Revision Techniques Research Articles

V1-08 PRIMARY ROBOTIC URETEROENTERIC ANASTOMOTIC REVISION IN STUDER NEOBLADDER: OPERATIVE TECHNIQUE AND CASE SERIES

You have accessJournal of UrologyRobotics-Bladder/Reconstruction1 Apr 2016V1-08 PRIMARY ROBOTIC URETEROENTERIC ANASTOMOTIC REVISION IN STUDER NEOBLADDER: OPERATIVE TECHNIQUE AND CASE SERIES Jaspreet Parihar, Greg Gin, Clayton Lau, Kevin Chan, and Jonathan Yamzon Jaspreet PariharJaspreet Parihar More articles by this author , Greg GinGreg Gin More articles by this author , Clayton LauClayton Lau More articles by this author , Kevin ChanKevin Chan More articles by this author , and Jonathan YamzonJonathan Yamzon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2122AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteroenteric strictures occur in 3-13% of urinary diversions. Endoscopic treatment has a low long-term success rate and may subject the patient to multiple interventions and nephrostomy tubes. Open repair is considered the gold standard but is commonly avoided because of morbidity or utilized mostly after endoscopic failure. We report our technique and experience of primary robot-assisted ureteroenteric anastomotic revision in Studer neobladders (RUAR) METHODS We describe our operative techniques. Results of total four cases that underwent primary robot assisted revision in patients with Studer neobladders from 2013-2015 are presented. Data was collected retrospectively from medical records. RESULTS Two patients had right sided revisions, and two patients had left-sided revisions. The median OR time was 180 min (range 180-300). The median length of stay was 3 days (2-4). With a median follow up of 11.2 months (1.3-20.3), all patients were free of recurrent stricture. The median time to stricture after neobladder reconstruction was 2.5 months (1.3-1301), and the median time with a stent or nephrostomy tube was 3 months (1.5-6). CONCLUSIONS Primary robot-assisted revision is a feasible solution for ureteroenteric strictures in Studer neobladders with excellent intermediate success rate. As a primary repair, RUAR may avoid multiple endoscopic interventions and decrease the patient’s time with a nephrostomy or stent. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e63-e64 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jaspreet Parihar More articles by this author Greg Gin More articles by this author Clayton Lau More articles by this author Kevin Chan More articles by this author Jonathan Yamzon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Surgical and endovascular revision of brachio-basilic vein fistula.

The brachio-basilic vein fistula (BBVF) is currently the third vascular access option for patients on hemodialysis, following radio-cephalic and brachio-cephalic arterio-venous fistulas. Like all types of hemodialysis vascular access, a variety of procedures may have to be performed in order to maintain long-term use of the BBVF. The aim of the present study was to perform a literature review of endovascular or surgical revisions of BBVFs. On Pubmed search, 676 records were obtained and reviewed for relevance with the aim of the search. A variety of endovascular and surgical revision techniques has been described to manage BBVF poor maturation, dysfunction manifested as failing BBVF (most often the result of a stenosis at the transposed/swing segment), thrombosis, aneurysm formation and hemodialysis access-induced hand ischemia (steal syndrome). The role of revision is crucial in BBVF maintenance, taking into account that around 70% of these fistulas will require some intervention by 18 months and as a result of revision, secondary patency is preserved in the vast majority, according to the results of one study. Endovascular revision is the treatment of choice for most cases of BBVF dysfunction or thrombosis, with redo surgery reserved for failures of endovascular techniques or other specific indications. BBVF revision, more often in the form of endovascular surgery, plays a crucial role in BBVF maintenance and its continued use for hemodialysis, necessary for reducing graft and catheter use and the associated morbidity.

Revision for taper corrosion at the neck-body junction following total hip arthroplasty: pearls and pitfalls.

