Results Of Revision Hip Arthroplasty Research Articles

What Characteristics of the Acetabular Defect Influence the Choice of the Acetabular Component During Revision Hip Arthroplasty?

The purposes of the retrospective cohort study were: 1) to determine the severity of defects in the acetabulum and the probable causes of their formation in patients who underwent revision hip arthroplasty (RHA), as well as an assessment of factors that exacerbate the severity of the defects; 2) identifying the proportion of severe defects in the overall structure of acetabular revisions and determining the effectiveness of using serial implants in comparison with individual constructions made by 3D printing; 3) the rationale for rational indications for the use of individual constructions.Materials and Methods. The structure and reasons for the formation of bone defects in the acetabulum were evaluated in 726 cases of revisions performed from 2004 to 2018. In addition, the results of revision operations in a group of patients with severe defects (type 3 according to Paprosky and pelvic discontinuity) were evaluated.Results. The most frequent cause of defect formation was iatrogenic (53.2%), and the share of severe defects was 39.5% (287 observations). A factor aggravating the severity of the defect is the lack of its limitation by the support bone. The results of RHA in patients with severe defects were assessed in 186 cases out of 287 (64.8%). In 73 (39.2%) cases, individual constructions were used, the average follow-up was 26 months. (from 12 to 50), and in 113 (60.8%) cases, serial implants were used, the average follow-up period was 62 months. (12 to 186). Individual constructions were more often implanted in patients with 3B acetabular defects (p0.05) and its uncontained defects (p0.001). The number of cases of aseptic loosening in the group of patients undergoing endoprosthetics using serial implants was greater than in the group of patients with individual constructions for the entire period (p0.05) and in the early stages of observation (p0.05).Conclusion. In case of RHA in patients with severe acetabular defects, individual implants, in comparison with serials, demonstrate better survival with an average follow-up of 26 months and due to design features, they can count on great long-term effectiveness. This study needs to be continued to increase follow-up.

Clinical Results of Revision Hip Arthroplasty for Neck-Taper Corrosion and Adverse Local Tissue Reactions Around a Modular Neck Stem

BackgroundAdverse local tissue reactions (ALTRs) around a modular neck stem at our institution lead to a 13.5% rate of revision. The purpose of this study was to report the clinical results of revision total hip arthroplasty (THA) in this patient population. MethodsWe identified 80 hips in 77 patients who underwent revision THA due to neck-stem corrosion. Intraoperative and postoperative complications, clinical outcomes, re-revision rates, and the postoperative ion levels were recorded. ResultsThe mean follow-up period after revision was 45.3 ± 16.3 months (range 24-81 months). There were no intraoperative mechanical complications during the revision surgery. Eight hips (10%) had postoperative complications related to the revision implant, of which 6/8 came to re-revision: postoperative implant dislocation in 4 hips—2 treated nonsurgically, aseptic loosening of femoral component in 2 hips, and periprosthetic femoral fracture in 2 hips. No patients had recurrence of ALTR nor the recurrence of groin pain within the follow-up period. With 2 exceptions, ion levels normalized within one year of the revision surgery. The survival rate was 94% (95% confidence interval 84-98) at 32 months and 82% (95% confidence interval 56-93) at 63 months after revision THA (using re-revision THA due to any reason as the endpoint). ConclusionIntraoperative complication, postoperative complication, and re-revision rates are equivalent to femoral revision surgeries for other causes (infection, fracture, loosening). We recommend selecting revision-type stems to minimize the risk of femoral loosening or periprosthetic fracture, and larger femoral heads or dual mobility bearings to minimize the risk of dislocation.

Porous tantalum shells and augments for acetabular cup revisions

The purpose of this study was to evaluate early functional results of revision hip arthroplasty with pelvic bone loss revised with porous tantalum (PT) acetabular components. Twenty-five consecutive patients (25 hips) with loose acetabular components after total hip arthroplasty with a minimum of Paprosky IIa pelvic bone loss treated with PT cups with and without modular augments were retrospectively reviewed. Clinical outcomes were assessed using Harris hip score, and Western Ontario and McMaster Universities scores. Mean follow-up was 20.5 months and no patient was lost during follow-up. The average Harris hip score, and Western Ontario and McMaster Universities scores improved from 40 and 36 preoperatively to 79 and 73 postoperatively, respectively. No statistically significant differences in functional outcome scores were found between the group with moderate (Paprosky IIa, b) and severe (Paprosky IIc or more) acetabular bone loss. At the most recent radiographic evaluation, 24 cups demonstrated no lucent lines and 1 cup had lucent lines but remained well fixed. One cup was revised for traumatic dislocation but was found well fixed at open reduction. There were no septic or aseptic failures in this series. While awaiting longer-term follow-up studies, trabecular metal components show sufficient primary stability and appear suitable for revision hip arthroplasty with acetabular bone loss.

Early Results of Revision Hip Arthroplasty Using a Ceramic Revision Ball Head

In the case of a ceramic fracture or cup revision with exchange of the ceramic ball head on a used stem, there is always the danger of another ceramic fracture when using a standard ceramic ball head owing to a possibly damaged stem taper. The purpose of this study was to analyze the results of revision hip arthroplasty using a new ceramic revision ball head. Ninety-one patients, who underwent revision hip arthroplasty using a ceramic revision ball head, were analyzed clinically. The Harris hip score and visual analog scale score increased significantly. There were no further ceramic fractures or noises. Especially, in cases with a damaged taper or ceramic fracture, surgeons should consider using a ceramic revision ball head in combination with a ceramic or a polyethylene insert.

