Cementless Primary or Revision Stem in the First-time Revision Hip Arthroplasty for Aseptic Stem Loosening? A Retrospective Comparative Study.

IntroductionThe use of primary or revision stem during the first-time revision total hip arthroplasty(THA) procedure for aseptic stem loosening remains controversial. The aim of this study was to compare the outcome of patients that underwent revision THA with a primary or revision stem.Materials and MethodsWe retrospectively reviewed 78 patients that received first-time revision THA for aseptic stem loosening using primary(N=28) or revision stems(N=50). The bone defects were classified as Paprosky type I or II. The mean follow-up duration was 72.3±34.7 months. The primary outcome domains included surgical complications and implant failures. The secondary outcome domains included medical complications, 30-day and 90-day readmission, and Harris hip score (HHS).ResultsThe use of revision stem was associated with higher incidence of patient having complications (60.0% vs. 32.1%, p=0.018), including intraoperative femur fracture (28.0% vs. 7.1%, p=0.029) and greater trochanter fracture (16.0% vs. 0%, p=0.045), compared with the use of primary stem. The implant survival was comparable in both groups. HHS at the final follow-up was similar.ConclusionWith a lower risk of surgical complication and similar mid-term implant survival, cementless primary stem might be a better alternative to revision stem in the first-time revision THA for aseptic stem loosening.

Application of a bone conserving revision stem for unstable intertrochanteric fractures in senile osteoporotic population

Purpose Primary hemi-arthroplasty is gaining rising attention to treat unstable intertrochanteric fractures in senile patients with severe osteoporosis. The objective of this study is to evaluate the early clinical and radiographic outcomes using bone conserving revision stem for unstable intertrochanteric fractures in senile osteoporotic population. Methods A retrospective observation of a series of 31 patients with unstable intertrochanteric fractures were conducted. The average age of the patients enrolled was 82.1 years and all patients underwent primary hemi-arthroplasty with the application of bone conserving and fully porous-coated revision stem. Clinical and radiographic evaluations during both the hospital-stay and follow-up were performed. Results The 31 patients were followed up for an average of 23 months postoperatively. The average operation time was 74.2 min while the mean intraoperative blood loss was 200.1 ml, with an average 11.1 g/L decrease of hemoglobulin after the procedure. The mean Harris hip score was 82.1 and visual analog scale was 1.7 at the latest follow-up. No intra-operative or postoperative peri-prosthetic fracture was noted. Postoperative complications included one thrombosis formation in posterior tibial vein and one congestive heart failure, both patients were discharged uneventfully after treatment. Twenty-one (21/31, 67.7%) patients regained their pre-injury walking activities. Radiographically, none of these hips had evident loosening of the stem or osteolysis. With follow-up period of 23 months, the mortality rate was 3.2% (1/31) with no revision required. Conclusion Primary hemi-arthroplasty with application of the bone conserving, cementless revision stem could serve as a reliable alternation in treatment of unstable intertrochanteric fractures in senile population with osteoporosis.

Hip Revision Arthroplasty of Periprosthetic Fractures Vancouver B2 and B3 with a Modular Revision Stem: Short-Term Results and Review of Literature

Background Periprosthetic fractures Vancouver type B2/B3 after total hip arthroplasty (THA) is a challenging entity with increasing numbers. Limited data are available for this type of fracture treated with modular stems. Therefore, this study evaluated the outcome of Vancouver type B2/B3 fractures treated with a modular hip revision stem using a subproximal/distal anchorage and compared it to the current literature. Materials and Methods A consecutive series of periprosthetic Vancouver type B2/B3 fractures treated with a modular revision stem was retrospectively (2013 – 2016) evaluated. Assessment included the clinical (HHS, pain, ROM) as well as the radiological outcome (subsidence, loosening, facture healing). In adddition, the surgical technique is described in detail and results are compared with the current literature. Results A total of 18 patients (female/male 12/6) with Vancouver B2/B3 (n = 12/6) fractures with a mean age of 75.5 (60 – 89) years were included. The revision stem was inserted via a modified transgluteal approach (n = 16) or classical transfemoral approach (n = 2). The mean follow-up was 18.5 months, with a mean Harris Hip Score of 72.5 ± 18.7 (35.0 – 99.0) points. The fracture healing rate was 94.4% (n = 17) with osseous integration according to Engh in all cases. Dislocations of the greater trochanter were recorded in seven patients (38.9%). According to Beals and Towers, all results were rated excellent or good. No implant-related failure or relevant subsidence during this time was observed. Major complications were observed in five patients with two periprosthetic joint infections and two cases of major revision surgery. Conclusion This study assessing Vancouver B2/3 fractures shows reproducible, good, short-term results in terms of subsidence and clinical functional outcome by the use of a modular revision stem. The transfemoral approach together with the modular stem allows for a stable fixation and good fracture healing. However, our data and review of the literature also documents the difficulties and higher complication rate associated with Vancouver B2/3 fractures.