Femoral defects in revision hip arthroplasty: a therapy-oriented classification

Jaenisch, Max; Kohlhof, Hendrik; Kasapovic, Adnan; Gathen, Martin; Randau, Thomas M.; Kabir, Koroush; Roessler, Philip P.; Pagenstert, Geert; Wirtz, Dieter Christian

doi:10.1007/s00402-021-04201-7

Cited by 10 publications

(4 citation statements)

References 47 publications

(63 reference statements)

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“…In 2023, a new FDC was published by the group Jaenisch et al ( 13 ). The FDC is based on the analysis of the integrity of the main femoral segments which determine function and structural support.…”

Section: Discussionmentioning

confidence: 99%

Proximal femoral defect classifications in revision total hip arthroplasty from X-rays imaging to advanced 3D imaging: a narrative review

Marongiu,

Leinardi,

Antuofermo

et al. 2024

Ann Joint

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Background and Objective Femoral bone defect in hip arthroplasty revision surgery represents a complex problem, and the treatment is a challenge for orthopedic surgeons called to assess the residual bone stock in an altered anatomy and obtain stability for the new implant. Classification systems available are mostly based on X-rays two-dimensional images and lack of accuracy and reproducibility and comprehensive therapeutic algorithms. However, there is no record of any classification based on computed tomography (CT)-scan images or three-dimensional (3D) modeling modern techniques. We aimed to review the current literature around femoral defect classifications (FDCs) analyzing their different rationale basis, reliability and accuracy, and their benefit in clinical practice. Moreover, we highlighted the role of CT scan-based 3D modeling techniques in the setting of femoral bone defects and revision hip arthroplasty. Methods A narrative review was conducted. The articles were selected from the PubMed and Scopus medical database updated to March 2023. All Level-I to IV studies in the English language were considered for inclusion. The research was performed using relevant search term items: “femoral defects”, “classification”, “radiographic”, “revision hip arthroplasty”, “CT scan” and “3D” and we included only articles that evaluated the accuracy or reliability (or both) of the different femoral bone defects classification system. Key Content and Findings Our search yielded 408 results, of which 17 were deemed highly relevant. We found seven X-ray-based classification systems which have been attempted to quantify the degree of bone loss with low to good reproducibility. The most used classification system for femoral bone defects were the AAOS and Paprosky classification, which also offers a clinical therapeutic algorithm. In 2021, the FDC interestingly showed a new simple classification system with sub-optimal reproducibility and a practical therapeutic algorithm. Despite the numerous classification system of femoral defects, none of them comprehends the use of CT scan and 3D imaging technologies. Conclusions Traditional X-rays-based classification system are still widely used event if their intra-observer and inter-observer reliability is sub-optimal. 3D modeling techniques represent an important diagnostic tool that could improve the understanding of bone defects and residual bone supportive structures, allowing to elaborate new, more precise, classification systems.

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Section: Discussionmentioning

confidence: 99%

Proximal femoral defect classifications in revision total hip arthroplasty from X-rays imaging to advanced 3D imaging: a narrative review

Marongiu,

Leinardi,

Antuofermo

et al. 2024

Ann Joint

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“…With rising health-care costs and limited financial resources, the economics of THA in the elderly population have been an increasing focus among science and policymakers 22,23 . Postoperative complications due to preexisting comorbidities have been shown to be associated with longer inpatient stay, higher readmission rates, and, thus, substantial treatment costs, which further emphasizes the importance of detailed preparation of individual patients and, thus, avoidance of postoperative complications 17,24 . This was partially reflected in our data, as older patient groups, who more frequently had comorbidities, had significantly longer inpatient stays than younger patients.…”

Section: Discussionmentioning

confidence: 99%

Is Elective Total Hip Arthroplasty Safe in Nonagenarians?

Leopold,

Krull,

Hardt

et al. 2023

Journal of Bone and Joint Surgery

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Background: An increasing number of elderly patients are becoming candidates for elective total hip arthroplasty (THA). Conflicting results exist with regard to the safety of THA in nonagenarians. The aims of this study were to evaluate postoperative mortality and morbidity after THA in nonagenarians and underlying risk factors. We hypothesized that nonagenarians undergoing elective THA would show higher morbidity than younger patients and higher mortality than nonagenarians in the general population. Methods: This was an observational cohort study using data from the German Arthroplasty Registry (Endoprothesenregister Deutschland [EPRD]). Of 323,129 THAs, 263,967 (including 1,859 performed on nonagenarians) were eligible. The mean follow-up (and standard deviation) was 1,070 ± 641 days (range, 0 to 3,060 days). The exclusion criteria were age of <60 years at admission and nonelective THAs or hemiarthroplasties. The cohort was divided into 4 age groups: (1) 60 to 69 years, (2) 70 to 79 years, (3) 80 to 89 years, and (4) ≥90 years. Comorbidities representing independent risk factors for postoperative complications and mortality were identified via a logistic regression model. Mortality rates were compared with those from the general population with data from the Federal Statistical Office. The end points of interest were postoperative major complications, minor complications, and mortality. Results: Among the greatest risk factors for major and minor complications and mortality were congestive heart failure, pulmonary circulation disorders, insulin-dependent diabetes, renal failure, coagulopathy, and fluid and electrolyte disorders. Compared with younger groups, the risks of major and minor complications and mortality were significantly higher in nonagenarians. Mortality increased when major complications occurred. After 1 year, the survival rate in patients without a major complication was 94.4% compared with 79.8% in patients with a major complication. The mortality rates of nonagenarians in the study population were lower than those in the corresponding age group of the general population. The 1-year mortality rates at 90 years of age were 10.5% for men and 6.4% for women within the study group compared with 18.5% for men and 14.7% for women among the general population. Conclusions: Comorbidities favor the occurrence of complications after elective THA in nonagenarians and thus increase postoperative morbidity. In the case of complications, mortality is also increased. The fact that mortality is still lower than within the general population shows that this aspect can be controlled by careful patient selection and adequate preparation. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…Bei den zementfreien Schäften ist darauf zu achten, dass ein möglichst weitreichender Knochenkontakt besteht. In der Literatur werden Strecken von 5-7 cm, mindestens aber 3 cm empfohlen [13]. Berücksichtigt werden muss dabei allerdings, dass jede Konusverbindung ein Frakturrisiko mit sich bringt.…”

Section: Take Home Messageunclassified

“…Wenn immer möglich, sollte nicht nur bei den zementierten Schäften, sondern auch bei den zementfreien Schäften versucht werden, durch Knochenunterfütterung bzw. Impaction Bone Grafting ein sogenanntes Biological Downgrading zu ermöglichen, um nicht nur die Verankerung, sondern auch den langfristigen Knochenerhalt zu verbessern [13].…”

Section: Take Home Messageunclassified