Minimally invasive hollow trephine technique is recommended for revision of broken uncemented and extensively porous-coated monolithic femoral stems: a review of three cases

Abstract

Total hip arthroplasty has been used for almost over five decades as a well-established procedure. Increasing number of revision total hip replacements (THR) due to aseptic and septic complications. [1,2] lead to the design of improved revision prostheses. Distally fixed, cementless, cylindrical femoral stems with an extensive porous coating are one of principal revision options in case of failed THR on the femoral side. These stems have been used in absence of adequate proximal femoral bone stock for over 30 years. [3] Their design enables them to achieve a solid initial diaphyseal fixation. A very stable secondary bone ingrowth occurs along the whole length of the coating. Good distal fixation actually leads to the fracture in the metaphyseo-diaphyseal junction of femoral component, particularly in the presence of proximal femoral bone loss. [4][5][6][7] Fracture of a revised stem is a result of material fatigue, [4,8] after a course without any complaints. Distal bone ingrowth of the prosthesis and present inadequate bone support [9] in the metaphyseal region leads to increased stress of the revision femoral stem. The clinical signs of a stem fracture in intact Kırık, çimentosuz ve aşırı düzeyde poroz kaplamalı femur başlarının revizyonu güçtür. Bu yazıda, çimentosuz ve aşırı düzeyde poroz kaplamalı kırık femur başlarının Solution™ başlar (DePuy, Warsaw, Indiana) ile revizyon cerrahisi uygulanan üç olgu sunuldu. Tüm olgularda femur osteotomisi veya kortikal fenestrasyon olmaksızın, minimal invaziv endofemoral revizyon başarıyla yapıldı. Distal kırık femur başı, skopi altında delikli trepan tekniği ile temizlendi. Femur komponentinin revizyon artroplastisinde daha büyük Solution™ başlar kullanıldı. Endofemoral yaklaşım ameliyat süresini ve kan ve kemik kaybı miktarını azaltır. Kırık ve çimentosuz femur başlarında minimal invaziv teknik önerilmektedir.Anahtar sözcükler: Femur başı; kırık; delikli trepan; poroz kaplamalı; revizyon.Revisions of fractured, uncemented and extensively porous-coated femoral stems are challenging. In this article, we report three cases of revision surgeries for broken, cementless, and extensively porous-coated femoral stems with Solution™ stems (DePuy, Warsaw, Indiana). In all cases, minimally invasive endofemoral revision was successfully performed without femoral osteotomy or cortical fenestration. Removal of distal broken femoral stem was performed with hollow trephine technique under fluoroscopy. For revision arthroplasty of the femoral component, Solution™ stems of larger diameter were used. Endofemoral approach reduces duration of surgery and the amount of blood and bone loss. Minimally invasive technique for broken and uncemented femoral stem is recommended.

Fracture of Extensively Porous-Coated Cylindrical Femoral Stem Following Revision Total Hip Arthroplasty

“…Although some studies have linked excessive body weight of patients to stem fractures,[ 2 3 ] in our study, the body weight of the two patients was only 35.0 kg and 66.8 kg, with BMI of 16.2 and 24.8, respectively. They could not be classified as overweight but fractures still happened, which implies that proximal bone loss and stem sizes are more important risk factors than body weight.…”

“…However, complications of these stems are not uncommon. Fracture of these stems, although rarely reported in literature,[ 1 2 3 ] is challenging for orthopedic surgeons. Extraction of the broken components is difficult, and special instruments or techniques are usually required.…”

Use of a Trephine to Extract a Fractured Corail Femoral Stem During Revision Total Hip Arthroplasty: Tips From Our Case Report

“…When the diagnosis was confirmed, several methods were considered for management such as the femoral cortical window approach and the extended trochanteric osteotomy. Nevertheless, these methods are either extreme, offer restricted visibility of the distant fragment, or result in the absence of distal intra-medullary support [ 10 ]. Wroblewski developed an innovative method using specialized tools.…”

Revision for Solid‐Body Breakage of the 3D‐Printed Implant Following Joint‐Sparing Surgery: A Technical Note

“…Revision surgery for stand modular prosthesis due to mechanical failure is not uncommon in orthopaedic oncology, and several studies have documented such revisions. 9 , 10 , 11 , 12 Feasible revision methods for corresponding broken sites, such as corticotomy 9 the hollow trephine technique 11 , 12 for extracting the broken stem, and use of a retrograde inserted instrument for punching the modular prosthetic component, 10 are well documented. However, the literature on revision for 3D‐printed implant is scarce, and clinical experience is limited.…”