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Owen AR, Bettencourt JW, Wyles CC, Bedard NA, Hannon CP, Berry DJ, Abdel MP. Contemporary results of total femoral arthroplasties for non-oncological conditions. Bone Joint J 2025; 107-B:449-454. [PMID: 40164183 DOI: 10.1302/0301-620x.107b4.bjj-2024-0959.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
Aims Contemporary outcomes of total femoral arthroplasties (TFAs) in the non-oncological setting are limited. This study aimed to assess implant survival free from revision and reoperation, clinical outcomes, and radiological results associated with TFAs for non-oncological conditions. Methods We identified 24 patients who received TFAs between 1 January 2007 and 31 December 2021 through our institutional total joint registry. The patients' mean age was 66 years (48 to 83), mean BMI was 33 kg/m2 (21 to 54), and median follow-up was four years (IQR 2 to 5). Bearings used included eight flat-faced polyethylene bearings, seven dual-mobility constructs, six constrained liners, and three face-changing liners. Of the 24 patients, 17 had a previously documented periprosthetic joint infection (PJI) and 12 were treated with chronic antibiotic suppression following their TFAs. Results The two-, five-, and ten-year survivals free of any revision were 66%, 51%, and 34%, respectively. There were 12 revisions: five for hip dislocation, four for PJI, one for aseptic tibial loosening, one for prosthetic knee dislocation, and one for acetabular loosening with pelvic discontinuity. The two-, five-, and ten-year survivals free of any reoperation were 53%, 47%, and 34%, respectively. In addition to the stated TFA revisions, one patient required open reduction of a hip dislocation, and two patients required superficial irrigation and debridement procedures for wound complications. Mean Harris Hip Scores improved from a mean score of 48 to 69 (p = 0.002), and Knee Society Scores improved from a mean score of 56 to 71 (p = 0.110). At final follow-up, 20 patients had TFAs in situ, but four patients had been treated with hip disarticulation due to recalcitrant infection. All but one tibial and all non-revised acetabular components were radiologically well-fixed at final follow-up. Conclusion The use of TFAs in the non-oncological setting, mostly for salvage of multiply revised hips with previous PJI, had a low five-year survival free from any revision of 51%, mostly for hip dislocation and infection. Nevertheless, clinical outcomes improved in this challenging cohort of patients.
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Affiliation(s)
- Aaron R Owen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas A Bedard
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles P Hannon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Liu CM, Ehlers CB, Berger GK, Ball ST, Chiarappa FE. Total femur replacement in revision arthroplasty for non-oncologic patients: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2025; 35:112. [PMID: 40074982 DOI: 10.1007/s00590-025-04226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 02/19/2025] [Indexed: 03/14/2025]
Abstract
PURPOSE Revision total joint arthroplasty cases including those complex enough to require limb-salvage procedures are expected to significantly increase. Total femoral replacements represent a limb-preserving procedure with potential utility for these complicated cases. This review seeks to summarize the outcomes of total femoral replacements when used in the revision arthroplasty setting. METHODS A systematic review was performed by searching Embase, Ovid MEDLINE, PubMed, Wiley Cochrane Library: Central Register of Controlled Trials, and Thompson Reuters Web of Science: Citation Index on February 8, 2024 for studies describing any outcomes and complications of total femur replacements performed for revision arthroplasty. Functional outcomes and postoperative complications were subsequently summarized. This study was registered with PROSPERO (CRD42024509031). Risk of bias assessment was performed using the Methodological Index for Nonrandomized Studies. RESULTS Eleven of 4817 initially screened studies were included. Indications for total femur replacement largely consisted of periprosthetic infection, periprosthetic fracture, hardware loosening, or a combination thereof. Articles described variable benefit in function, pain, and ambulatory ability. Patients had improved hip and knee function, reduced pain levels, and preserved independent ambulatory ability, though patients largely still required assistive devices. Benefits were limited by the high risk of postoperative complications, especially infection and dislocation. CONCLUSION Total femur replacement is an option for limb-salvage surgery in complex revision arthroplasty cases but has high complication rates, particularly infection and dislocation. Advancements aimed at minimizing these complication rates including silver- and iodine-coated implants will be critical in establishing the viability of total femur replacements in this setting.
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Affiliation(s)
- Christopher M Liu
- Department of Orthopaedic Surgery, University of California San Diego, 4150 Regents Park Row, La Jolla, CA, 92037, USA.
| | - Cooper B Ehlers
- Department of Orthopaedic Surgery, University of California San Diego, 4150 Regents Park Row, La Jolla, CA, 92037, USA
| | - Garrett K Berger
- Department of Orthopaedic Surgery, University of California San Diego, 4150 Regents Park Row, La Jolla, CA, 92037, USA
| | - Scott T Ball
- Department of Orthopaedic Surgery, University of California San Diego, 4150 Regents Park Row, La Jolla, CA, 92037, USA
| | - Frank E Chiarappa
- Department of Orthopaedic Surgery, University of California San Diego, 4150 Regents Park Row, La Jolla, CA, 92037, USA
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Taylor AJ, Gililland JM, Anderson LA. Intramedullary Total Femur via a Direct Anterior Approach for Complex Revision Total Hip and Knee Arthroplasty. Arthroplast Today 2024; 28:101474. [PMID: 39188565 PMCID: PMC11345508 DOI: 10.1016/j.artd.2024.101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/17/2024] [Accepted: 07/06/2024] [Indexed: 08/28/2024] Open
Abstract
Total femur replacement is a well-recognized salvage procedure and an alternative to hip disarticulation in patients with massive femoral bone loss. Compared to conventional total femur replacement, intramedullary total femur (IMTF) requires less soft tissue dissection and preserves femoral bone stock and soft-tissue attachments. Despite these advantages, patients can still anticipate compromised functional outcomes and high complication rates following IMTF. Prior studies describe IMTF with the patient positioned laterally and utilizing posterior or anterolateral approaches to the hip. We describe our IMTF technique performed via the direct anterior approach in the supine position. In our experience, this is an effective method, with potential benefits including intraoperative limb length and rotational assessment, use of fluoroscopy, more convenient exposure of the knee, and potential lower rates of hip instability.
