underwent total hip arthroplasty (THA) with the Alteon Neck Preserving Femoral Stem (ANPS). MethodsA prospectively maintained database was reviewed which analyzed 92 THAs between the years 2016 and 2018. Patient-reported outcomes, patient satisfaction, complication rates, and radiographic outcomes were assessed at 2-5 years postoperatively. ResultsThe final cohort consisted of 63 hips. Five patients (7.9%) underwent revision surgery and 2 (3.2%) had other complications not requiring revision. Survivorship when considering only the femoral component was 93.7% at an average of 41.4 months of follow-up. The average postoperative Oxford Hip Score (41.5 ± 8.3) and Harris Hip Score (77.9 ± 16.6) demonstrated significant improvement among our nonrevised patients, respectively (P < .001). Radiographs demonstrated spot welding in 56% of arthroplasties most commonly in Gruen Zones 2, 3, and 13 and that femur radiolucencies were visualized in 58% predominantly along the distal aspect of the stem. Radiographic femoral component subsidence was present in 9.7% of patients. ConclusionThe ANPS may be less reliable than previously reported. Our cohort’s revision rate was unacceptably high with 6.3% requiring revision surgery for femoral component loosening in less than 5 years. Surgeons should consider the challenges and prohibitive failure rate associated with SSFIs before routine usage in THA.

Clinical outcome in total hip arthroplasty for septic sequelae in childhood : a retrospective study.

AimsAdult patients with history of childhood infection pose a surgical challenge for total hip arthroplasty (THA) due to distorted bony anatomy, soft-tissue contractures, risk of reinfection, and relatively younger age. Therefore, the purpose of the present study was to determine clinical outcome, reinfection rate, and complications in patients with septic sequelae after THA.MethodsA retrospective analysis was conducted of 91 cementless THAs (57 male and 34 female) performed between 2008 and 2017 in patients who had history of hip infection during childhood. Clinical outcome was measured using Harris Hip Score (HHS) and Modified Merle d’Aubigne and Postel (MAP) score, and quality of life (QOL) using 12-Item Short Form Health Survey Questionnaire (SF-12) components: Physical Component Score (PCS) and Mental Component Score (MCS); limb length discrepancy (LLD) and radiological assessment of the prosthesis was performed at the latest follow-up. Reinfection and revision surgery after THA for any reason was documented.ResultsThere was significant improvement in HHS, Modified Merle d’Aubigne Postel hip score, and QOL index SF 12-PCS and MCS (p < 0.001) and there was no case of reinfection reported during the follow-up. The minimum follow-up for the study was three years with a mean of 6.5 (SD 2.3; 3 to 12). LLD decreased from a mean of 3.3 cm (SD 1) to 0.9 cm (SD 0.8) during follow-up. One patient required revision surgery for femoral component loosening. Kaplan-Meier survival analysis estimated revision-free survivorship of 100% at the end of five years and 96.9% (95% confidence interval 79.8 to 99.6) at the end of ten years.ConclusionWe found that cementless THA results in good to excellent functional outcomes in patients with a prior history of childhood infection. There is an exceedingly low rate of risk of reinfection in these patients, even though complications are not uncommon.Cite this article: Bone Jt Open 2022;3(4):314–320.

Diagnostic Performance of MRI for Component Loosening in Total Knee Arthroplasty Compared with Radiography

Background Because loosening of total knee arthroplasty (TKA) occurs due to poor osseous integration at component-bone interfaces, interface assessment may be helpful in diagnosing loosening at MRI. Purpose To determine interreader reproducibility for characterizing component interfaces and diagnosing loosening and to evaluate the diagnostic performance of MRI for diagnosing loosening after TKA compared with radiography. Materials and Methods Consecutive knees with TKA that underwent revision between July 2018 and June 2019 and were imaged at MRI and radiography were included in this retrospective study. Interface type (normal, fibrous membrane, fluid, or osteolysis), percent integration (<33%, 33%-66%, or >66%), and presence of bone marrow edema pattern were assessed. Loosening was diagnosed at MRI if no or almost no normal interface was present. Sensitivity and specificity were compared with radiographs by using surgical findings as reference. Gwet agreement coefficient evaluated interreader reproducibility between two readers and multivariable logistic regression assessed risk factors for loosening. Results Among 116 knees in 114 patients (mean age, 63 years ± 10 [SD]; 59 women), 61 of 116 knees (52.6%) had at least one loose component. Interreader reproducibility of MRI was substantial to excellent (Gwet agreement coefficient, 0.67-0.96). Loosening was associated with fluid interface (odds ratio [OR], 20.1; 95% CI: 5.7, 70.9) or osteolysis (OR, 3.1; 95% CI: 1.8, 5.3), absence of any normal interface (OR, 11.8; 95% CI: 6.3, 22.2), poor (<33%) osseous integration (OR, 20.4; 95% CI: 9.7, 42.6), and bone marrow edema pattern (OR, 4.7; 95% CI: 2.8, 7.8). Sensitivity and specificity of MRI for loosening were 84% (27 of 32; 95% CI: 72, 97) and 85% (71 of 84; 95% CI: 77, 92) for the patellar, 31% (eight of 26; 95% CI: 13, 49) and 100% (90 of 90; 95% CI: 100, 100) for the femoral, and 81% (22 of 27; 95% CI: 66, 96) and 98% (87 of 89; 95% CI: 95, 100) for the tibial component, respectively. MRI had higher sensitivity (84% vs 31%; P < .001) but lower specificity (85% vs 96%; P = .003) for patellar component loosening than did radiography, respectively, whereas no evidence of a difference was found for femoral (sensitivity and specificity, MRI vs radiography: 31% vs 46% [P = .20] and 100% vs 99% [P > .99], respectively) or tibial (sensitivity and specificity, MRI vs radiography: 81% vs 70% [P = .16] and 98% vs 97% [P = .32], respectively) component loosening. Conclusion MRI demonstrated substantial to excellent interreader reproducibility and higher sensitivity than did radiography for diagnosing patellar component loosening after total knee arthroplasty. © RSNA, 2022 Online supplemental material is available for this article.

Revision Total Hip Arthroplasty with Primary Stem or Full-Porous-Coated Long Stem for Aseptic Femoral Component Loosening: A Matched-Pair Study.

BackgroundRevision total hip arthroplasty (RTHA) for loosening the femoral stem is a technical challenge. Distally fixed, full-porous-coated long stems are widely accepted as the standard selection for these revisions. However, the success of primary stems in RTHA is not well known.MethodsThis study enrolled 24 patients with aseptic loosening of the femoral stem who underwent RTHA using primary stems. Another 72 patients with aseptic loosening who underwent RTHA using full-porous-coated long stems were matched in terms of operation date, proximal femoral bone stock (Paprosky classification), sex, and age. The primary and secondary outcomes of failure were the need for revision for any reason and the radiographic change in the stem respectively.ResultsIn the primary stem group, one patient had a periprosthetic fracture and received a second RTHA 2 years after the previous one. The primary outcome’s 5-and 10-year survival rates were both 95.8%. For the matched comparison group, one patient had an immediate periprosthetic fracture of the femoral shaft requiring further open reduction internal fixation surgery. Another patient had a full-porous-coated long stem breakage 6 years postoperatively, which required a second RTHA. The primary outcome’s 5-and 10-year survival rates were 98.6% and 97.2%, respectively.ConclusionPrimary stems can achieve non-inferior clinical success compared to a full-porous-coated long stem for aseptic stem loosening RTHA in patients with adequate proximal femoral bone stock.