Risk of periprosthetic femur fracture after anterior cortical bone windowing: a mechanical analysis of short versus long cemented stems in pigs.

Background And Purpose: Removal of distal cement at femoral implant revision is technically challenging and is associated with complications such as cortical perforations. A technique that can reduce the risks and operating time is to make a small cortical window in the distal femur for enhanced access. We wanted to determine whether the use of long, bridging, cemented femoral stems is necessary to reduce the risk of postoperative periprosthetic fractures after using an anterior cortical bone window.

Revision total knee arthroplasty: clinical outcome comparison with and without the use of femoral head structural allograft.

The use of femoral head structural allograft (FHSA) for the management of massive bony defects during revision total knee arthroplasty (TKA) is well documented in the literature. The purpose of this study was to compare the clinical outcomes of patients undergoing revision (TKA) with FHSA to those without. All patients undergoing revision TKA between January 2000 and August 2005 were reviewed.

Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection?

Background: Methicillin-resistant hip infections are increasingly common. Reports of the surgical management of these patients using two-stage THA show variable control of infection, but all reports used static spacers.

Questions/purposes: We therefore determined (1) the rate of successful control of infection and (2) function in patients with methicillin-resistant infection treated with a two-stage THA using an articulated cement spacer during the first stage.

Cement-in-cement femoral revision for the treatment of highly selected vancouver B2 periprosthetic fractures.

The use of the cement-in-cement technique for femoral component revisions has been well described. The application of this technique in the management of selected Vancouver B2 periprosthetic femur fractures, after careful preoperative and intraoperative evaluation, offers a novel alternative that is rapid and technically less demanding, with resulting decreased blood loss and decreased risk of iatrogenic fragmentation of bone during cement removal.

Conversion of hip arthrodesis to total hip arthroplasty: survivorship and clinical outcome.

This study evaluated survivorship and clinical outcomes of patients undergoing conversion of a hip arthrodesis to a total hip arthroplasty (THA) and compared them to 2 patient cohorts: primary THA and first-time revision THA. Patients completed 5 standardized outcome questionnaires. The study cohort was compared to matched groups of primary THA and first-time revision THA patients.

Femoral revision hip arthroplasty: a comparison of two stem designs.

Unlabelled: For various reasons the tapered, fluted, modular titanium (TFMT) stem has become our component of choice over cylindrical, nonmodular cobalt chrome (CNCC) components for THA revision. We therefore asked whether the TFMT femoral components better achieved three important goals of revision arthroplasty than CNCC stems: (1) improving quality of life; (2) avoiding complications; and (3) preserving or restoring femoral bone stock. We compared patients undergoing femoral component revision hip arthroplasty with either a CNCC (N = 105) component or a TFMT (N = 95) component to determine if the increased use of TFMT components is justified.

Vancouver type B3 periprosthetic fractures: evaluation and treatment.

Periprosthetic fracture with preexisting severe loss of bone stock is a challenging condition to treat. Available surgical options can be divided into three categories: complex reconstruction of the deficient proximal femur with secure distal fixation; segmental substitution of the proximal femur with a megaprosthesis or allograft/stem composite; and distally fixed replacement with a modular stem, which acts as a scaffold around which the remaining deficient proximal bone can be assembled, to unite and possibly reconstitute.

Severe femoral bone loss in infected total hip arthroplasty: surgical management.

The management of severe bone loss in a patient with a chronically infected total hip arthroplasty is a complex surgical challenge. The surgical alternatives are numerous and include the use of allografts, both structural and morcellized; cemented and cementless femoral components; and segmental replacement megaprostheses.

Distally fixed scaffold technique for the management of Vancouver B3 periprosthetic fractures.

Periprosthetic femoral fractures with associated severe bone loss are challenging problems to treat. High failure rates are reported throughout the literature for the various surgical options. The novel distally fixed scaffold technique is a rapid procedure with reduced blood loss and high versatility that allows early mobilization.

Risk of periprosthetic femoral neck fracture after hip resurfacing arthroplasty: valgus compared with anatomic alignment. A biomechanical and clinical analysis.

Background: Early clinical results of hip resurfacing arthroplasty have led to the recommendation to achieve a neck-shaft angle of 140 degrees when inserting the femoral component. In addition, the idea of adhering to an absolute angle when inserting instrumentation in hips with excessive anatomic varus or valgus neck-shaft angles has raised concern. A biomechanical analysis was completed in order to determine if the achieved valgus orientation of the femoral component reduced the risk of periprosthetic fracture.

Surgical nuances to minimize muscle damage during the anterolateral intermuscular approach in minimally invasive hip replacement.

Muscle damage that can occur during minimally invasive total hip replacement is an important concern. Minimizing this iatrogenic injury can help achieve the goals of the minimally invasive approach: decreased postoperative pain, decreased blood loss, and faster rehabilitation. Knowledge of particular aspects of minimally invasive anterolateral total hip arthroplasty is important, with focus on the nuances that aid in reducing muscle injury.