The management of the patient with a recalled, modular neck-body total hip arthroplasty can be complex, as it involves a combination of clinical, technical, and medicolegal challenges. Management begins with a thorough history and physical exam, radiographic evaluation, infection workup, and serum metal ion levels. Three-dimensional imaging is obtained based on patient symptomatology and metal ion levels and is used to evaluate for the presence of an adverse local tissue response as well as the integrity of the existing soft tissue envelope. The decision to perform revision surgery is based on a combination of patient symptomatology, laboratory values, and imaging findings. Revision surgery involves the entire armamentarium of femoral revision techniques, and the acetabulum may need to be revised at the surgeon's discretion. The femoral implant can often be removed without disrupting the femoral bone envelope; however, the surgeon should have a low threshold to perform an extended trochanteric osteotomy.

Use of an Anatomic Long-Stemmed Component in Femoral Impaction Grafting

We describe a challenging femoral revision for aseptic loosening in a relatively young and active man. The femur had gross osteolysis, an absent calcar and a cortical diaphyseal defect at the level of the isthmus (Paprosky 3b defect). The cortical defects were repaired and the whole femur then restored with Femoral Impaction Grafting (FIG) using custom-made impaction instruments and an anatomic shaped collarless, polished, tapered femoral component.In the active adult, bone restoring revision techniques such as impaction grafting should be considered to give a realistic prospect of host bone augmentation rather than simply aiming for a distally fixed stem in a patulous femoral canal.

Increased risk for extended acetabular reconstruction in failed hip resurfacing as compared to failed total hip arthroplasty.

Hip resurfacing (HR) is intended to preserve the femoral bone stock during primary arthroplasty. On the other hand, little has been reported regarding the intraoperative need of bone reconstruction for extended acetabular defects during hip resurfacing revision. Thus, the aim of the presented study was to identify whether there is an increased need for acetabular bone reconstruction in HR revision surgery. We analyzed the data of 38 patients who underwent 39 conversions from a HR to a total hip arthroplasty (THA). Acetabular bone defects and the respective revision technique were compared against a temporary cohort of patients undergoing revision surgery of a conventional THA. In 29 HR patients revision required either autogenous or allogenous impaction bone grafting to adequately manage acetabular host bone degradation. In 10 cases additional implantation of a reinforcement device was necessary. Compared to the THA cohort revision of failed HR is associated with a significantly increased risk of higher grade bone defects (Paprosky classification) and extended acetabular reconstruction (p<0.05). This study provides evidence that revision of failed HR devices is associated with an increased risk for extensive acetabular defects. Furthermore, the preoperative radiographic assessment of HR devices often underestimates the intraoperative acetabular defect. Surgeons should be aware of this fact not to technically underestimate HR revision procedures.

An Approach to Endovascular and Percutaneous Management of Transjugular Intrahepatic Portosystemic Shunt (TIPS) Dysfunction: A Pictorial Essay and Clinical Practice Algorithm.

Transjugular intrahepatic portosystemic shunts (TIPS) have evolved as an effective and durable nonsurgical option in the treatment of portal hypertension (PH). It has been shown to improve survival in decompensated cirrhosis and may also serve as a bridge to liver transplantation. In spite of the technical improvements in the procedure, problems occur with the shunt which jeopardizes effective treatment of the PH. Appropriate management is vital to ensure the longevity of the conduit. Shunt revision techniques include endovascular revision techniques and new shunt creation or, in the appropriate patients, alternative/rescue therapies. The ability of interventional radiologists to restore adequate TIPS function has enormous implications for quality of life with palliation, morbidity/mortality related to variceal bleeding and survival if transplant candidates can live long enough to receive a new liver. As such, it is imperative that these treatment strategies are understood and employed when these patients are encountered. In this review, the restoration of appropriate shunt function using various techniques will be discussed as they apply to a variety of clinical scenarios, based on literature. In addition, illustrative case examples highlighting our experience at an academic tertiary medical center will be included. It is the intent to have this document serve as a concise and informative reference to be used by those who may encounter patients with suboptimal functioning TIPS.

Artificial Urinary Sphincter Mechanical Failures—Is it Better to Replace the Entire Device or Just the Malfunctioning Component?