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Affiliation(s)
- Adam J. Taylor
- Department of Orthopaedics, UC Davis Medical Center, University of California, Sacramento, CA, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | - Lucas A. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Ali A, Ahmed I, Shearman A, McCulloch R, Carrington R, Skinner J. Survival Rates and Patient-Reported Outcomes Support the Use of Custom Cement-Over Megaprosthesis (CCOM) in Complex Revision Lower Limb Arthroplasty. J Arthroplasty 2024; 39:1811-1819. [PMID: 38244641 DOI: 10.1016/j.arth.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Patients presenting with periprosthetic osteolysis or fracture between ipsilateral hip and knee arthroplasties are challenging to treat successfully. Long-stem implants, osteopenic bones, and patient comorbidities all represent considerable surgical challenges. Poor results of fracture fixation in this group, coupled with the desire to retain well-performing implants and minimize soft-tissue trauma led to the developmentof the custom cement-over megaprostheses (CCOM). The aims of the study were to evaluate implant survivals, complications, and patient outcomes in those undergoing CCOM within our institution. METHODS A retrospective analysis of patients undergoing CCOM between 2002 and 2022 was performed. We studied 34 cases, 33 patients, one patient underwent staged bilateral surgery with 26 women and 8 men. INDICATIONS trauma (16), failure of implants /aseptic loosening (9), or joint pathology. The mean Charlson comorbidity index was 3.5 (range, 0 to 8). All patients were followed up (mean 75 months [range, 9 to 170]) at 6 weeks, 6 months, 1 year, and annually thereafter. The VAS, EuroQol-5D-3L and MSTS scores were collected at 1 year. RESULTS Implant survival defined by the primary outcome (all-cause revision of the implant at any time point) at 12 months of 97% (32 of 33). In surviving patients, implant survival was 90% (18 of 20) and all 7 survived at 5 and 10 years, respectively. Implant survival including those in the primary outcome group and those free of infection at 12 months was 84.8% (28 of 33) and in surviving patients, implant survival was 70% (14 of 20) and 7 out of 7 at 5 and 10 years, respectively. CONCLUSIONS The CCOM technique demonstrates good implant survivorships and satisfactory patient-reported outcomes in complex, often frail patients who have compromised bone stock. This series confirms the technique as an established alternative to total femoral replacement in these cases.
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Affiliation(s)
- Asad Ali
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Iftikhar Ahmed
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Alex Shearman
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Robert McCulloch
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Richard Carrington
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - John Skinner
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Lari A, Esmaeil A, AlSalem Y, Alabbad F, Shahin M, Aoude A. Comparative Outcomes and Failure Rates of Total Femur Replacement in Oncologic and Nononcologic Indications: A Systematic Review and Meta-analysis. JBJS Rev 2024; 12:01874474-202407000-00001. [PMID: 38968379 PMCID: PMC11221795 DOI: 10.2106/jbjs.rvw.24.00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
BACKGROUND Total femur replacement (TFR) has become increasingly significant as a salvage procedure for both oncologic reconstruction and complex nononcologic conditions such as revision arthroplasty. Despite its effectiveness in limb salvage, TFR is associated with high complication and failure rates, which vary depending on the underlying indication. METHODS This systematic review and meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of MEDLINE, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases was conducted, focusing on studies that reported outcomes of TFR in oncologic and nononcologic cases. Primary outcomes included failure mode and rates according to the Henderson classification, functional outcomes scores, and mobility status. Data were analyzed using random-effects models and generalized linear mixed models. RESULTS A total of 35 studies involving 1,002 patients were included. The majority of TFRs were performed for oncologic reasons (63.7%). The mean Musculoskeletal Tumor Society (MSTS) score was 66%, with a limb salvage rate of 89%. The meta-analysis revealed a combined failure rate of 34%. For type 4 failures (infection), nononcologic patients exhibited a significantly higher rate at 18% (95% confidence interval [CI], 12%-26%, I2 = 46%, p < 0.01) compared with 8% in oncologic patients (95% CI, 6%-12%, I2 = 0%). Regarding combined types 1 to 4 failures, oncologic patients had a rate of 20% (95% CI, 25%-52%, I2 = 60%), whereas nononcologic patients faced a higher rate of 37% (95% CI, 12%-26%, I2 = 63%) (p < 0.05), indicating a significant difference. There were no significant differences in the MSTS score. In addition, there were no notable differences when comparing failure modes 1, 2, and 3 independently. Mobility analysis showed that approximately 70% of patients required walking aids after surgery. CONCLUSION TFR offers a valuable limb salvage option in both oncologic and nononcologic scenarios, despite its high failure rates. Although functional outcomes were similar between groups, the higher failure rate in nononcologic cases and the poor overall quality of evidence warrant further comprehensive assessments into predictors of outcomes to optimize results. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ali Lari
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait
| | - Ali Esmaeil
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait
| | - Yousef AlSalem
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait
| | - Fahad Alabbad
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait
| | - Maged Shahin
- Department of Orthopedic Surgery, AlFarwaniya Hospital, Kuwait
| | - Ahmed Aoude
- McGill University Health Centre, Montreal, Quebec, Canada
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Gonzalez MR, Inchaustegui ML, Layme J, Ruiz-Arellanos K, Larios F, Pretell-Mazzini J. Postoperative Outcomes of Total Femur Replacement in Oncologic and Nononcologic Patients: A Systematic Review of the Literature. J Arthroplasty 2024; 39:1624-1631.e2. [PMID: 38061400 DOI: 10.1016/j.arth.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Total femur replacement (TFR) is used for primary reconstruction after extensive tumor resection or as a revision surgery due to prosthetic failure. Studies on TFR rates of failure and functional outcomes are scarce. The purpose of our study was to compare the modes of failure, amputation rates, and functional outcomes after TFR between oncologic and nononcologic patients. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were for this manuscript. Our study was registered on PROSPERO (413582). Quality assessment of all studies was performed using Strengthening the Reporting of Observational Studies in Epidemiology checklist. Endoprosthesis failure was assessed using the Henderson classification and functional outcomes using the Musculoskeletal Tumor Society score. Weighted means and standard deviations were calculated. RESULTS Overall failure rate was similar between groups. Henderson type 4 failures were more common within the nononcologic group, while the others were more frequently found in the oncologic group. Overall amputation rate was higher in the oncologic group mainly due to type 5 failure. Amputations occurred mainly after type 4 and type 5 failures. Functional outcome was better within the oncologic group (70.5 versus 61.7, respectively; P < .001). CONCLUSIONS Total femoral replacement in the oncologic and nononcologic group is associated with a high rate of failure (31% and 32.5%, respectively). Overall amputation rate was higher in the oncologic group mainly due to type 5 failure. Functional outcome was better within the oncologic group. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Marcos R Gonzalez
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maria L Inchaustegui
- Department of Orthopaedics and Traumatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Josue Layme
- Department of Orthopaedics and Traumatology, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Kim Ruiz-Arellanos
- Department of Orthopaedics and Traumatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Felipe Larios
- Department of Orthopaedics and Traumatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Pretell-Mazzini
- Division of Orthopedic Oncology, Miami Cancer Institute, Baptist Health System South Florida, Plantation, Florida
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Savvidou O, Gavriil P, Trikoupis IG, Goumenos S, Vottis C, Melissaridou D, Kaspiris A, Megaloikonomos PD, Papagelopoulos P. Ipsilateral Hip and Knee Reconstruction Using an Intramedullary Total Femoral Replacement System. J Long Term Eff Med Implants 2024; 34:59-63. [PMID: 37938206 DOI: 10.1615/jlongtermeffmedimplants.2022045124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The intramedullary total femoral reconstruction (ITFR) was used successfully in a 62-year-old patient with myxoid liposarcoma of the thigh and post-radiation fracture nonunion of the proximal femur and osteonecrosis of the ipsilateral knee. This described technique offers the advantage of a less invasive prosthesis insertion, preservation of the surrounding muscle attachments, better functional outcomes, and lower complication rates. Total femoral reconstruction using ITFR, preserving the femoral diaphysis, could be an option to address concomitant hip and knee defects, especially in patients with poor soft tissue quality.
