Revision total hip arthroplasty after removal of a fractured well-fixed extensively porouscoated femoral component using a trephine

D. F. Amanatullah, H. Siman, G. D. Pallante, D. B. Haber, R. J. Sierra, R. T. Trousdale

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1192-1196
Number of pages5
JournalBone and Joint Journal
Volume97-B
Issue number9
DOIs
StatePublished - Sep 1 2015

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Thigh
Arthroplasty
Hip
Osteotomy
Necrosis
Bone and Bones

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery
  • Medicine(all)

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Revision total hip arthroplasty after removal of a fractured well-fixed extensively porouscoated femoral component using a trephine. / Amanatullah, D. F.; Siman, H.; Pallante, G. D.; Haber, D. B.; Sierra, R. J.; Trousdale, R. T.

In: Bone and Joint Journal, Vol. 97-B, No. 9, 01.09.2015, p. 1192-1196.

Research output: Contribution to journalArticle

Amanatullah, D. F. ; Siman, H. ; Pallante, G. D. ; Haber, D. B. ; Sierra, R. J. ; Trousdale, R. T. / Revision total hip arthroplasty after removal of a fractured well-fixed extensively porouscoated femoral component using a trephine. In: Bone and Joint Journal. 2015 ; Vol. 97-B, No. 9. pp. 1192-1196.
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abstract = "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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