Classifications In Brief: The Paprosky Classification of Femoral Bone Loss

Ibrahim, David A.; Fernando, Navin

doi:10.1007/s11999-016-5012-z

Cited by 40 publications

(27 citation statements)

References 35 publications

(60 reference statements)

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“…Eleven patients (17%) received an acetabular bone graft to fill bone defects (four graded as Paprosky type 2A, 1 as 2B, 4 as 3A, and 2 as 3B). Among them, three also had a femoral allograft (one graded as Paprosky type 1, 1 as 3A, and 1 as 3B) ( 34 , 35 ).…”

Section: Resultsmentioning

confidence: 99%

One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

et al. 2020

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Background: Prosthetic hip infection (PHI) is a disastrous scenario after an arthroplasty. International guidelines contraindicate one-stage exchange arthroplasty for fistulizing chronic prosthetic hip infection (FCPHI), nevertheless few surgical teams, mostly from Europe, support one stage procedure for this indication. Questions/Purposes: Analysis of infection recurrence and implant failure of a series of FCPHIs treated with one stage arthroplasty. Patients and Methods: Sixty-six FCPHIs treated with one-stage exchange arthroplasty were prospectively followed up at least 2 years. Clinical, radiological and bacteriological signs suggestive of reinfection were sought, as well as implant failures and PHI related deaths. Results: Thirty-four females and thirty-two males with median age of 69.5 years [61-77] and BMI of 26 kg/m² [22-31] were included. Fistulae were productive in 50 patients (76%). Staphylococcus was responsible for 45% of PHI and 21% were polymicrobial. Twentynine patients (44%) received preoperative antibiotic therapy. After a median 60-month follow-up [35-82], 3 patients (4.5%) presented reinfection (two new infections, one relapse) and 3 patients experienced implant failure (1 femoral fracture, 1 stem breakage, 1 recurrent dislocation). One death was related to PHI. After a minimum of 2 years, the infection control rate was of 95.3% (±0.02). Conclusion: One-stage exchange arthroplasty for FCPHIs showed a good infection control rate similar to that of non-fistulizing PHI. Systematic preoperative microbiological documentation with joint aspiration and, in some specific cases, the use of preoperative antibiotic therapy are among the optimizations accounting for the success of the one-stage arthroplasty. In light of these results, and those of other studies, international recommendations could evolve. Level of Evidence: Descriptive therapeutic prospective cohort study. Level of evidence: IV.

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Section: Resultsmentioning

confidence: 99%

One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

et al. 2020

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“…Preoperative conventional radiographs were obtained and femoral bone loss was assessed and classified using the Paprosky Index in cases of aseptic loosening [5,30,31]. In 5 cases of loosening combined with a periprosthetic fracture of the femur the Vancouver classification was used [32,33] (Table 2).…”

Section: Plos Onementioning

confidence: 99%

“…PLOS ONE [5,30]. Modular tapered stems for a cementless distal fixation are the preferred method for hip revision surgery in cases of major bone loss [7,22].…”

Section: Plos Onementioning

confidence: 99%

Promising results of revision total hip arthroplasty using a hexagonal, modular, tapered stem in cases of aseptic loosening

et al. 2020

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Background Modular stems are widely used in revision total hip arthroplasty (THA) with aseptic loosening being a common reason for revision. Despite the good results reported on the use of modular stem designs, there are only few studies focusing on aseptic revisions and few studies on a hexagonal stem design. The goal of this study is to determine stem survival, clinical and functional outcome along with possible risk factors for implant failure in aseptic revision THA. Methods We retrospectively identified 53 patients with aseptic THA revision using a modular hexagonal stem with a minimum follow-up of two years. Femoral bone loss, radiographic and clinical outcomes as well as function measured using the Harris Hip Score (HHS) was assessed. Patients' previous medical history was analyzed for comorbidities and the body mass index. Stem survival was calculated using the Kaplan-Meier method. Possible risk factors for implant failure were analyzed using the log-rank test. The median age at revision was 69 (IQR 62-73) with a median follow up of 74 months. Results Implant survival rates amounted to 90.4% at 3 and 5 years. The median HHS improved by 47 points (34 (IQR 22-47) vs 81 (IQR 59-90) p<0.001). There was a reduced implant survival after 5 years when the revision stem was used following a previous cemented stem (83.4% vs 100%, p = 0.04). Conclusion A modular, hexagonal stem can be successfully used in aseptic revision THA with remarkable functional results and excellent survivorship. Revision of a cemented stem using this implant might result in reduced survival which must be considered when planning treatment.

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“…The preoperative bone defect was categorized by the Paprosky classi cation [25] for prosthesis loosening and Vancouver classi cation [26] for peri-prosthetic fracture. Patients whose bone loss classi cation met Paprosky type II, III or IV and Vancouver type B2 or B3 were included.…”

Section: Patientsmentioning

confidence: 99%

Mid- to long-term outcomes of cementless modular, fluted, tapered stem for massive femoral bone loss in revision total hip arthroplasty

Zheng

Zhang

et al. 2020

Preprint

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Abstract Background: Revision total hip arthroplasty is frequently accompanied by bone loss. The purpose of this study is to evaluate mid- to long-term results of revision total hip arthroplasty for massive femoral bone loss using cementless modular, fluted, tapered stems.Methods: During the period of 2007 to 2015 at a single hospital, 34 hips (33 patients) underwent primary revision surgery with cementless modular, fluted, tapered stems due to massive bone loss, and patients with prosthetic joint infection (PJI) or tumours were excluded. The hips were revised with the LINK MP (Waldemar Link, Hamburg, Germany) prosthesis. Bone loss was categorized by the Paprosky classification for prosthesis loosening and Vancouver classification for peri-prosthetic fracture. All revision bearing surfaces were ceramic-on-ceramic (CoC). Clinical outcomes, radiographic outcomes and survivorship were evaluated.Results: The mean follow-up was 9.1±2.5 years (range, 5-13 years). The Harris hip score was 43.6±11.5 preoperatively and maintained at 86.5±6.6 at the time of latest follow-up (p<0. 05). The X-ray showed bone ingrowth fixation in 30 hips (88%), fibrous stable fixation in 3 hips (9%) and instability in 1 hip (3%). The average stem subsidence was 3.9±2.2 mm (range, 1 to 10 mm). The survivorship of prostheses with re-revision for any reason was 95% (95% CI, 12.0 to 13.0) at the 10-year follow-up. Three (9%) re-revisions were needed, including 1 for aseptic loosening, 1 for dislocation and 1 for infection.Conclusions: The mid- to long-term results of revision total hip arthroplasty with the cementless modular, fluted, tapered stem (LINK MP stem) are encouraging for massive femoral bone loss.

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Classifications In Brief: The Paprosky Classification of Femoral Bone Loss

Cited by 40 publications

References 35 publications

One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

Promising results of revision total hip arthroplasty using a hexagonal, modular, tapered stem in cases of aseptic loosening

Mid- to long-term outcomes of cementless modular, fluted, tapered stem for massive femoral bone loss in revision total hip arthroplasty

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