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Affiliation(s)
- Olga Savvidou
- First Department of Orthopedics, National and Kapodistrian University of Athens, Medical School, ATTIKON University General Hospital, GREECE
| | - Panayiotis Gavriil
- First Department of Orthopedics, National and Kapodistrian University of Athens, Atikon University General Hospital, Athens, Greece
| | - Ioannis G Trikoupis
- First Department of Orthopedics, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462, Athens, Greece
| | - Stavros Goumenos
- First Department of Orthopedics, National and Kapodistrian University of Athens, ATTIKON University General Hospital, Athens, Greece
| | - Christos Vottis
- First Department of Orthopedics, National and Kapodistrian University of Athens, ATTIKON University General Hospital, Greece
| | - Dimitra Melissaridou
- First Department of Orthopedics, National and Kapodistrian University of Athens, ATTIKON University General Hospital, Athens, Greece
| | - Angelos Kaspiris
- First Department of Orthopedics, National and Kapodistrian University of Athens, Atikon University General Hospital, Athens, Greece
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Panayiotis Papagelopoulos
- First Department of Orthopedics, National and Kapodistrian University of Athens, Atikon University General Hospital, Athens, Greece
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Shao X, Dou M, Yang Q, Li J, Zhang A, Yao Y, Chu Q, Li K, Li Z. Reconstruction of massive bone defects after femoral tumor resection using two new-designed 3D-printed intercalary prostheses: a clinical analytic study with the cooperative utilization of multiple technologies. BMC Musculoskelet Disord 2023; 24:67. [PMID: 36698116 PMCID: PMC9875495 DOI: 10.1186/s12891-023-06171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND To reconstruct massive bone defects of the femoral diaphysis and proximal end with limited bilateral cortical bone after joint-preserving musculoskeletal tumor resections, two novel 3D-printed customized intercalary femoral prostheses were applied. METHODS A series of nine patients with malignancies who received these novel 3D-printed prostheses were retrospectively studied between July 2018 and November 2021. The proximal and diaphyseal femur was divided into three regions of interest (ROIs) according to anatomic landmarks, and anatomic measurements were conducted on 50 computed tomography images showing normal femurs. Based on the individual implant-involved ROIs, osteotomy level, and anatomical and biomechanical features, two alternative 3D-printed prostheses were designed. In each patient, Hounsfield Unit (HU) value thresholding and finite element analysis were conducted to identify the bone trabecula and calcar femorale and to determine the stress distribution, respectively. We described the characteristics of each prosthesis and surgical procedure and recorded the intraoperative data. All patients underwent regular postoperative follow-up, in which the clinical, functional and radiographical outcomes were evaluated. RESULTS With the ROI division and radiographic measurements, insufficient bilateral cortical bones for anchoring the traditional stem were verified in the normal proximal femur. Therefore, two 3D-printed intercalary endoprostheses, a Type A prosthesis with a proximal curved stem and a Type B prosthesis with a proximal anchorage-slot and corresponding locking screws, were designed. Based on HU value thresholding and finite element analysis, the 3D-printed proximal stems in all prostheses maximally preserved the trabecular bone and calcar femorale and optimized the biomechanical distribution, as did the proximal screws. With the 3D-printed osteotomy guide plates and reaming guide plates, all patients underwent the operation uneventfully with a satisfactory duration (325.00 ± 62.60 min) and bleeding volume (922.22 ± 222.36 ml). In the follow-up, Harris Hip and Musculoskeletal Tumor Society scores were ameliorated after surgery (P < 0.001 and P < 0.001, respectively), reliable bone ingrowth was observed, and no major complications occurred. CONCLUSIONS Two novel 3D-printed femoral intercalary prostheses, which achieved acceptable overall postoperative outcomes, were used as appropriate alternatives for oncologic patients with massive bone defects and limited residual bone and increased the opportunities for joint-preserving tumor resection. Several scientific methodologies utilized in this study may promote the clinical design proposals of 3D-printed implants.
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Affiliation(s)
- Xianhao Shao
- grid.460018.b0000 0004 1769 9639Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Mengmeng Dou
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.417024.40000 0004 0605 6814Department of Biomedical Engineering, Tianjin First Central Hospital, Tianjin, 300070 China
| | - Qiang Yang
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
| | - Jianmin Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
| | - Ailin Zhang
- grid.417021.10000 0004 0627 7561Physiotherapy department, Acute Neurosciences, the Wesley Hospital, 451 Coronation Drive, Auchenflower, QLD 4066 Australia
| | - Yuan Yao
- Department of Radiography, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
| | - Qing Chu
- grid.415105.40000 0004 9430 5605State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037 China ,grid.415105.40000 0004 9430 5605Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100037 China
| | - Ka Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
| | - Zhenfeng Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
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Logoluso N, Pedrini FA, Morelli I, De Vecchi E, Romanò CL, Pellegrini AV. Megaprostheses for the revision of infected hip arthroplasties with severe bone loss. BMC Surg 2022; 22:68. [PMID: 35216567 PMCID: PMC8876444 DOI: 10.1186/s12893-022-01517-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/14/2022] [Indexed: 01/14/2023] Open
Abstract
Background Periprosthetic hip infections with severe proximal femoral bone loss may require the use of limb salvage techniques, but no agreement exists in literature regarding the most effective treatment. Aim of this study is to analyze the infection eradication rate and implant survival at medium-term follow-up in patients treated with megaprostheses for periprosthetic hip infections with severe bone loss. Methods Twenty-one consecutive patients were retrospectively reviewed at a mean 64-month follow-up (24–120). Functional and pain scores, microbiological, radiological and intraoperative findings were registered. Kaplan Meier survival analysis and log rank test were used for infection free survival and implant survival analyses. Results The infection eradication rate was 90.5%, with an infection free survival of 95.2% at 2 years (95%CI 70.7–99.3) and 89.6%(95%CI 64.3–97.3) at 5 years. Only two patients required major implant revisions for aseptic implant loosening. The most frequent complication was dislocation (38.1%). The major revision-free survival of implants was 95.2% (95%CI 70.7–99.3) at 2 years and 89.6% (95%CI 64.3–97.3) at 5 years. The overall implant survival was 83.35% (CI95% 50.7–93.94) at 2 and 5 years. Subgroup analyses (cemented versus cementless MPs, coated versus uncoated MPs) revealed no significant differences at log rank test, but its reliability was limited by the small number of patients included. Conclusions Proximal femoral arthroplasty is useful to treat periprosthetic hip infections with severe bone loss, providing good functional results with high infection eradication rates and rare major revisions at medium-term follow-up. No conclusions can be drawn on the role of cement and coatings.