We evaluate the characteristics of artificial urinary sphincter mechanical failures and compare outcomes based on the surgical revision strategy, replacing only the failed component or the entire device. A total of 1,802 male patients with stress urinary incontinence underwent artificial urinary sphincter procedures from 1983 to 2011 at our institution, of which 1,082 were primary placements. Of these patients 125experienced mechanical device malfunction. Multiple clinical and surgical variables were evaluated for a potential association with device malfunction. In addition, we evaluated for predictors of failure of the revised device, including time from primary artificial urinary sphincter to revision surgery and surgical revision strategy (single component vs entire device), with failure defined as any tertiary surgery. At a median followup of 4.2 years (IQR 0.8, 7.9) 125 patients experienced device malfunction. The urethral cuff was the most common component failure (46.1%), followed by abdominal reservoir (22.6%), tubing (21.7%) and pump (9.6%). There was no association of time from primary surgery to revision for mechanical failure (HR 0.89, p=0.33) or revision strategy (HR 0.47, p=0.15) withthe risk of tertiary surgery. Additionally, as there was no significant interaction between these variables (HR 1.11, p=0.39), no cutoff could be identified at which one revision technique produced significantly improved device survival compared to another. However, there was a trend toward improved 3-year device survival after replacement of the entire device vs a single component (76% vs 60%, p=0.11). No cutoff in time to mechanical failure could be identified to guidedecision making in the management of mechanical artificial urinary sphincter failure. Likewise, it is unclear if replacing the entire device, rather than the single malfunctioning component, alters device survival. As such, further studies are needed. However, given the current trend toward improved overall device survival, the limited additional risk and the lack of adequate clinical predictors fortertiary surgery, we would advocate for replacement of the entire device whenpossible.

Avoiding prepositional pile-up.

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The pursestring technique for endoscopic revision of gastric bypass

A significant proportion of patients regain weight after Roux-en-Y gastric bypass. Endoscopic revision of dilated gastrojejunal anastomosis, called transoral outlet reduction (TORe), has proven effective and allows patients to avoid reoperation. Traditionally, TORe has been performed with an interrupted stitching technique with placement of stitches across the anastomosis. In this video, we demonstrate the pursestring and double pursestring techniques for TORe.

Revision Techniques After Artificial Urinary Sphincter Failure in Men: Results From a Multicenter Study

To compare the results of various single-component artificial urinary sphincter (AUS) revision techniques for continued/recurrent stress urinary incontinence (SUI). Although AUS placement for male SUI has a high rate of success, revisions may be performed for mechanical failure of an isolated component or continued/recurrent SUI. From 1993 to 2012, 90 AUS revisions including urethral cuff downsizing (19), pressure-regulating balloon replacement (18), cuff repositioning (11), or tandem cuff placement (42) were performed at 2 institutions. End points included reoperation, incontinence failure, and urethral erosion. The Kruskal-Wallis test was used to compare continuous variables, and the log-rank test was used to compare Kaplan-Meier curves. Mean age was 70.2 years, and median follow-up was 33.6 months. Median time to revision was 28.9 months. Tandem cuff placement was associated with a lower rate of incontinence failure (P = .02), whereas cuff repositioning was associated with a higher rate of incontinence failure (P = .02). An increased rate of mechanical failure was observed with cuff downsizing (P = .01). Among options for revision (1) cuff downsizing is associated with a higher rate of mechanical failure, and (2) cuff repositioning with the same size is associated with a higher rate of incontinence failure, whereas (3) tandem cuff placement is associated with a lower rate of recurrent SUI compared to other types of AUS revision. Cuff repositioning is associated with an increased rate of persistent incontinence after AUS revision whereas tandem cuff placement is associated with a lower rate of recurrent or persistent incontinence.

The use of the Explant® device in metal backed Exeter™ acetabular component revision.

BACKGROUND Revision of a well fixed cemented acetabular component can lead to significant bone loss. This can be avoided with the in-cement revision technique. We report the use of the Explant (Zimmer, Swindon, UK) acetabular cup removal system for revision of an ExeterTM (Stryker, Newbury, UK) metal backed cup with preservation of the original cement mantle, allowing subsequent cement-in-cement revision.