Revision Total Hip Arthroplasty Using a Fully Porous-Coated Long Stem - a Minimum 5 Years Follow up -

Purpose: We wanted to evaluate the mid-term results of revision total hip arthroplasty using a fully porous-coated long stem. Materials and Methods: A retrospective series of 20 hips in 19 patients who underwent stem revision with a fully porous-coated long stem were evaluated at a mean follow-up of 64.6 months. The causes of revision were aseptic loosening, periprosthetic fracture and infected arthroplasty. Four kinds of implants had previously been used and an additional bone graft procedure had been done in 17 cases. The Harris hip scores, thigh pain, limping and ROM were reported. Radiological changes of the radiolucent signs, subsidence, loosening and the stress shielding signs were evaluated. Results: The Harris hip score improved from an average of 56.5 to 91.9 and the ROMs were satisfactory. The only case with persistent thigh pain showed stable bony ingrowth. No signs of subsidence or loosening of the stem was found in all the cases. There were 2 cases of periprosthetic fracture. None of the patients experienced re-revision surgery. Conclusion: The mid-term results of revision hip arthroplasty using a fully porous coated long stem have demonstrated that it provides a reliable initial fixation with a propensity for stable longevity. It is relatively easy for the techniques, and there is the opportunity to restore the bone stock by bone-grafting procedures with diaphyseal fixation and bypassing a bone defect. Yet alternative techniques may be required for the femur with extensive diaphyseal bone loss. There are some concerns about the technique and the possibility of making a crack in the femur during the operation, which will cause thigh pain at the follow-up. So, only by employing great caution when performing this technique can successful results be guaranteed.

Results of revision hip arthroplasty with S-ROM cementless stem

Results of revision hip arthroplasty with S-ROM cementless stem

Results of Revision Hip Arthroplasty using Cemented Femoral Stem

Results of Revision Hip Arthroplasty using Cemented Femoral Stem

Component removal in revision total hip arthroplasty.

One of the primary steps in revision hip arthroplasty is the extraction of retained components before surgical reconstruction. In revision arthroplasty, the removal of well-fixed components and cement can be extremely demanding, time consuming, and damaging to the remaining host bone. The aims of the current study were to examine the numerous operative techniques used during extraction of acetabular and femoral components and review the results of revision hip arthroplasty after cementless component removal. A review of 157 acetabular components and 113 femoral components removed from 219 patients during hip revision arthroplasty between 1985 and 2000 was done. The average age of the patients was 64.3 years. The average followup was 5 years (range, 0.7-12.5 years). An extended proximal femoral osteotomy was done in 37 (33%) of the femoral revisions. There were 14 (5%) acetabular failures for which the patients required reoperation. There were no femoral rerevisions. Complications included dislocation (6% after acetabular revision and 9% after femoral revision), infection (6%), femoral fracture (6%), hematoma (3.5%), acetabular fixation failure (2.5%), and femoral osteolysis (1%). The removal of cemented and well-fixed porous-coated implants can be done with adequate preoperative planning and a thorough knowledge of numerous implant removal techniques.

Clinical results of revision hip arthroplasty

Clinical results of revision hip arthroplasty

Revision Hip Arthroplasty for Aseptic Loosening: Three Years of Experience

Revision hip arthroplasty has become one of most common reconstructive procedures for problems following primary hip arthroplasties. During our three years of experience with this procedure, we performed 56 revision hip arthroplasties for aseptic loosening. A retrospective study was done in our section to evaluate the results of revision hip arthroplasty for aseptic loosening. Patients were diagnosed based on their detailed history; the symptoms and signs; and one or more than one of following studies: plain film, arthrography, gallium scan study for the diagnosis of septic loosening, bacterial cultures, operative findings and laboratory data such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The functional result was evaluated using the Merle d'Aubigne hip score and patients were followed up either by telephone or by one of us at the outpatient department. Fifty-six hips underwent revision hip arthroplasties for aseptic loosening. Mean follow-up period 3.83 years (ranged from 2.44 to 5.29 years). Three hips (5.36%) received re-revision hip arthroplasties and all were due to aseptic loosening. About the functional result, 42.11% were excellent, 21.05% were good, 10.53% were medium, 5.26% were fair and 21.05% were poor. After reviewing and comparing with the previous reported series, the re-revision rate, complication rate and functional result in our section were within the reported range. Hence we think revision hip arthroplasty is an acceptable treatment for aseptic loosening after total hip arthroplasty.

Long-term results of revision hip arthroplasty. Survival analysis with special reference to the femoral component

We report a clinical and radiological survival analysis of 148 consecutive revisions of hip arthroplasties. All patients referred were offered revision if it was indicated and they were medically fit. About one-third (32%) had had at least one previous revision, and about one-third had an established deep infection. The revisions were performed in ultra-clean air with body-exhaust suits. The usual method of fixation was by contained and pressurised cement of standard viscosity, to which appropriate antibiotics had been added in infected cases. Some patients had cementless revision. Clinical failure meant that one or both of the implants had been removed; radiological failure was assessed from serial radiographs. The clinical survival at ten years was 95%. The Merle D'Aubigné and Postel rating for pain improved from a mean of 2.9 to 5.2; and in Charnley group A and B cases, walking ability improved from 2.3 to 4.3. In contrast to some reports we also found good radiological survival; this was 90.5% for cemented femoral stems. Isoelastic revision stems inserted without cement gave poor results.