Femoral cement extraction in revision total hip arthroplasty – an in vitro study comparing computer-assisted freehand-navigated cement removal to conventional cement extraction

Mumme, T.; Friedrich, M; Rode, Henrik; Gravius, Sascha; Andereya, S.; Müller-Rath, R.; Fuente, M. de la

doi:10.1515/bmt-2014-0041

Cited by 4 publications

(7 citation statements)

References 10 publications

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“…Therefore, subsidence might be associated with incomplete cement mantle removal or endosteal ischemia due to cementation during primary stem fixation. Mumme et al 18) reported that there is still some difficulty in achieving complete removal of a residual well-fixed cement mantle, showing a mean value of 1.6 ± 0.4 mm with conventional methods. 19) These remnants of the cement mantle in the intramedullary canal may interrupt on-growth on the stem surface.…”

Section: Discussionmentioning

confidence: 99%

Does the Periprosthetic Fracture Pattern Depend on the Stem Fixation Method in Total Hip Arthroplasty?

2023

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Background Management of periprosthetic femoral fractures (PFFs) is reportedly challenging. Different patterns of PFFs would occur based on whether stem fixation was primarily cemented or cementless and whether these patterns would be associated with clinical outcomes, such as subsidence, fracture union, and complications, after stem revision. Methods A retrospective comparative study was performed, involving 52 PFF patients treated with tapered fluted modular stems (TFMSs). In the 52 patients with Vancouver B2 or B3, including 21 cemented stems and 31 cementless stems, fracture patterns and bone stock were analyzed. Clinical outcomes after revision surgery using the TFMSs were compared between the two groups. Results Transverse or short oblique type PFFs occurred around the cemented stem with loosening at the bone-cement interface. The Paprosky type III femoral deficiency and Vancouver type B3 fracture were observed more frequently in the cemented stem group. Otherwise, spiral fractures occurred more frequently in the cementless group ( p < 0.001). Excessive subsidence of > 5 mm was observed more frequently in the cemented stem group ( p < 0.001). The re-revision rates were higher in the cemented group than in the cementless group ( p = 0.047). Conclusions In our study, it was found that the patterns of transverse or oblique PFFs were more frequently produced with cemented stems, while long spiral fractures were more frequent with cementless stems. Stem subsidence and reoperation related to complications were more common in patients with PFFs around cemented stems than those with PFFs around cementless stems.

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Section: Discussionmentioning

confidence: 99%

Does the Periprosthetic Fracture Pattern Depend on the Stem Fixation Method in Total Hip Arthroplasty?

2023

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“…Extraction techniques of well-fixed cemented or uncemented RTKA implants can be challenging and are linked with increased risks for complication [40][41][42][43][44][45][46][47]. Ultrasonic methods [48], pneumatic shock wave technology and intramedullary endoscopy (mostly for hip procedures but also for the knee) [49,50] customized guides [51], highpowered drills with centralizers [52], and computer assisted freehand navigations [53] are new technologies and methods for implant removal in revision total knee and hip arthroplasties that aim to reduce complication risks and possibly the need for osteotomies. However, due to several limitations and still missing reliable evidence for the superiority of one or another method, these techniques rely mostly on the individual preference of the surgeon and have not gained enough acceptance until now to prevail on the daily praxis in RTKA.…”

Section: Discussionmentioning

confidence: 99%

Impact of stem profile on the revisability and the need for osteotomy in well-fixed cemented revision total knee arthroplasty implants

Maslaris

Spyrou

Schoeneberg

et al. 2022

Arch Orthop Trauma Surg

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Introduction While re-revision total knee arthroplasty (ReRTKA) steadily increases, the ease and bone-sparing removal of RTKA implants is gaining more and more in importance. Biomechanical data suggest that cemented conical stems can be removed significantly easier than cylindrical stems. However, no clinical evidence exists supporting this observation. Aim of this study was to compare the revisability and need for osteotomy (OT) between removals of well-fixed cemented conical vs. cylindrical RTKA stems. Materials and methods 55 removals of well-fixed full-cemented RTKA stems (29 knees) performed between 2016 and 2018 were retrospectively analyzed. Main outcome variables were: bone loss, fractures, osteotomy incidence, surgery duration, early postoperative complications (EPC), hemoglobin drop and blood transfusion. SPSS was used for the statistical analysis. Results 44.8% were conical, 48.3% cylindrical, and 6.9% combined stem designs. Causes for re-revision were PJI (75.9%), malposition (17.2%) and persistent pain (6.9%). 10 stem removals (18.2%) required an OT (four femoral, six tibial): eight stems (14.5%) had cylindrical and two (3.6%) conical designs (P = 0.041). Fractures were noted solely in removals without OT (11.1% vs. 0%,). There was a tendency to more bone loss in cylindrical stem revisions (53.8% vs. 32%, P = 0.24). A longer overall surgery time was observed in revisions of cylindrical stems (+ 37 min, P = 0.05). There was higher hemoglobin drop and need for blood transfusion in revisions of cylindrical stems or after OT but without reaching statistical significance. The EPC rates were slightly higher in ReRTKA on cylindrical stems (P = 0.28). Conclusion Well-fixed cemented conical stems may be revision friendlier with less demands on OT and shorter overall surgery time than cemented cylindrical stems.

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“…Biplanar setup fluoroscopically guided cement removal in revision total hip arthroplasty have lowered the risk of intraoperative bone injury [10]. A recent publication reported on a new computer-assisted 3D navigation in a reconstruction model [11]. However, studies on the use of conventional cement extraction techniques and employing computed imaging were unable to demonstrate that this resulted in significantly shorter operating times [11,19].…”

Section: Discussionmentioning

confidence: 99%

“…A recent publication reported on a new computer-assisted 3D navigation in a reconstruction model [11]. However, studies on the use of conventional cement extraction techniques and employing computed imaging were unable to demonstrate that this resulted in significantly shorter operating times [11,19]. This may be due to the fact that repeated image converter adjustment under sterile conditions and the poor view in the medullary cavity of the bone all require significant operating time.…”

Section: Discussionmentioning

confidence: 99%

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Thermomechanical method for cement extraction in revision arthroplasty

Ghanem

Köenig

Dehn

et al. 2017

Eur J Orthop Surg Traumatol

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Femoral cement extraction in revision total hip arthroplasty – an in vitro study comparing computer-assisted freehand-navigated cement removal to conventional cement extraction

Abstract: The freehand-navigated cement removal, with the exception of the preparatory examinations, is time saving compared to the conventional method. However, a potential for technical development especially for the milling device and accuracy exist.

Cited by 4 publications

References 10 publications

Does the Periprosthetic Fracture Pattern Depend on the Stem Fixation Method in Total Hip Arthroplasty?

Does the Periprosthetic Fracture Pattern Depend on the Stem Fixation Method in Total Hip Arthroplasty?

Impact of stem profile on the revisability and the need for osteotomy in well-fixed cemented revision total knee arthroplasty implants

Thermomechanical method for cement extraction in revision arthroplasty

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