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Total femoral allograft with simultaneous revision total hip and knee arthroplasty: 18 year follow-up.

ABSTRACT: Massive allograft can be a useful option in revision total joint arthroplasty for treatment of significant bone loss. In rare cases, revision hip and knee arthroplasty procedures can be performed simultaneously using massive allograft-prosthetic composites. We present an 18 year follow up of a patient who received a simultaneous revision hip and knee total femoral allograft and discuss recent literature as it relates to this case.

SUBMITTER: Harris RN

PROVIDER: S-EPMC4956687 | biostudies-literature | 2015 Sep

REPOSITORIES: biostudies-literature

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Total femoral allograft with simultaneous revision total hip and knee arthroplasty: 18 year follow-up.

Harris Ryan N RN Owen Trevor M TM Moskal Joseph T JT

Arthroplasty today 20150828 3

Massive allograft can be a useful option in revision total joint arthroplasty for treatment of significant bone loss. In rare cases, revision hip and knee arthroplasty procedures can be performed simultaneously using massive allograft-prosthetic composites. We present an 18 year follow up of a patient who received a simultaneous revision hip and knee total femoral allograft and discuss recent literature as it relates to this case. ...[more]

PMID: 28326372

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Left Profunda Femoral Artery Pseudoaneurysm After Revision Total Hip Arthroplasty.

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Revision total hip arthroplasty using the Zweymuller femoral stem.

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Removing a well-fixed femoral sleeve during revision total knee arthroplasty.

Project description:The following surgical technique describes a case of a 51-year-old man with severe juvenile rheumatoid arthritis that required a 2-stage revision of an infected revision total knee implant. The patient had previously been implanted with a revision rotating platform, constrained condylar device which gained excellent fixation through the use of diaphyseal-engaging stems, and a well-ingrown, fully porous-coated femoral metaphyseal sleeve. To avoid intraoperative complications while removing the femoral sleeve, a novel technique for femoral sleeve extraction was used. Using this technique, the femoral sleeve was successfully removed without intraoperative fracture or substantial bone loss.

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| S-EPMC5833041 | biostudies-literature

A novel, multi-level approach to assess allograft incorporation in revision total hip arthroplasty.

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Early femoral condyle insufficiency fractures after total knee arthroplasty: treatment with delayed surgery and femoral component revision.

Project description:Background:Periprosthetic fracture following total knee arthroplasty (TKA) is usually associated with a traumatic event and typically treated with fracture fixation techniques. However, we report on a series of patients with early atraumatic condyle fractures that occurred as a result of insufficiency of the unloaded preoperative femoral condyle treated with delayed reconstruction. Methods:We retrospectively reviewed a series of 7 patients who sustained femoral condyle fractures following TKA and evaluated risk factors for insufficiency. Results:There were 6 females and 1 male with an average age of 65.5 (range, 63-75) years and an average body mass index of 29.4 (range, 27-32). Fracture occurred on average 24.9 days from the index surgery and secondary to a low energy mechanism. Five patients had valgus alignment (mean, 15.2°) preoperatively and sustained fracture of the unloaded medial femoral condyle. Two patients had varus alignment (mean, 7.0°) preoperatively and both fractured the unloaded lateral condyle. One patient underwent early intervention requiring distal femoral replacement secondary to femoral bone loss. The remaining 6 patients underwent delayed surgery for an average of 6 weeks to allow for fracture healing followed by femoral component revision. At last follow-up (average, 48.5 months), 1 patient required a tibial component revision; however, no revision of the femoral component was required. Conclusions:Early femoral condyle insufficiency fractures following TKA may be a risk in females with poor bone quality and preoperative valgus alignment. Delayed surgery and femoral component revision is a treatment strategy that prevented the need for other tertiary reconstruction.

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Sister, Sister! Siblings With Simultaneous Early Femoral Insufficiency Fractures After Total Knee Arthroplasty.

Project description:Early periprosthetic fractures after total knee arthroplasty are rare but devastating complications which require revision surgery and lead to poor patient satisfaction. We present 2 siblings who underwent primary total knee arthroplasty on the same day and then both presented 2 weeks after surgery with atraumatic periprosthetic femur fractures. The first patient underwent revision for a cemented distal femoral replacement with stemmed tibial fixation. The second patient underwent an isolated femoral component revision with a stemmed femoral component and distal augment. Histological evaluation identified significant peri-implant osteoporosis. The variation in complexity associated with early periprosthetic femoral insufficiency fractures is highlighted by these 2 cases. Surgeons may consider using stemmed femoral components in similar patients if poor distal femoral bone stock is encountered intraoperatively.

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Early outcomes after revision total hip arthroplasty with a modern modular femoral revision stem in 65 consecutive cases.

Project description:BackgroundWe evaluated the early outcomes, including all-cause revisions, aseptic revisions, and reoperations after revision total hip arthroplasty (THA) using a single modern modular femoral stem design.MethodsA retrospective cohort study on a consecutive series of 62 patients (65 hips) who underwent revision THA with a modern modular femoral stem system, between January 2011 and October 2015, at a single academic medical center was performed. A cumulative incidence competing risk model was used to evaluate the cumulative incidence of failure with death as the competing risk.ResultsThe cumulative incidence rate of all-cause revision THA was 14.5% (95% confidence interval [CI], 6%-24%) at 2 years when accounting for the competing risk of death. The rate of aseptic revisions was 6.8% (95% CI, 0.1%-13%), and the rate of all-cause reoperations was 21.6% (95% CI, 11%-31%). Ten THA cases (15%) underwent re-revision THA for any reason: five for infection and five for aseptic failures. The mean time to re-revision was 1 year (range, 0.04-5.34). Patients with a preoperative Mallory classification of 3 or more were at greater risk for reoperation (sub-hazard rate, 3.84; 95% CI, 1.54-9.53; P = .004).ConclusionsAlthough the high incidence of reoperation illustrates the complexity of the revision THA population, particularly related to infection and joint instability, the relatively low rate of aseptic failures, minimal radiographic subsidence, and the lack of modular junctional failures suggest that the use of this modular revision THA system may provide adequate fixation and could be considered as a viable treatment option in the setting of revision THA.

| S-EPMC6470366 | biostudies-literature

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