A new classification for proximal femur bone defects in conservative hip arthroplasty revisions
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In the last three decades, total hip replacement in young patient became a habitual procedure.
Principles of bone preservation are pushing many surgeons to implant conservative femoral components in patient younger than 65 years. Despite an overall good survivorship and clinical outcomes of conservative implants, failed cases are reported and the need to revise a conservative femoral component became an occasional procedure (with high prevalence of failed resurfacing implants).
During conservative femoral component revisions, we analyzed proximal bone stock preservation, considering the type of original component removed, etiology of failure, timing of revision, and femoral explantation technique.
We identified four patterns of proximal femoral changes (types I–IV). We suggest, for each of them, a revision strategy directed toward a “conservative revision procedure” using conservative or primary component. Out of our 21 cases, none underwent further revision due to mechanical failure (follow-up ranging from 6 to 152 months, mean 54 months). We had two case of re-operation: one for early septic loosening and one for prosthetic modular neck fracture.
If literature offers well-established guidelines to femoral revision of conventional stems, there is, on the other hand, a lack of data about revision strategies in presence of failed conservative implants. Although the mean follow-up of our procedures is still too short (4.5 years) to give final conclusions, we would leave a message: a conservative hip arthroplasty is not a “one-time” opportunity for young and active people. A “conservative revision” is a valid option for at least a part of them, when an early failure of primary procedure occurred.
KeywordsTotal hip replacement Hip revision Arthroplasty Conservative
- 11.Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27Google Scholar
- 12.Amstuz HC, Campbell PA, Le Duff MJ. (2004) Fracture of the neck of the femur after surface arthroplasty of the hip. J Bone Joint Surg 86A (9); 1874–1877Google Scholar
- 13.Indelli PF, Vail TP, Dominguez D, Pickering T. (2005) Resurfacing hip replacement: surgical technique and clinical results with minimum 1-year follow-up. Paper presented at 90th Nation Congress of Italian Orthopaedic and Traumatologic Society. 9-13th of October 2005Google Scholar
- 14.Li D, Hu Q, Kang P, Yang J, Zhou Z, Shen B, Pei F. (2018) Reconstructed the bone stock after femoral bone loss in Vancouver B3 periprosthetic femoral fractures using cortical strut allograft and impacted cancellous allograft. Int Orthop doi: https://doi.org/10.1007/s00264-018-3997-5 CrossRefGoogle Scholar
- 16.Cavagnaro L, Formica M, Basso M, Zanirato A, Divano S, Felli L (2018) Femoral revision with primary cementless stem: a systemic review of the literature. Muscoloskelet Surg 102(1):1–9Google Scholar