High Rates of Spacer Fracture in the Setting of Extended Trochanteric Osteotomy With a Specific Thin-Core Articulating Antibiotic Hip Spacer

Lancaster, Alex; Carlson, V. R.; Pelt, Christopher E.; Anderson, Lucas A.; Peters, Christopher L.; Gililland, Jeremy M.

doi:10.1016/j.arth.2021.01.086

Cited by 9 publications

(9 citation statements)

References 16 publications

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“…After the exclusion of duplicates, 132 studies were examined. After title and abstract screening, 21 clinical studies were assessed for fulltext evaluation, and nine clinical studies [7][8][9][13][14][15][16][17][18] that met the inclusion criteria were finally included in this systematic review. The bibliography of each article was crosschecked to find other relevant publications for inclusion in the current study.…”

Section: Search Strategy and Study Screeningmentioning

confidence: 99%

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Extended trochanteric osteotomy is a safe procedure in two-stage hip revision: a systematic review of the literature

Cacciola

Giustra

Bosco

et al. 2023

Eur J Orthop Surg Traumatol

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Background Extended trochanteric osteotomy (ETO) has proved to be an effective technique in complicated stem removal in femoral aseptic loosening or periprosthetic fracture. Debate remains about its safety in periprosthetic joint infection (PJI). The primary aim of this study is to analyze the ETO reinfection and union rate in two-stage hip revision. Material and methods A systematic literature review was performed regarding all studies reporting ETO outcomes in the two-stage revision for hip PJI up to October 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. A literature search was conducted in the following databases: MEDLINE/EMBASE, Scopus, Web of Science, and Cochrane. Quality assessment of the articles was performed using the Methodological Index for Non-Randomized Studies. This systematic review was registered in the International Prospective Registry of Systematic Reviews. Patient demographic, clinical, and surgical data were collected. Results This systematic review included and analyzed nine clinical studies with a total of 382 ETO PJI hips in two-stage revision. The overall ETO reinfection rate was 8.9% (34 hips), consistent with the reinfection rate after two-stage revision in patients without ETO. The overall ETO union rate was 94.8% (347 hips), comparable to the ETO union rate in non-septic patients. Compared between a group of patients with ETO PJI and a group of patients with non-PJI ETO, there were no significant differences in postoperative complications, both septic and aseptic, and for postoperative HHS. Conclusion ETO proved to be a safe and effective procedure in PJI revisions. It may be a viable option in challenging femoral stem removal during the two-stage hip revision in PJI. Level of evidence IV.

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Section: Search Strategy and Study Screeningmentioning

confidence: 99%

“…A mean ETO union time after a twostage revision for PJI of the hip of 12 (10.6-15.6) weeks was reported. All nine studies [7][8][9][13][14][15][16][17][18] reported the postoperative ETO reinfection rate in the setting of a twostage revision for hip PJI. The overall reinfection rate was 8.9%.…”

Section: Rate and Time Of Union And Reinfection Rate Of Etomentioning

confidence: 99%

Extended trochanteric osteotomy is a safe procedure in two-stage hip revision: a systematic review of the literature

Cacciola

Giustra

Bosco

et al. 2023

Eur J Orthop Surg Traumatol

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“…Antibiotic-coated prostheses (ACP), such as Zimmer-Biomet Stage One Select Femoral Spacer (ZBSO) used in stage-1 revision surgery in the setting of ETO like moulded or hand-made spacers have high rate of spacer fracture, with ACP spacer fracture rate being at 25% due to its thin core, compared to a rate of 2.4% without ETO. This implant should be used with caution with an ETO, and an alternative ACP should be considered when performing ETO [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Extended trochanteric osteotomy in revision hip arthroplasty: a case series study and systematic literature review