A Novel Technique for Distal Shunt Revision: Retrospective Analysis of Guidewire-Assisted Distal Catheter Replacement.

Ventriculoperitoneal shunt revision is a common procedure. Disconnection and fracture of the distal catheter remain a common cause of ventriculoperitoneal shunt malfunction. To describe a novel procedure for peritoneal replacement of the distal catheter by using a guidewire and a modified Seldinger technique (guidewire-assisted distal catheter replacement) and retrospectively evaluate the results of the surgical procedure. Between September 2005 and December 2013, 68 patients were treated by a single surgeon (DMW) with distal catheter replacement using our technique. In brief, the previously placed distal catheter was exposed at its entry site into the abdomen. A soft guidewire with hydrophilic coating was inserted down the distal catheter into the peritoneum. The distal catheter was then removed over the guidewire, leaving the guidewire in place. A peel-away sheath and dilator were then inserted over the guidewire, and the dilator and guidewire were removed. The new distal catheter was then passed from the valve to the abdomen and was then fed through the peel-away sheath into the peritoneum. Charts were retrospectively reviewed for preoperative presentation, operative technique, and postoperative outcome. Records were specifically examined for any early or late complications. The mean patient age at surgery was 13 years. No immediate acute complications were noted. Of the 68 total patients, 45 patients had more than 6 months of follow-up. Of the 68 patients, 7 patients required another distal revision after guidewire-assisted distal catheter replacement. Distal shunt malfunction due to a mechanical failure is a common reason for shunt revision. We describe a technique for guidewire-assisted distal catheter replacement.

Satisfying outcomes scores and survivorship achieved with impaction grafting for revision THA in young patients.

BackgroundThe increasing number of total hip arthroplasties (THAs) performed in younger patients will inevitably generate larger numbers of revision procedures for this specific group of patients. Unfortunately, no satisfying revision method with acceptable survivorship 10 years after revision has been described for these patients so far.Questions/purposesThe purposes of this study were to (1) analyze the clinical outcome; (2) complication rate; (3) survivorship; and (4) radiographic outcome of cemented revision THA performed with impaction bone grafting (IBG) on both the acetabular and femoral sides in one surgery in patients younger than 55 years old.MethodsDuring the period 1991 to 2007, 86 complete THA revisions were performed at our institution in patients younger than 55 years. In 34 of these 86 revisions (40%), IBG was used on both the acetabular and femoral sides in 33 patients. Mean patient age at revision surgery was 46.4 years (SD 7.6). No patient was lost to followup, but three patients died during followup. None of the deaths were related to the revision surgery. The mean followup for the surviving hips was 11.7 years (SD 4.6). We also analyzed complication rate.ResultsThe mean Harris hip score improved from 55 (SD 18) preoperatively to 80 points (SD 16) at latest followup (p = 0.009). Six hips underwent a rerevision (18%): in four patients, both components were rerevised; and in two hips, only the cup was revised. Patient 10-year survival rate with the endpoint of rerevision for any component for any reason was 87% (95% confidence interval [CI], 67%–95%) and with the endpoint of rerevision for aseptic loosening, the survival rate was 97% (95% CI, 80%–100%). In total six cups were considered radiographically loose, of which four were rerevised. Three stems were radiographically loose, of which none was rerevised.ConclusionsIBG is a valuable biological revision technique that may restore bone stock in younger patients. Bone stock reconstruction is important, because these patients likely will outlive their revision implants. Bone reconstruction with impaction grafting may facilitate future revisions.Level of EvidenceLevel IV, therapeutic study.

CORR Insights(®): Do Rerevision Rates Differ After First-time Revision of Primary THA With a Cemented and Cementless Femoral Component?