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Affiliation(s)
- Nicola Logoluso
- IRCCS Istituto Ortopedico Galeazzi, Centre for Reconstructive Surgery and Osteoarticular Infections (C.R.I.O. Unit), via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Francesca Alice Pedrini
- Residency Program in Orthopaedics and Traumatology, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy
| | - Ilaria Morelli
- ASST Ovest Milanese, Ospedale di Legnano, UOC Ortopedia e Traumatologia, via Papa Giovanni Paolo II, 20025, Legnano, MI, Italy.
| | - Elena De Vecchi
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, via Riccardo Galeazzi 4, 20161, Milan, Italy
| | | | - Antonio Virgilio Pellegrini
- IRCCS Istituto Ortopedico Galeazzi, Centre for Reconstructive Surgery and Osteoarticular Infections (C.R.I.O. Unit), via Riccardo Galeazzi 4, 20161, Milan, Italy
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10
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Bonnomet F, Favreau H, Bonnevialle P, Adam P, Ehlinger M. Interimplant femoral fractures. Orthop Traumatol Surg Res 2022; 108:103117. [PMID: 34666198 DOI: 10.1016/j.otsr.2021.103117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 02/03/2023]
Abstract
The number of hip or knee arthroplasties, and internal fixations of the proximal and distal femur, is increasing in proportion to the growing and ageing population, whose life expectancy is lengthening. Thus, fractures of the femur between proximal and distal implants, although rare, are becoming more frequent. Women over the age of 70, with fragile bones and whose ends of the two implants are close to each other ("kissing implants") are particularly vulnerable to them. Reliable and reproducible fracture classifications exist when it comes to 2 prostheses, but they are less well established in the presence of one, or even two, non-prosthetic implants. Their treatment is difficult and must consider the possibility of fracture consolidation while ensuring or restoring the stability and role of the implants. Whether it is the main element of treatment or a complement to prosthesis revision, locked plating forms the basis of the treatment but it must be rigorous, considering that failures are mainly the result of technical errors. Other more invasive treatments (total femoral arthroplasty, cortical sleeves) are offered more rarely if consolidation appears compromised.
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Affiliation(s)
- François Bonnomet
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France.
| | - Henri Favreau
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | - Paul Bonnevialle
- Département universitaire d'orthopédie traumatologie, hôpital Paul-Riquet, place Baylac, 31052 Toulouse, France
| | - Philippe Adam
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | - Matthieu Ehlinger
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
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11
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Huang Y, Zhou Y, Shao H, Yang D, Tang H, Guo S. A Novel Endosteal Reconstruction of the Femur from Distal Femoral Remnant Using 3D-Printed Titanium Rings: A Two-Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00096. [PMID: 34449452 DOI: 10.2106/jbjs.cc.20.01038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Femur reconstruction with only the distal femoral remnant is challenging because of poor bone volume required for stem fixation. Although proximal femoral replacement, total femur replacement, allograft prosthesis composite, and custom porous tantalum implants are options, hybrid fixation enhanced by endosteal reconstruction with three-dimensional (3D)-printed porous titanium rings to reconstruct the femur without supporting isthmus has not been described. We report 2 cases with satisfactory 34- and 22-month follow-up results of hybrid fixation enhanced by endosteal reconstruction with 3D-printed porous titanium rings. CONCLUSION This novel method provides a solution to revise loosened femoral endoprosthesis with only distal femoral remnant.
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Affiliation(s)
- Yong Huang
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
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12
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Femoral neck fracture to total femoral replacement: a case report. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Henderson ER, Keeney BJ, Husson EG, Bernthal NM, Ji T, Pala E, Funovics PT, Groundland JS, Lozano-Calderon S, Puchner S, Zoller SD, Ruggieri P, Windhager R, Guo W, Hornicek FJ, Letson GD, Temple HT. Nonmechanical Revision Indications Portend Repeat Limb-Salvage Failure Following Total Femoral Replacement. J Bone Joint Surg Am 2020; 102:1511-1520. [PMID: 32453111 DOI: 10.2106/jbjs.19.01022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is scant evidence to guide decision-making for patients considering total femoral replacement (TFR). We aimed to identify the indication, patient, disease, and surgical technique-related factors associated with failure. We hypothesized that failure occurs more frequently in the setting of revision surgical procedures, with infection as the predominant failure mode. METHODS We performed a retrospective cohort study of patients receiving total femoral endoprostheses for oncological and revision arthroplasty indications; 166 patients met these criteria. Our primary independent variable of interest was TFR for a revision indication (arthroplasty or limb salvage); the primary outcome was failure. Analyses were performed for patient variables (age, sex, diagnosis group, indication), implant variables (model, decade, length, materials), and treatment variables. We analyzed TFR failures with respect to patient factors, operative technique, and time to failure. We conducted bivariate logistic regressions predicting failure and used a multivariate model containing variables showing bivariate associations with failure. RESULTS Forty-four patients (27%) had treatment failure. Failure occurred in 24 (23%) of 105 primary TFRs and in 20 (33%) of 61 revision TFRs; the difference was not significant (p = 0.134) in bivariate analysis but was significant (p = 0.044) in multivariate analysis. The mean age at the time of TFR was 37 years in the primary group and 51 years in the revision group (p = 0.0006). Of the patients who had mechanical failure, none had reoccurrence of their original failure mode, whereas all 8 patients from the nonmechanical cohort had reoccurrence of the original failure mode; this difference was significant (p = 0.0001). CONCLUSIONS TFR has a high failure rate and a propensity for deep infection, especially in the setting of revision indications and prior infection. All failed TFRs performed for revision indications for infection or local recurrence failed by reoccurrence of the original failure mode and resulted in amputation. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eric R Henderson
- Department of Orthopaedics and the Sarcoma & Connective Tissue Oncology Program, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
| | - Benjamin J Keeney
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire.,Berkley Medical Management Solutions, Overland Park, Kansas
| | - Emily G Husson
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
| | - Nicholas M Bernthal
- University of California at Los Angeles Sarcoma Program, Los Angeles, California
| | - Tao Ji
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Elisa Pala
- Orthopaedic Oncology Unit, University of Padua, Padua, Italy
| | - Philipp T Funovics
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Stephan Puchner
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephen D Zoller
- University of California at Los Angeles Sarcoma Program, Los Angeles, California
| | - Pietro Ruggieri
- Orthopaedic Oncology Unit, University of Padua, Padua, Italy
| | - Reinhard Windhager
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Francis J Hornicek
- University of California at Los Angeles Sarcoma Program, Los Angeles, California
| | - G Douglas Letson
- Sarcoma Program, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
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14
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DeRogatis MJ, Issack PS. Total Femoral Replacement as a Salvage Operation for the Treatment of Massive Femoral Bone Loss During Revision Total Hip Arthroplasty. JBJS Rev 2019; 6:e9. [PMID: 29847442 DOI: 10.2106/jbjs.rvw.17.00195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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15
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Abdelaziz H, Saleri S, Mau H, Sandiford NA, Lausmann C, Zahar A, Gehrke T, Haasper C, Citak M. Interprosthetic Femoral Sleeves in Revision Arthroplasty: A 20-Year Experience. J Arthroplasty 2019; 34:1423-1429. [PMID: 30904363 DOI: 10.1016/j.arth.2019.02.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/18/2019] [Accepted: 02/25/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Interprosthetic femoral fractures in patients with ipsilateral stemmed total hip arthroplasty (THA) and total knee arthroplasty (TKA) can be technically demanding to treat surgically. Nonunion and implant failure are among the main complications following fixation of interprosthetic femoral (IF) fractures. Total femoral arthroplasty (TFA) is associated with a high incidence of infection and instability. IF sleeves have been designed to avoid the disadvantages of these techniques and to provide a stable construct. The aim of this study was to present the results with this device from a single center. METHODS We reviewed 26 patients who underwent revision arthroplasty procedures, using custom-made cemented IF sleeves between 1997 and December 2017 in our institution. Two-part sleeves were used in 18 patients and one-part sleeves in 8 patients. The most common indication was an IF fracture (18 patients). Patients were monitored for postoperative complications, implant failure, and re-revision. The minimum follow-up of the survivors with nonrevised sleeves was 12 months. RESULTS Twenty-three patients were included for the final analysis. The mean survivorship of the IF sleeve was 4.6 years at latest follow-up (mean 48.5 months; range 12 to 156). The overall rate of complications was 47.8%. The rate of mechanical failure was 21.7%. Late infections occurred in 3 patients (13%). At the latest follow-up, the mean Harris Hip Score was 69.9 points (range 39 to 94), and the mean functional Knee Society Score was 42.5 points (range 0 to 90), with average knee flexion of 95° (range 90° to 100°). CONCLUSION The IF sleeve is a valid technique for the management of selected patients with IF fractures, particularly when a stable fracture fixation is not possible. Hip instability is not a concern, and functional improvement is achievable. Careful planning is required preoperatively to avoid mechanical failure.
