Minimum 8-year follow-up of revision THA with severe femoral bone defects using extensively porous-coated stems and cortical strut allografts

Ding, Zichuan; Ling, Tingxian; Yuan, Min; Yu, Qin; Mou, Ping; Wang, Haoyang; Zhou, Zongke

doi:10.1186/s12891-020-03250-0

Cited by 17 publications

(7 citation statements)

References 40 publications

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“…All struts achieved union with 10-year revision for any cause survivorship at 96.2% (95% CI: 75.7e99.5%). 31 Others have reported similar outcomes, Park et al reviewed their use of cortical strut allografts in 19 hip revision patients with 94.7% incorporation rate with average 21.2 months' time to union with no significant differences between patients with fractures, aseptic loosening or infection. 32 The role of strut allografts for managing patients with hip periprosthetic fractures around/or at the tip of well-fixed implants (Vancouver B1) continues to be debated in the literature.…”

Section: Discussionmentioning

confidence: 92%

Cortical strut allografts in salvage revision arthroplasty: Surgical technique and clinical outcomes

Matar

Selvaratnam

Jain

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background: The aim of this study was to present our clinical outcomes and surgical technique in strut allografts preparation using staggered holes to enhance osteointegration and demineralised bone matrix (DBM) as an adjunct to cortical strut allografts in salvage revision arthroplasty patients. Methods: Retrospective consecutive series of patients who required strut allograft femoral reconstructions with minimum 2 years follow up between 2012 and 2018. Frozen washed irradiated, cortical struts were used and prepared adding 2 mm staggered drill holes along the length of the strut and applying DBM paste on the graft-host interface. Outcome measures included radiographic strut union, graft resorption, infection and complications. Results: 15 patients included; 3 males and 12 females with median age 72 years (range 60e93). All had significant bony defects (Paprosky III/IV in 12 cases including 3 cases of periprosthetic hip fractures and further 3 cases of periprosthetic knee fractures around revision hinged implants). At final follow up, median 3.8 years (range 2.7e7.2), 14/15 (93.3%) struts had united at a median 6 months (range 5e8), complete incorporation with cortical round-off was seen at median 12 months (range 8e48) in 12/15 (80%) struts, 2/15 (13.3%) show radiographic evidence of proximal minimal graft resorptions although the remainder of the strut had integrated and were asymptomatic. There were no cases of infection. Conclusions: Use of strut allografts helps to reconstruct bone defects, restore bone stock, and provide stable fixation for complex patterns of periprosthetic fractures around hip/knee implants and salvage revision cases with 93.3% union rate at median 6 months.

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Section: Discussionmentioning

confidence: 92%

Cortical strut allografts in salvage revision arthroplasty: Surgical technique and clinical outcomes

Matar

Selvaratnam

Jain

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…In the current study, the clinical results showed that the improved mHHS and MSTS scores were similar to previous studies reported. 9,28,29 The radiologic outcomes showed all the allografts were united to the host bone at the latest follow-up. Therefore, we believed that the revision technique using cortical strut allografts was also suitable for benign bone tumors patients.…”

Section: Discussionmentioning

confidence: 96%

Clinical and radiological outcomes of combined modular prothesis and cortical strut for revision proximal femur in giant cell tumor of bone patients

Zhang

Tang

et al. 2022

J Orthop Surg (Hong Kong)

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Background Femoral bone deficiency is a challenging problem in revision proximal femoral replacement. The purpose of this study is to evaluate the clinical and radiological outcomes of revision proximal femoral replacement as a salvage treatment for severe bone loss after oncologic proximal replacement surgery in patient with benign giant cell tumor of bone. Methods 16 patients (6 men and 10 women) were included in this retrospective study, with a mean age of 46.6 year at the time of revision surgery. All patients underwent revision proximal femoral replacement with the use of modular prosthesis and cortical strut allografts. The modified Harris Hip Score, Short Form 36, and musculoskeletal Tumor Society Score were used for patient evaluation. Regular follow-up was performed to evaluate the recurrence and metastases rate, limb function, and long-term complications of patients. Results The average follow-up was 46.3 months (range, 26–75 months), during which there was no local recurrence and metastases of patient. At the latest follow-up, the mean modified Harris Hip Score was 70.6 points, which was significantly improved compared with that of preoperative ( p < 0.05). The final follow-up results of Short Form 36, Musculoskeletal Tumor Society Score, and limb-length discrepancy were also significantly improved compared to that of preoperative ( p < 0.05). At the latest follow-up, the implanted femoral stems were all stable and all cortical strut allografts were also incorporated to their own bone. Conclusion Using modular prosthesis and cortical strut allografts in revision, proximal femur replacement is an acceptable procedure for relatively young patient with severe proximal femoral bone loss after oncologic surgery with benign giant cell tumor of bone. More attentions should be paid to reduce the risk of complications in these complex reconstructions.