T he lack of consensus regarding the best method of component fixation in primary total hip replacement reflects the complexity of the issue. In addition to method of fixation, multiple factors such as implant characteristics, surgical technique, patient demography and comorbidities affect the outcomes in terms of implant survival, pattern of prosthesis-related complications, and functional outcomes. Although some registry data suggest superior implant survival for cemented fixation [4, 5], other registry data show similar revision rates regardless of method of fixation at primary surgery [7]. Nevertheless, there is an increasing use of cementless fixation in primary total hip replacement worldwide even though support for this approach is not unanimous [4, 5, 8]. Since the pattern of implant failure and structural damage differ depending on primary method of fixation, implant survival after revision surgery could potentially differ for cemented and cementless components. While previous research [3, 6] has focused on different revision techniques, to our knowledge, the role of primary fixation in revision outcomes has not been investigated. Using data on first time revision cases from the Danish Hip Arthroplasty Register [1], the current study by Gromov and colleagues aimed to investigate the association between method of femoral component fixation in the primary total hip replacement and the risk of subsequent rerevision. Gromov and colleagues found that in patients younger than 70 years of age, cementless fixation at the time of index arthroplasty was associated with an increased likelihood of repeat revision surgery, even after controlling for potential confounding variables, This CORR Insights is a commentary on the article ‘‘Do Rerevision Rates Differ After First-time Revision of Primary THA With a Cemented and Cementless Femoral Component?’’ by Gromov and colleagues available at: DOI: 10.1007/s11999-015-42456. The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or the Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999-0154245-6. O. Rolfson MD, PhD Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Reduction and Mastopexy of the Reconstructed Breast: Special Considerations in Free Flap Reconstruction

Autologous breast reconstruction is capable of creating a breast that closely resembles a natural breast. Reduction and mastopexy in this type of reconstruction yields several challenges to the reconstructive surgeon. Revision surgery is common to achieve symmetry; however, reduction, mastopexy, and other revision techniques are sparse in the current literature. Often, these techniques are passed from mentor to student during plastic surgery training or are learned with experience in managing one's own patients. Reviewing anatomical principles unique to this subset of patients is essential. We must also consider factors unique to this group including the effects of delayed reconstruction, radiation, skin paddle size, and flap volume. In this article, the authors describe some of the common principles used by experienced reconstructive surgeons to perform reduction and mastopexy in autologous breast reconstruction to achieve a natural, aesthetically pleasing breast reconstruction. In addition, they have included several case examples to further illustrate these principles.

V12-14 SYNCHRONOUS PANNICULECTOMY AND ILEAL CONDUIT REVISION FOR OBESE PATIENTS WITH STOMAL STENOSIS

You have accessJournal of UrologyReconstruction1 Apr 2015V12-14 SYNCHRONOUS PANNICULECTOMY AND ILEAL CONDUIT REVISION FOR OBESE PATIENTS WITH STOMAL STENOSIS Michael Garcia-Roig, David Pan, Devendar Katkoori, and Murugesan Manoharan Michael Garcia-RoigMichael Garcia-Roig More articles by this author , David PanDavid Pan More articles by this author , Devendar KatkooriDevendar Katkoori More articles by this author , and Murugesan ManoharanMurugesan Manoharan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2784AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy with ileal conduit urinary diversion is a common procedure for muscle invasive bladder cancer. With the rise in obesity, surgeons more frequently face obesity-related challenges in perioperative management. Specific to ileal conduit diversion, obese patients with abnormal skin folds may develop stomal retraction or stenosis. This results in a poorly fitting appliance followed by urinary leakage and skin excoriation. Here we describe our technique for synchronous panniculectomy and ileal conduit revision in such patients. METHODS After routine prepping and position of the patient, the stoma and umbilicous are mobilized. Then, a transverse elliptical incision is made and the panus is excised above the anterior rectus sheath. The lateral limit of the ellipse is the anterior axillary line bilaterally and a vertical distance between the top and bottom of the ellipse is 8-15 cm, depending on the patient's body habitus. The upper flap is mobilized allowing for a tension free re-approximation. The neo-stoma and neo-umbilicus sites are marked and created on the upper flap and the upper flap is sutured to the lower flap. RESULTS Panniculectomy with stomal revision was performed for four female patients who presented with stomal stenosis and a mean BMI of 42 (38-49) kg/m3. Follow-up ranged from 2-5 yrs with patients reporting improved fit of the stoma appliance and no recurrent stomal complications. There were no postoperative complications related to the procedure. CONCLUSIONS The main advantage of this approach is in reducing excessive peri-stomal fat that leads to uneven skin and thus urostomy leakage. Furthermore, it avoids a laparotomy in a surgically unfavorable patient population. Our technique of panniculectomy and stomal revision is safe and carries minimal morbidity. It may improve nursing care and quality of life for obese patients with urinary diversion and stomal retraction. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e981 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Garcia-Roig More articles by this author David Pan More articles by this author Devendar Katkoori More articles by this author Murugesan Manoharan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A New Technique in Revision Hip Arthroplasty for Vancouver B Periprosthetic Fractures