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Affiliation(s)
- Hussein Abdelaziz
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Solmaz Saleri
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Hans Mau
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | | | - Christian Lausmann
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Akos Zahar
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Carl Haasper
- Department of Orthopaedic Surgery, AMEOS Klinikum Seepark Geestland, Geestland, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
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16
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Total femur replacement in non-oncologic indications: Functional and radiological outcomes from a French survey with a mean 6 years' follow-up. Orthop Traumatol Surg Res 2019; 105:591-598. [PMID: 31027981 DOI: 10.1016/j.otsr.2018.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/25/2018] [Accepted: 12/06/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There are few published studies on total femur replacement (TFR) because its indications are rare. Other than malignant diseases, the indications extend to revisions and interprosthetic femur fractures; however, the outcomes of these indications have not been well defined. The aim of this retrospective survey was to analyze the complication rate and functional outcomes of these newer indications. HYPOTHESIS The morbidity and outcomes after TFR are comparable to those reported in the literature for non-cancer indications. MATERIAL AND METHODS Between 1997 and 2016, 29 TFR procedures were done at 6 French teaching hospitals in 15 women and 14 men, average age 68±14 years [32-85]. The primary indication was degenerative joint disease in the hip and/or knee in 16 cases, mechanical failure of the implant used after tumor resection in 11 cases and femur fracture in 2 cases. The mean number of surgical procedures before TFR was 3.6 (maximum 5) at the hip and 4.5 (maximum 10) at the knee. Six different models were implanted consisting of a rotational hinge knee (except in one case); 20 patients received a dual mobility system and 9 a standard hip replacement bearing. The femoral shaft was partially conserved 21/29 times and the trochanter 25/29 times. RESULTS Five patients suffered a general complication and 12 suffered a local complication (including 4 hematomas and 2 hip dislocations). Eight patients (28.6%) suffered a surgical site infection, although three had a prior infection. Among the 12 patients with a history of infection or progressive infection before the TFR, 9 healed and 3 had the infection continue. At a minimum follow-up of 2 years and mean of 6 years, 23 TFR implants were still in place and not infected; the other 6 had been removed or were infected, including one patient who underwent disarticulation. The median survival of the non-infected TFR was 15 years. At 10 years, 70% of TFR implants were still in place and non-infected. Walking was possible with or without a cane in 15 patients (51.7%), with two canes or a walker in 12 patients (41.3%) and impossible in 2 patients. Active knee flexion averaged 79.4°±30.3° [0°-120°]; 17 patients (62.9%) had 90° or more flexion; two patients (7.4%) had no flexion. The extension deficit averaged 3.7°±7°[-20° to 10°] and 20 patients had no flexion deformity. The leg length difference averaged 1.3cm±2.3 [0-10]; 19 patients (67.8%) had no difference in leg length. DISCUSSION Our starting hypothesis was confirmed for the complication rate and clinical outcomes. The benefits of dual mobility cups are emphasized. While the indications for TFR are rare, they will likely increase in the coming years. LEVEL OF EVIDENCE IV, Retrospective cohort study….
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17
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Wu F, Fang X, Lang Z, Liu H, Duan H. [Advances in total femur replacement]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1346-1350. [PMID: 30215485 PMCID: PMC8414164 DOI: 10.7507/1002-1892.201804006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/19/2018] [Indexed: 02/05/2023]
Abstract
Objective To summarize the advances of total femur replacement in recent years. Methods The literature related to total femur replacement was reviewed, and the indications, techniques, prosthesis design, complications, rehabilitation, and function were summarized. Results The indication of total femur replacement is a wide involvement of the femur, skip lesions and a huge bone defect in revision. Watson-Jone is the main incision in the proximal, and then the full length of the thigh to the patella. Vascular and nerve bundle, abduction muscles are well protected, and combined or costumed prosthesis are replaced. The prosthesis design progresses, showing a diversified prostheses. Complication is frequent and varied. Rehabilitation in early stage is physical therapy, weight training is evolutionary. The main function evaluation system is Musculoskeletal Tumor Society (MSTS) score. Conclusion Total femur replacement is effective in limb salvage. Large sample size and long-term follow-up study should be carried out to unify indications and functional exercise standards and reduce postoperative complications.
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Affiliation(s)
- Fan Wu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;Department of Orthopedics, Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P.R.China
| | - Xiang Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zhigang Lang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Hongyuan Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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18
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Use of modular megaprosthesis in managing chronic end-stage periprosthetic hip and knee infections: Is there an increase in relapse rate? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:627-636. [DOI: 10.1007/s00590-018-2127-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/01/2018] [Indexed: 10/18/2022]
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Length of Endoprosthetic Reconstruction in Revision Knee Arthroplasty Is Associated With Complications and Reoperations. Clin Orthop Relat Res 2017; 475:72-79. [PMID: 27093862 PMCID: PMC5174028 DOI: 10.1007/s11999-016-4836-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Complex revision total knee arthroplasty (TKA) often calls for endoprosthetic reconstruction to address bone loss, poor bone quality, and soft tissue insufficiency. Larger amounts of segmental bone loss in the setting of joint replacement may be associated with greater areas of devascularized tissue, which could increase the risk of complications and worsen functional results. QUESTIONS/PURPOSES Are longer endoprosthetic reconstructions associated with (1) higher risk of deep infection; (2) increased risk of reoperation and decreased implant survivorship; or (3) poorer ambulatory status? METHODS This is a single-institution retrospective case series of nononcologic femoral endoprosthetic reconstructions for revision TKA from 1995 to 2013 (n = 32). Cases were categorized as distal (n = 17) or diaphyseal (n = 15) femoral reconstructions based on extension to or above the supracondylar metaphyseal-diaphyseal junction, respectively. Five patients from each group were lost to followup before 2 years (distal mean 4 years [range, 2-8 years]; diaphyseal mean = 6 years [range, 2-16 years]), and one of the 12 distal reconstructions and two of the 10 diaphyseal reconstructions had not been evaluated within the past 5 years. Clinical outcomes and ambulatory status (able to walk or not) were assessed through chart review by authors not involved in any cases. Prior incidence of periprosthetic joint infection was high in both groups (distal = seven of 12 versus diaphyseal = four of 10; p = 0.670). RESULTS Patients with diaphyseal femoral replacements were more likely to develop postoperative deep infections than patients with distal femoral replacements (distal = three of 12 versus diaphyseal = nine of 10; p = 0.004). Implant survivorship (revision-free) for diaphyseal reconstructions was worse at 2 years (distal = 100%, 95% confidence interval [CI], 100%-100% versus diaphyseal = 40%, 95% CI, 19%-86%; p = 0.001) and 5 years (distal = 90%, 95% CI, 75%-100% versus diaphyseal = 30%, 95% CI, 12%-73%; p = 0.001). Infection-free, revision-free survival (retention AND no infection) was worse for diaphyseal femoral replacing reconstructions than for distal femoral replacements at 2 years (distal = 70%, 95% CI, 48%-100% versus diaphyseal = 20%, 95% CI, 6%-69%; p = 0.037) and 5 years (distal = 70%, 95% CI, 48%-100% versus diaphyseal = 10%, 95% CI, 2%-64%; p = 0.012). There was no difference with the small numbers available in proportion of patients able to walk (distal reconstruction = eight of 11 versus diaphyseal = seven of 10; p = 1.000), although all but one patient in each group required walking aids. CONCLUSIONS Endoprosthetic femoral reconstruction is a viable salvage alternative to amputation for treatment of failed TKA with segmental distal femoral bone loss. In our small series even with substantial loss to followup and likely best-case estimates of success, extension proximal to the supracondylar metaphyseal-diaphyseal junction results in higher infection and revision risk. In infection, limb salvage remains possible with chronic antibiotic suppression, which we now use routinely for all femoral replacement extending into the diaphysis. LEVEL OF EVIDENCE Level III, therapeutic study.