Hamad¹,

Konan²

2022

Arthroplasty

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Background Extended trochanteric osteotomy (ETO) in revision hip arthroplasty provides direct access to the femoral medullary canal and facilitates removal of implants and re-implantation. This study looks at objective outcomes of ETO from a systematic review of the literature and a case series of revision total hip arthroplasty (THA) cases with ETOs from the authors’ local institution. Methods (1) The National Institutes of Health (NIH) national library of medicine was searched for studies related to ETO and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) technique were followed. (2) Case series of 23 revision THAs with ETOs from University College London Hospital (UCLH) were retrospectively analyzed with a minimum of 2-year follow-up for radiological outcomes. Results (1) The main revision THAs diagnoses were aseptic loosening (880/1,386; 63.4%), prosthetic joint infection (PJI) (301/1,386; 21.7%) and periprosthetic THA fractures (78/1,386; 5.6%). Other diagnoses, including non-specified reasons for THA revision in the chosen studies, accounted for 9.2% (127/1,386). The total mean was a union rate of 95.2%, an infection eradication rate of 91.6%, a femoral stem subsidence rate of 16.6%, with the rate of subsidence more than 5 mm being 10.7%. ETO proximal migration was reported in 7.8% of ETOs; however, it rarely required re-attachment (0.9%). Intraoperative fracture during revision THA with ETO was reported to be at a rate of 5%; while postoperative femoral fracture rate was at 7.8%. (2) All 24 cases had radiographic union at 3 to 6 months and there was no reported femoral stem subsidence. Conclusion The overall outcome of this literature review provides moderate-quality evidence indicating that ETO provides safe outcome for revision THAs in single and 2-stage revision surgeries with low ETO non-union, femoral stem subsidence, greater trochanter (GT) proximal migration and fracture rates in the different diagnoses groups of revision THA at over 2-year follow up. In the case series group, there was radiographic union of all ETOs with no reported femoral stem subsidence or periprosthetic fractures.

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“…The main rationale for performing ETOs without spacers is to mitigate the high risk of spacer-associated complications, with reported rates of up to 25% [ 18 , 19 , 20 , 21 , 22 , 29 ]. In our series, only one patient (3%) with ETO required revision for a fracture in the interim period.…”

Section: Discussionmentioning

confidence: 99%

“…The use of ETO in two-stage revision for infected total hip arthroplasty (THA) has shown excellent union rates and comparable infection-free survival rates [ 18 , 19 , 20 , 21 , 22 ]. However, in the setting of ETO and/or bone loss, spacer-associated complications such as spacer dislocation, spacer migration, spacer breakage and femur fracture are not uncommon [ 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Therefore, we performed ETOs in cases with bone defects and/or abductor deficiency without interim spacers to avoid such complications.…”

Section: Introductionmentioning

confidence: 99%

Extended Trochanteric Osteotomy with Intermediate Resection Arthroplasty Is Safe for Use in Two-Stage Revision Total Hip Arthroplasty for Infection

Hardt

Leopold

Khakzad

et al. 2021

JCM

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Background: This study sought to compare the results of two-stage revision total hip arthroplasty (THA) for periprosthetic infection (PJI) in patients with and without the use of an extended trochanteric osteotomy (ETO) for removal of a well-fixed femoral stem or cement. Methods: Thirty-two patients who had undergone an ETO as part of a two-stage revision without spacer placement were matched 1:2 with a cohort of sixty-four patients of the same sex and age who had stem removal without any osteotomy. Clinical outcomes including interim revision, reinfection and aseptic failure rates were evaluated. Modified Harris hip scores (mHHS) were calculated. Minimum follow-up was two years. Results: Patients undergoing ETO had a significantly lower rate of interim re-debridement compared to non-ETO patients (0% vs. 14.1%, p = 0.026). Reinfection following reimplantation was similar in both groups (12.5% in ETO patients vs. 9.4% in non-ETO patients, p = 0.365). Revision for aseptic reason was necessary in 12.5% in the ETO group and 14.1% in the non-ETO group (p = 0.833). Periprosthetic femoral fractures were seen in three patients (3.1%), of which all occurred in non-ETO patients. Dislocation was the most common complication, which was equally distributed in both groups (12.5%). The mean mHHS was 37.7 in the ETO group and 37.3 in the non-ETO group, and these scores improved significantly in both groups following reimplantation (p < 0.01). Conclusion: ETO without the use of spacer is a safe and effective method to manage patients with well-fixed femoral stems and for thorough cement removal in two-stage revision THA for PJI. While it might reduce the rate of repeated debridement in the interim period, the use of ETO appears to lead to similar reinfection rates following reimplantation.

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High Rates of Spacer Fracture in the Setting of Extended Trochanteric Osteotomy With a Specific Thin-Core Articulating Antibiotic Hip Spacer

Cited by 9 publications

References 16 publications

Extended trochanteric osteotomy is a safe procedure in two-stage hip revision: a systematic review of the literature

Extended trochanteric osteotomy is a safe procedure in two-stage hip revision: a systematic review of the literature

Extended trochanteric osteotomy in revision hip arthroplasty: a case series study and systematic literature review

Extended Trochanteric Osteotomy with Intermediate Resection Arthroplasty Is Safe for Use in Two-Stage Revision Total Hip Arthroplasty for Infection

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