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“…Adverse events were recorded at the latest follow‐up. Adverse events including aseptic loosening, periprosthetic joint infection, periprosthetic fracture, hip dislocation, blood transfusion, venous thrombosis, pulmonary embolism and neurovascular events, were collected in details 14,15 …”

Section: Methodsmentioning

confidence: 99%

Preoperative High Sleep Quality Predicts Further Decrease in Length of Stay after Total Joint Arthroplasty under Enhanced Recovery Short‐stay Program: Experience in 604 Patients from a Single Team

Ding

et al. 2022

Orthopaedic Surgery

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Objective To investigate the safety, efficiency and cost of total joint arthroplasty (TJA) under the enhanced recovery after surgery (ERAS) program and identify predictors facilitating further decrease in length of stay (LOS). Methods We retrospectively collected the information of patients who underwent primary unilateral TJA by a single surgical team between January 2017 and June 2019. A total of 604 patients with LOS ≤ 3 was enrolled in this study. All patients completed 12‐month or longer follow‐up. Patients received the same ERAS protocol, mainly including preoperative preparation (patient education, preoperative functional exercises, nutritional support), blood management, pain management, sleep management, prevention of infection, prevention of thrombosis and strict discharge criteria. Preoperative characteristics of patients were collected from the medical record system and were compared between the LOS ≤ 2 group and the LOS = 3 group. Factors with significant difference were included in multivariate logistic regression analysis to find independent preoperative predictors for LOS. Joint function at the latest follow‐up, adverse events rate and hospitalization costs were compared between the LOS ≤ 2 group and the LOS = 3 group. Results Of the enrolled 604 patients, 271 patients (44.9%) had a LOS of 2 days or less while 333 patients (55.1%) had a LOS of 3 days. Pittsburgh Sleep Quality Index score (odds ratio [OR] = 1.084, 95% confidence interval [CI] = 1.024–1.147, P = 0.005), preoperative albumin level (OR = 0.945, 95% CI = 0.905–0.988, P = 0.012), digestive diseases (OR = 1.084, 95% CI = 1.024–1.147, P = 0.005) and total hip arthroplasty (THA) (OR = 0.273, 95% CI = 0.170–0.439, P < 0.001) were predictors of LOS ≤ 2 in the multivariate logistic analysis model. The postoperative joint function scores and adverse event rates were comparable between the LOS ≤ 2 group and the LOS = 3 group. The hospital costs were lower in the LOS ≤ 2 group than the LOS = 3 group. Conclusion Under the rigorous ERAS program, 2‐day discharge in unselected TJA patients can be routinely applied. Patients with high preoperative sleep quality, high preoperative albumin level, free of digestive disease and undergoing THA procedure are more likely to be discharged within 2 days.

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Minimum 8-year follow-up of revision THA with severe femoral bone defects using extensively porous-coated stems and cortical strut allografts

Cited by 17 publications

References 40 publications

Cortical strut allografts in salvage revision arthroplasty: Surgical technique and clinical outcomes

Cortical strut allografts in salvage revision arthroplasty: Surgical technique and clinical outcomes

Clinical and radiological outcomes of combined modular prothesis and cortical strut for revision proximal femur in giant cell tumor of bone patients

Preoperative High Sleep Quality Predicts Further Decrease in Length of Stay after Total Joint Arthroplasty under Enhanced Recovery Short‐stay Program: Experience in 604 Patients from a Single Team

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