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20
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Konan S, Sandiford N, Unno F, Masri BS, Garbuz DS, Duncan CP. Periprosthetic fractures associated with total knee arthroplasty. Bone Joint J 2016; 98-B:1489-1496. [PMID: 27803224 DOI: 10.1302/0301-620x.98b11.bjj-2016-0029.r1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/30/2016] [Indexed: 11/05/2022]
Abstract
Fractures around total knee arthroplasties pose a significant surgical challenge. Most can be managed with osteosynthesis and salvage of the replacement. The techniques of fixation of these fractures and revision surgery have evolved and so has the assessment of outcome. This specialty update summarises the current evidence for the classification, methods of fixation, revision surgery and outcomes of the management of periprosthetic fractures associated with total knee arthroplasty. Cite this article: Bone Joint J 2016;98-B:1489–96.
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Affiliation(s)
- S. Konan
- University of British Columbia, Vancouver
General Hospital, JP North 3rd floor, Room 3114, 910
West 10th Avenue, Vancouver, BC
V5Z 4E3, Canada
| | - N. Sandiford
- University of British Columbia, Vancouver
General Hospital, JP North 3rd floor, Room 3114, 910
West 10th Avenue, Vancouver, BC
V5Z 4E3, Canada
| | - F. Unno
- University of British Columbia, Vancouver
General Hospital, JP North 3rd floor, Room 3114, 910
West 10th Avenue, Vancouver, BC
V5Z 4E3, Canada
| | - B. S. Masri
- University of British Columbia, Vancouver
General Hospital, JP North 3rd floor, Room 3114, 910
West 10th Avenue, Vancouver, BC
V5Z 4E3, Canada
| | - D. S. Garbuz
- University of British Columbia, Vancouver
General Hospital, JP North 3rd floor, Room 3114, 910
West 10th Avenue, Vancouver, BC
V5Z 4E3, Canada
| | - C. P. Duncan
- University of British Columbia, Vancouver
General Hospital, JP North 3rd floor, Room 3114, 910
West 10th Avenue, Vancouver, BC
V5Z 4E3, Canada
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Haldar A, Kantharuban S, Sharma A, Davidson JA, Briggs TWR. How to salvage a salvage endoprosthesis. J Surg Case Rep 2016; 2016:rjv172. [PMID: 26781449 PMCID: PMC4716447 DOI: 10.1093/jscr/rjv172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Custom-made endoprostheses can be linked to existing well-fixed implants in the treatment of complex periprosthetic femoral fractures. By adopting this salvage approach, secure implants can be retained in favour of patients undergoing more tissue disruptive procedures such as total femoral replacements. In this piece, we present a unique case illustrating a salvage strategy for treating a failed cement-linked salvage endoprosthesis, a complex scenario which to our knowledge has never before been reported.
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Affiliation(s)
- Anil Haldar
- Bone Tumour and Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Middlesex, UK
| | - Shanjitha Kantharuban
- Bone Tumour and Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Middlesex, UK
| | - Aadhar Sharma
- Bone Tumour and Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Middlesex, UK
| | - Jerome A Davidson
- Bone Tumour and Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Middlesex, UK
| | - Timothy W R Briggs
- Bone Tumour and Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Middlesex, UK
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Ramanathan D, Siqueira MBP, Klika AK, Higuera CA, Barsoum WK, Joyce MJ. Current concepts in total femoral replacement. World J Orthop 2015; 6:919-926. [PMID: 26716087 PMCID: PMC4686438 DOI: 10.5312/wjo.v6.i11.919] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/31/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Total femoral replacement (TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20th century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing literature is mainly composed of a rather heterogeneous mix of retrospective case series and a wide assortment of case reports. Numerous TFR prostheses are currently available and the surgeon must understand the unique implications of each implant design. Long-term functional outcomes are dependent on adherence to proper technique and an appropriate physical therapy program for postoperative rehabilitation. Revision TFR is mainly performed for periprosthetic infection and the severe femoral bone loss associated with aseptic revisions. Depending on the likelihood of attaining infection clearance, it may sometimes be advisable to proceed directly to hip disarticulation without attempting salvage of the TFR. Other reported complications of TFR include hip joint instability, limb length discrepancy, device failure, component loosening, patellar maltracking and delayed wound healing. Further research is needed to better characterize the long-term functional outcomes and complications associated with this complex procedure.
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Interposition sleeve as treatment option for interprosthetic fractures of the femur: a biomechanical in vitro assessment. INTERNATIONAL ORTHOPAEDICS 2015; 39:1743-7. [PMID: 25913266 DOI: 10.1007/s00264-015-2788-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The number of patients having hip and knee arthroplasties on the ipsilateral leg is going to rise. In this regard, the prevalence of interprosthetic femoral fractures is going to increase further. The treatment of these fractures is difficult and sometimes it is impossible to perform an osteosynthesis because of worse bone quality. The goal of this study was to investigate the use of an interposition sleeve as an alternative treatment option for interprosthetic fractures with major bone loss. METHODS Six human cadaveric femurs were instrumented using cemented hip- and knee prosthesis. Interprosthetic fractures were induced during a four-point-bending test and then treated using the interposition sleeve. Afterwards the constructs were tested using the four-point-bending test again. RESULTS Load-to-failure of the construct before fracturing was significantly higher than after treatment with the interposition sleeve (10681 N vs. 5083 N; p = 0.002). The failure mechanism of the femurs with the interposition sleeve was plastic deformation of the hip or knee prosthesis. The interposition sleeve did not fail in any specimen. CONCLUSION The interposition sleeve is a valuable treatment option for interprosthetic fractures in situations in which osteosynthesis is impossible or insecure due to major bone defects. However, fracture healing should be preferred whenever possible.
