TY - JOUR
T1 - Revision total hip arthroplasty after removal of a fractured well-fixed extensively porouscoated femoral component using a trephine
AU - Amanatullah, D. F.
AU - Siman, H.
AU - Pallante, G. D.
AU - Haber, D. B.
AU - Sierra, R. J.
AU - Trousdale, R. T.
N1 - Publisher Copyright:
© 2015 The British Editorial Society of Bone & Joint Surgery.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - When fracture of an extensively porous-coated femoral component occurs, its removal at revision total hip arthroplasty (THA) may require a femoral osteotomy and the use of a trephine. The remaining cortical bone after using the trephine may develop thermally induced necrosis. A retrospective review identified 11 fractured, well-fixed, uncemented, extensively porous-coated femoral components requiring removal using a trephine with a minimum of two years of follow-up. The mean time to failure was 4.6 years (1.7 to 9.1, standard deviation (SD) 2.3). These were revised using a larger extensively porous coated component, fluted tapered modular component, a proximally coated modular component, or a proximal femoral replacement. The mean clinical follow-up after revision THA was 4.9 years (2 to 22, SD 3.1). The mean diameter of the femoral component increased from 12.7 mm (SD 1.9) to 16.2 mm (SD 3.4; p > 0.001). Two revision components had radiographic evidence of subsidence that remained radiographically stable at final follow-up. The most common post-operative complication was instability affecting six patients (54.5%) on at least one occasion. A total of four patients (36.4%) required further revision: three for instability and one for fracture of the revision component. There was no statistically significant difference in the mean Harris hip score before implant fracture (82.4; SD 18.3) and after trephine removal and revision THA (81.2; SD 14.8, p = 0.918). These findings suggest that removal of a fractured, well-fixed, uncemented, extensively porous-coated femoral component using a trephine does not compromise subsequent fixation at revision THA and the patient's pre-operative level of function can be restored. However, the loss of proximal bone stock before revision may be associated with a high rate of dislocation post-operatively.
AB - When fracture of an extensively porous-coated femoral component occurs, its removal at revision total hip arthroplasty (THA) may require a femoral osteotomy and the use of a trephine. The remaining cortical bone after using the trephine may develop thermally induced necrosis. A retrospective review identified 11 fractured, well-fixed, uncemented, extensively porous-coated femoral components requiring removal using a trephine with a minimum of two years of follow-up. The mean time to failure was 4.6 years (1.7 to 9.1, standard deviation (SD) 2.3). These were revised using a larger extensively porous coated component, fluted tapered modular component, a proximally coated modular component, or a proximal femoral replacement. The mean clinical follow-up after revision THA was 4.9 years (2 to 22, SD 3.1). The mean diameter of the femoral component increased from 12.7 mm (SD 1.9) to 16.2 mm (SD 3.4; p > 0.001). Two revision components had radiographic evidence of subsidence that remained radiographically stable at final follow-up. The most common post-operative complication was instability affecting six patients (54.5%) on at least one occasion. A total of four patients (36.4%) required further revision: three for instability and one for fracture of the revision component. There was no statistically significant difference in the mean Harris hip score before implant fracture (82.4; SD 18.3) and after trephine removal and revision THA (81.2; SD 14.8, p = 0.918). These findings suggest that removal of a fractured, well-fixed, uncemented, extensively porous-coated femoral component using a trephine does not compromise subsequent fixation at revision THA and the patient's pre-operative level of function can be restored. However, the loss of proximal bone stock before revision may be associated with a high rate of dislocation post-operatively.
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U2 - 10.1302/0301-620X.97B9.35037
DO - 10.1302/0301-620X.97B9.35037
M3 - Article
C2 - 26330584
AN - SCOPUS:84942514772
SN - 2049-4394
VL - 97-B
SP - 1192
EP - 1196
JO - Bone and Joint Journal
JF - Bone and Joint Journal
IS - 9
ER -