We describe a new revision technique for Vancouver B periprosthetic hip fractures that leaves the original acetabular components in situ and causes minimal damage to the hip capsule. Twenty-eight patients, average age 79, with Vancouver B periprosthetic fracture had femoral component revision using

Revision techniques for failed PD catheters: outcome in a University Hospital.

A disfunctioning peritoneal dialysis (PD) catheter has been reported in upto 35%. We report different salvage techniques used and its outcome. We retrospectively reviewed our database on PD patients from 2009 to 2014. Operational data and data on PD catheter function were checked. From 2009 to 2014, we operated on 32 patients. Malfunction of their PD catheter was found in 23 patients and hernias in nine patients. Different laparoscopic techniques were used, including reposition of the catheter, fixation of the catheter, removal of adhesions and omentectomy. Of these 23 patients, 18 (78%) had a normal functioning catheter after the operation. Nine patients of the total of 32 patients had a correction of their hernia. In all cases, a non-absorbable mesh was used. Of those nine patients with a hernia, eight (89%) had a normal functioning catheter after the procedure. The salvage of the catheter by means of a laparoscopic procedure or correction of a hernia is worthwhile and can save up to 81% of the catheters.

(vii) Fixation in femoral revision: the role of cement

Abstract Evidence drawn from national joint registries and research from multiple centres affirm that highly successful long-term results can be achieved after primary hip replacement using polymethylmethacrylate (PMMA) cement fixation. Revision surgery provides a more diverse spectrum of surgical challenges, for which a number of different surgical techniques may be required. This paper reviews the femoral revision techniques that may be employed using PMMA fixation. It discusses the indications for and strengths of these techniques, as well as their limitations. It presents the results of the different techniques in standard situations as well as those for more demanding scenarios such as infection or femoral fracture. These results show that PMMA fixation of the femoral component at revision surgery is versatile and effective and brings with it several unique advantages over other methods of femoral revision.

Reoperations Following Cervical Disc Replacement.

Cervical disc replacement (CDR) has emerged as an alternative surgical option to cervical arthrodesis. With increasing numbers of patients and longer follow-ups, complications related to the device and/or aging spine are growing, leaving us with a new challenge in the management and surgical revision of CDR. The purpose of this study is to review the current literature regarding reoperations following CDR and to discuss about the approaches and solutions for the current and future potential complications associated with CDR. The published rates of reoperation (mean, 1.0%; range, 0%-3.1%), revision (mean, 0.2%; range, 0%-0.5%), and removal (mean, 1.2%; range, 0%-1.9%) following CDR are low and comparable to the published rates of reoperation (mean, 1.7%; range; 0%-3.4%), revision (mean, 1.5%; range, 0%-4.7%), and removal (mean, 2.0%; range, 0%-3.4%) following cervical arthrodesis. The surgical interventions following CDR range from the repositioning to explantation followed by fusion or the reimplantation to posterior foraminotomy or fusion. Strict patient selection, careful preoperative radiographic review and surgical planning, as well as surgical technique may reduce adverse events and the need for future intervention. Minimal literature and no guidelines exist for the approaches and techniques in revision and for the removal of implants following CDR. Adherence to strict indications and precise surgical technique may reduce the number of reoperations, revisions, and removals following CDR. Long-term follow-up studies are needed, assessing the implant survivorship and its effect on the revision and removal rates.