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Clement ND, MacDonald D, Ahmed I, Patton JT, Howie CR. Total femoral replacement for salvage of periprosthetic fractures. Orthopedics 2014; 37:e789-95. [PMID: 25350621 DOI: 10.3928/01477447-20140825-55] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/30/2014] [Indexed: 02/03/2023]
Abstract
Patients with complex periprosthetic fracture patterns of the femur may ultimately require amputation. Some authors have described the use of mega-endoprostheses as a salvage procedure. This study reports functional outcome, complications, and implant and patient survival after total femoral replacement (TFR) for salvage of periprosthetic fracture of the femur. A prospective database of 20 consecutive patients who underwent TFR for salvage of a periprosthetic fracture was compiled. Patient demographics, mobility information, and preoperative and postoperative Short Form 12-item Survey (SF-12) and 1-year Toronto Extremity Salvage Score (TESS) data were recorded. Postoperative complications were obtained from the hospital database and patient medical notes. One patient was lost to follow-up and was excluded from analysis. The study included 8 men and 11 women, with a mean age of 68.4 years. No significant difference was noted in the prefracture physical (4.4; P=.13) or mental (0.3; P=.78) component scores of the SF-12 compared with 1-year scores. The TESS at 1 year was 69%. However, patients were more likely to require a walking aid postoperatively (P<.0001). One-fourth of the patients had a postoperative medical complication. In addition, 1 patient had a dislocation and 2 patients had a periprosthetic infection. The implant survival rate was 86% at 10 years; however, the 10-year mortality rate was 58%. Although TFR for salvage of a periprosthetic fracture of the femur offers good functional outcome and implant survival, it is at the expense of postoperative complications, and TFR is associated with a high long-term mortality rate.
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Custom intramedullary intercalating device for treatment of supracondylar fracture between constrained total knee arthroplasty and well-fixed total hip arthroplasty. Knee 2014; 21:594-6. [PMID: 23266136 DOI: 10.1016/j.knee.2012.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 10/28/2012] [Accepted: 11/20/2012] [Indexed: 02/02/2023]
Abstract
Management of periprosthetic fractures between ipsilateral total knee arthroplasty (TKA) and total hip arthroplasty (THA) is difficult, and is further complicated in the setting of poor femoral bone stock. We present a case of supracondylar fracture between THA and long-stemmed TKA femoral components in a patient with rheumatoid arthritis, deficient metaphyseal bone stock, and recurrent fractures. A long custom intramedullary intercalating component was devised to link the well-fixed existing THA stem to a revision distal femoral component. The resulting construct was stable and allowed for full weight-bearing ambulation, representing a useful treatment option in the management of periprosthetic fractures between revision TKA and well-fixed THA.
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Coupling device and distal femoral replacement for periprosthetic supracondylar femur fractures with an ipsilateral total knee and hip replacement. HSS J 2014; 10:68-72. [PMID: 24482624 PMCID: PMC3903946 DOI: 10.1007/s11420-013-9360-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 08/02/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Periprosthetic supracondylar fractures in the setting of an ipsilateral total knee and hip replacement are a rare but serious orthopedic challenge. DESCRIPTION OF TECHNIQUE In this unique situation, we consider insertion of a custom coupling device with a distal femoral replacement as an appropriate surgical solution that allows for stability and preserves hip and knee functionality, while not relying on the poor healing potential of the remaining intercalary femoral bone. PATIENTS AND METHODS We report the outcomes of two patients who underwent this custom coupling procedure. RESULTS These custom devices resulted in successful outcomes with restoration of ambulatory function and range of motion at greater than 14 months follow-up. CONCLUSIONS We found that this technique provides sufficient stability and preserves functionality in a difficult-to-treat patient population. The results indicate that this technique may be considered as an alternative to more invasive procedures including total femoral replacement and complete femoral allograft constructs.
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Patel NK, Whittingham-Jones P, Aston WJ, Pollock RC, Skinner JA, Briggs TWR, Miles J. Custom-made cement-linked mega prostheses: a salvage solution for complex periprosthetic femoral fractures. J Arthroplasty 2014; 29:204-9. [PMID: 23648107 DOI: 10.1016/j.arth.2013.03.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 03/29/2013] [Accepted: 03/31/2013] [Indexed: 02/01/2023] Open
Abstract
Periprosthetic femoral fractures with long stem implants, poor bone stock and loosening pose a considerable surgical challenge. We describe a reconstruction technique using a custom-made mega-prosthesis, cement-linked to the femoral stem of a well-fixed existing implant. Clinical and radiological outcomes were assessed at our tertiary referral centre. There were 15 patients with a periprosthetic femoral fracture: 5 proximal and 10 distal femoral arthroplasties linked to existing femoral stems. The survival rate was 93.3% at a mean follow-up of 5.3 years (0.5-19.3) with 1 revision. We present a salvage technique with good intermediate-term outcomes for highly selected patients with complex periprosthetic femoral fractures, as another option to conventional fixation methods. Specifically, it allows immediate weight bearing and avoids some of the morbidity of total femoral arthroplasty or amputation.
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Affiliation(s)
- Nirav K Patel
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, London, UK
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Soenen M, Baracchi M, De Corte R, Labey L, Innocenti B. Stemmed TKA in a femur with a total hip arthroplasty: is there a safe distance between the stem tips? J Arthroplasty 2013; 28:1437-45. [PMID: 23489732 DOI: 10.1016/j.arth.2013.01.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 12/12/2012] [Accepted: 01/04/2013] [Indexed: 02/01/2023] Open
Abstract
When a stemmed TKA is needed in a femur in which a THA is already present, choosing an appropriate length for the TKA stem is crucial. Many surgeons intuitively fear that the distance between the stem tips correlates with the femur risk for fracture (RF). However, to date, no biomechanical data to support this intuition are available. Therefore, in this study, the RF in such a configuration was determined and compared for several activities, using a finite element modeling technique. During gait and sideways falling no difference in RF among different stem lengths was shown. However, a clear threshold appears during four-point bending. Stem tip distances shorter than 110 mm dramatically increased RF and, in osteoporotic bone, will certainly lead to fracture (RF>1) and thus should be avoided.
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Citak M, Klatte TO, Kendoff D, Haasper C, Gehrke T, Gebauer M. Treatment of interprosthetic femoral fractures with an interposition prosthesis: a technical note. Acta Orthop 2013; 84:326-7. [PMID: 23617704 PMCID: PMC3715825 DOI: 10.3109/17453674.2013.795434] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO Klinik Hamburg
| | - Till Orla Klatte
- Department of Orthopaedic Surgery, Helios ENDO Klinik Hamburg,Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Daniel Kendoff
- Department of Orthopaedic Surgery, Helios ENDO Klinik Hamburg
| | - Carl Haasper
- Department of Orthopaedic Surgery, Helios ENDO Klinik Hamburg
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO Klinik Hamburg
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Pelvic reconstruction with a free vascularized distal femur for revision total hip arthroplasty. J Arthroplasty 2012; 27:493.e19-22. [PMID: 21723694 DOI: 10.1016/j.arth.2011.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 11/15/2010] [Accepted: 03/02/2011] [Indexed: 02/01/2023] Open
Abstract
The reconstruction of massive structural acetabular defects after revision arthroplasty presents a unique challenge to the orthopedic surgeon. This report describes such a salvage procedure where an autologous vascularized distal femur was used to reconstruct acetabular bone stock with subsequent implantation of a total femoral endoprosthetic replacement that uses a constrained cup and a hinged total knee system. At 2 years of follow-up, there is a good functional result with full incorporation of the graft.
