Modified Exeter Technique in Revision Hip Surgery

Thomasson, E. de; Williams, Jay B.; Marmorat, J.-L.; Guigand, Olivier; Mazel, Christian

doi:10.1016/j.arth.2004.09.037

Cited by 8 publications

(3 citation statements)

References 27 publications

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“…55 Alternatively, the defect can be bypassed using a long-stemmed prosthesis. 15,19,[56][57][58] Some authors have used mesh fixed by cerclage wires and advocated a plate or strut graft in conjunction with a long stem, 40 whereas others have used long stems for the elderly and extramedullary augmentation combined with a standard stem for younger patients. 4 In our study the length of the stem was decided pre-operatively for each patient when anticipating the difficulties from removing the cement plug that might require a window, or when the femur had become bowed or cortically weakened.…”

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confidence: 99%

“…Avoiding intraand post-operative femoral fractures, as well as limiting the degree of subsidence, therefore remain the main challenges when using impaction grafting. 5,19,27,28 We have been using a collared polished CrCo stem adapted to the length of bone loss in order to avoid these complications. The aim of this study was to report our results at a mean follow-up of 12 years.…”

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confidence: 99%

“…7 Techniques aimed at reducing the incidence of subsidence include cementing the distal part of the stem directly to the host bone, 15,19 using the impaction grafting technique in association with a non-polished satin-finished chromium-cobalt (Cr-Co) stem 20 and optimising the grafting and cement mantle. [21][22][23][24][25][26] However, as yet there is no evidence that these options prevent extensive subsidence of the stem.…”

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A customised collared polished stem may reduce the complication rate of impaction grafting in revision hip surgery

Flécher

Blanc

Sainsous

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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We describe the results of 81 consecutive revision total hip replacements with impaction grafting in 79 patients using a collared polished chrome-cobalt stem, customised in length according to the extent of distal bone loss. Our hypothesis was that the features of this stem would reduce the rate of femoral fracture and subsidence of the stem. The mean follow-up was 12 years (8 to 15). No intra-operative fracture or significant subsidence occurred. Only one patient suffered a post-operative diaphyseal fracture, which was associated with a fall. All but one femur showed incorporation of the graft. No revision for aseptic loosening was recorded. The rate of survival of the femoral component at 12 years, using further femoral revision as the endpoint, was 100% (95% confidence interval (CI) 95.9 to 100), and at nine years using re-operation for any reason as the endpoint, was 94.6% (95% CI 92.0 to 97.2). These results suggest that a customised cemented polished stem individually adapted to the extent of bone loss and with a collar may reduce subsidence and the rate of fracture while maintaining the durability of the fixation.

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confidence: 99%

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confidence: 99%

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confidence: 99%

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A customised collared polished stem may reduce the complication rate of impaction grafting in revision hip surgery

Flécher

Blanc

Sainsous

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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Impaction bone grafting procedure with distal fixation of a cemented stem with a moldered mesh: a prospective study with a 12.5-year follow-up

et al. 2008

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A modified version of the impaction bone grafting technique was introduced in 1985. The use of a moldered metallic mesh to protect the graft from excessive cement penetration was promoted as well as to reinforce the reconstruction mechanically. The length of the revision stem was chosen to achieve distal fixation and to bridge the bone loss to prevent subsidence and postoperative femoral shaft fracture. The 8-year stem survivorship was 100% and 92.8 ± 6.8% at 12.5 years of follow-up. This technique achieved cortical and cancellous reconstruction in every case without postoperative femoral shaft fracture or significant subsidence. The clinical and radiological results are long lasting. However, the duration of surgery and the risk of viral agent's transmission by using extensive bone grafting may restrict the use of this technique.

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Greffe morcelée impactée et tiges cimentées dans les révisions fémorales de hanche

Soenen

Riera

Girard

et al. 2010

Reprise Des Prothèses De Hanches

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Modified Exeter Technique in Revision Hip Surgery

Cited by 8 publications

References 27 publications

A customised collared polished stem may reduce the complication rate of impaction grafting in revision hip surgery

A customised collared polished stem may reduce the complication rate of impaction grafting in revision hip surgery

Impaction bone grafting procedure with distal fixation of a cemented stem with a moldered mesh: a prospective study with a 12.5-year follow-up

Greffe morcelée impactée et tiges cimentées dans les révisions fémorales de hanche

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