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Osagie LE, Bostrom MPG. A custom coupling device of total knee and ipsilateral total hip arthroplasties after distal femoral fracture. J Arthroplasty 2011; 26:1571.e1-3. [PMID: 21353451 DOI: 10.1016/j.arth.2011.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 01/04/2011] [Indexed: 02/01/2023] Open
Abstract
The treatment of periprosthetic femoral fractures around long-stemmed hip implants is an orthopedic challenge, which may be complicated by the presence or need for a total knee arthroplasty. Treatment of this fracture when the proximal implant is well fixed and a distal implant is required poses ongoing challenges. Traditional plating and allograft struts have produced variable results, particularly in osteoporotic bone, where incidence of nonunion is greater. Thus, we report a custom interlocking device, which couples the stem of the fixed proximal implant to a new stemmed total knee prosthesis, resulting in the expedited restoration of functionality and fracture union.
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Affiliation(s)
- Liza E Osagie
- Hospital for Special Surgery, New York, New York 10021, USA
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Hoell S, Butschek S, Gosheger G, Dedy N, Dieckmann R, Henrichs M, Daniilidis K, Hardes J. Intramedullary and total femur replacement in revision arthroplasty as a last limb-saving option. ACTA ACUST UNITED AC 2011; 93:1545-9. [DOI: 10.1302/0301-620x.93b11.27309] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There has been a substantial increase in the number of hip and knee prostheses implanted in recent years, with a consequent increase in the number of revisions required. Total femur replacement (TFR) following destruction of the entire femur, usually after several previous revision operations, is a rare procedure but is the only way of avoiding amputation. Intramedullary femur replacement (IFR) with preservation of the femoral diaphysis is a modification of TFR. Between 1999 and 2010, 27 patients with non-oncological conditions underwent surgery in our department with either IFR (n = 15) or TFR (n = 12) and were included in this study retrospectively. The aim of the study was to assess the indications, complications and outcomes of IFR and TFR in revision cases. The mean follow-up period was 31.3 months (6 to 90). Complications developed in 37% of cases, 33% in the IFR group and 4% in the TFR group. Despite a trend towards a slightly better functional outcome compared with TFR, the indication for intramedullary femur replacement should be established on a very strict basis in view of the procedure’s much higher complication rate.
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Affiliation(s)
- S. Hoell
- University Hospital Münster, Department
of General and Tumor Orthopedics, Albert Schweitzerstrasse
33, Münster 48149, Germany
| | - S. Butschek
- University Hospital Münster, Department
of General and Tumor Orthopedics, Albert Schweitzerstrasse
33, Münster 48149, Germany
| | - G. Gosheger
- University Hospital Münster, Department
of General and Tumor Orthopedics, Albert Schweitzerstrasse
33, Münster 48149, Germany
| | - N. Dedy
- University Hospital Münster, Department
of General and Tumor Orthopedics, Albert Schweitzerstrasse
33, Münster 48149, Germany
| | - R. Dieckmann
- University Hospital Münster, Department
of General and Tumor Orthopedics, Albert Schweitzerstrasse
33, Münster 48149, Germany
| | - M. Henrichs
- University Hospital Münster, Department
of General and Tumor Orthopedics, Albert Schweitzerstrasse
33, Münster 48149, Germany
| | - K. Daniilidis
- University Hospital Münster, Department
of General and Tumor Orthopedics, Albert Schweitzerstrasse
33, Münster 48149, Germany
| | - J. Hardes
- University Hospital Münster, Department
of General and Tumor Orthopedics, Albert Schweitzerstrasse
33, Münster 48149, Germany
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Sah AP, Marshall A, Virkus WV, Estok DM, Della Valle CJ. Interprosthetic fractures of the femur: treatment with a single-locked plate. J Arthroplasty 2010; 25:280-6. [PMID: 19056231 DOI: 10.1016/j.arth.2008.10.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 10/10/2008] [Indexed: 02/01/2023] Open
Abstract
Interprosthetic fractures of the femur, those between an ipsilateral hip and knee arthroplasty, are challenging to treat secondary to limited bone available for fixation, osteopenic bone, a compromised intramedullary blood supply, and an often elderly patient population. From 2002 to 2006, 22 consecutive patients with an interprosthetic femur fracture were treated with a single-locking plate. Follow-up averaged 17.7 months, with fracture union achieved an average of 13.8 weeks postoperatively. All patients regained their preoperative ambulatory status and subjectively reported unchanged function of their hip and knee arthroplasties. Single-locked plating is an effective method of treatment of interprosthetic fractures of the femur. Emphasis on preservation of the soft tissue envelope and sufficient cortical purchase both above and below the fracture is of paramount importance.
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Sim JA, Lee BK, Kwak JH, Moon SH. Knee arthrodesis in failed total knee arthroplasty with severe osteolysis and ipsilateral long-stem total hip arthroplasty. J Arthroplasty 2009; 24:322.e19-22. [PMID: 18534416 DOI: 10.1016/j.arth.2007.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 12/11/2007] [Indexed: 02/01/2023] Open
Abstract
We report a case of knee fusion after a failed total knee arthroplasty (TKA) with severe osteolysis including the epicondyle and ipsilateral total hip arthroplasty (THA) with long Wagner revision stem (Sulzer Orthopedics, Baar, Switzerland). The conventional devices for arthrodesis were unavailable in this case because of the long Wagner revision stem and poor bone stock. A connector was made between the long Wagner revision stem and an intramedullary nail (IM nail; Solco, Seoul, Korea). The custom-made connector was coupled with a femoral stem by cylindrical taper fit with additional cement augmentation and an intramedullary nail by screws. Osseous fusion was achieved without pain or instability.
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Affiliation(s)
- Jae Ang Sim
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University, Incheon, South Korea
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Sherman SL, Cunneen KP, Walcott-Sapp S, Brause B, Westrich GH. Custom total femur spacer and second-stage total femur arthroplasty as a novel approach to infection and periprosthetic fracture. J Arthroplasty 2008; 23:781-6. [PMID: 18534389 DOI: 10.1016/j.arth.2007.05.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 05/18/2007] [Indexed: 02/08/2023] Open
Abstract
Total femur arthroplasty procedures have previously been used after tumor excision and as a last resort for failed revision arthroplasty. The patient in this case presented with massive loss of femoral bone stock, a periprosthetic fracture, and recurrent Staphylococcus epidermidis infection. A specially designed total femoral spacer impregnated with antibiotics was created for a 2-stage revision procedure that successfully restored functional ability and eradicated the infection. Although 2-stage protocols with spacers have been used to treat persistent infections after hip and knee arthroplasty, this is the first reported instance of the creation of a total femur antibiotic-impregnated cement spacer and subsequent total femoral arthroplasty as a 2-stage protocol at our institution.
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Affiliation(s)
- Seth L Sherman
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA
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