Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma

Dean, Benjamin; Matthews, Jon; Price, Andrew; Stubbs, David; Whitwell, Duncan; Gibbons, Christopher M. L. H.

doi:10.1007/s00264-011-1332-5

Cited by 40 publications

(22 citation statements)

References 10 publications

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“…Our series deals with all the fractures of the hip joint. Dean et al ,21 have described use of Modular Endoprosthetic Tumour System (METS) for eight cases of failed internal fixation of which only two were infected. One was managed by single stage where as the second case required two-stage surgery (spacer of antibiotic-impregnated cement modeled around a guidewire for the first stage).…”

Section: Discussionmentioning

confidence: 99%

Outcome of total hip arthroplasty as a salvage procedure for failed infected internal fixation of hip fractures

Mohanty¹,

Agashe²,

Sheth³

et al. 2013

IJOO

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Background:Failed infected internal fixation produces significant pain and functional disability. In infected internal fixation of hip fractures with partial or complete head destruction, total hip arthroplasty (THA) can be technically challenging; however, it restores hip biomechanics. The present study is to evaluate the results and assess the complications of THA following failed infected internal fixation of these fractures.Materials and Methods:A retrospective review of prospectively collected data in a tertiary healthcare center was performed of 20 consecutive patients of THA following failed infected internal fixation operated between September 2001 and November 2007. There were 11 dynamic hip screw failures for intertrochanteric fractures, 6 failed osteotomies following transcervical fractures, and 3 failed screw fixations for transcervical fractures.Results:The average age of the patients was 48.5 years (range 28-70 years) and the average followup period was 6.5 years (range 3.5-10.5 years). An indigenously designed cement spacer was used in a majority of patients (n = 15). The custom-made antibiotic impregnated cement spacer was prepared on-table, with the help of a K-nail bent at 130°, long stem Austin Moore's prosthesis (n=1), Charnley's prosthesis (n=1), or bent Rush nail (n=1). The antibiotic mixed cement was coated over the hardware in its doughy phase and appropriately shaped using an asepto syringe or an indigenously prepared spacer template. Nineteen of the 20 patients underwent two-stage revision surgeries. The average Harris hip score improved from 35.3 preoperatively to 82.85 postoperatively at the last followup. A significant difference was found (P < 0.0001). None of the patients had recurrence of infection.Conclusions:The results were comparable to primary arthroplasty in femoral neck fractures. Thus, THA is a useful salvage procedure for failed infected internal fixation of hip fractures.

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Section: Discussionmentioning

confidence: 99%

Outcome of total hip arthroplasty as a salvage procedure for failed infected internal fixation of hip fractures

Mohanty¹,

Agashe²,

Sheth³

et al. 2013

IJOO

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“…Custom-made prosthetic implants were used until the beginning of the 1980 s when the first modular prosthetic systems were introduced [5,23]. Modular systems can be used after oncologic resections and in posttraumatic or revision bone loss, allowing individual assembly based on intraoperative requirements [6]. Prosthetic replacement allows early weightbearing and functional recovery, but several complications have been reported with concerns about longterm implant survival (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…The same modular systems may be used to restore osteoarticular defects of the hip and knee in prosthetic revision surgery and posttraumatic situations [6,14,32]. The major advantages of endoprostheses are the relatively simple and quick intraoperative assembly and immediate mechanical stability, allowing early weightbearing and functional recovery.…”

Section: Introductionmentioning

confidence: 99%

What Was the Survival of Megaprostheses in Lower Limb Reconstructions After Tumor Resections?

Capanna

Scoccianti

Frenos

et al. 2015

Clinical Orthopaedics &Amp; Related Research

128

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Background Prosthetic replacement is the most commonly used option for reconstruction of osteoarticular bone loss resulting from bone neoplasm resection or prosthetic failure. Starting in late 2001, we began exclusively using a single system for large-segment osteoarticular reconstruction after tumor resection; to our knowledge, there are no published series from one center evaluating the use of this implant.

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“…The treatment options available in such a situation are structural allograft-prosthesis composite, impaction allografting, long cemented or press-fit revision stem resection arthroplasty and megaprosthesis [1,21]. There are many limitations associated with the use of allograft for reconstruction in bone loss, thus increasing the use of megaprosthesis for tumor surgery [5,6]. Encouraging results of the successful outcome of megaprosthesis for tumor salvage in the proximal and distal femur have broadened the indications for megaprosthesis for the treatment of non-neoplastic conditions with extensive bone loss in the proximal or distal femora [8,19].…”

Section: Introductionmentioning

confidence: 99%

Non-neoplastic indications and outcomes of the proximal and distal femur megaprosthesis: a critical review

Vaishya

Thapa

Vaish

2020

Knee Surg & Relat Res

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Purpose: Megaprosthesis or endoprosthetic replacement of the proximal and distal femur is a well-established modality for treatment of tumors. The indications for megaprosthesis have been expanded to the treatment of some non-neoplastic conditions of the knee and hip, with the severe bone loss associated with failed arthroplasty, communited fractures in the elderly with poor bone quality, and resistant non-union. Th aim of this study is to find out whether megaprosthesis of the knee and hip is successful in the treatment of non-neoplastic condtions. The study comprises a review of the indications, complications, and outcomes of megaprosthesis of the proximal and distal femur in non-neoplastic conditions of the knee and hip joints. Methods: We extensively reviewed the literature on non-neoplastic indications for megaprosthesis of the proximal and distal femur after performing a detailed search of the Pubmed database using the medical subject heading (MeSH) terms 'proximal femur replacement' or 'distal femur replacement' and 'hip or knee megaprosthesis.' The data obtained after the structured search were entered into a Microsoft Excel spreadsheet. The frequency distribution of the demographic data, indications, complications, and outcome was calculated. Result: We included ten studies (seven proximal femur replacement and three distal femur replacement) of 245 proximal femur and 54 distal femur mega prostheses for treatment of non-neoplastic conditions. Bone loss in failed arthroplasty, either due to periprosthetic fracture or deep infection, was the most common indication for megaprosthesis. Dislocation was the most common complication after proximal femur megaprosthesis, and infection was the leading cause of complications after distal femur megaprosthesis. Conclusion: Megaprosthesis for treatment of non-neoplastic conditions around the distal and proximal femur is a viable option for limb salvage, with an acceptable long-term outcome. Although the complications and survival rates of megaprosthesis in non-neoplastic conditions are inferior to a primary arthroplasty of the hip and knee but are comparable or better than the mega prosthetic replacement in the neoplastic conditions. Proximal femoral megaprosthesis has higher dislocation rates and requirement for revision compared to distal femoral megaprosthesis. However, the proximal femoral megaprosthesis has lower rates of infection, periprosthetic fractures, and soft tissue complications, as compared to distal femoral megaprosthetic replacement. Both associated with aseptic loosening but not statistically significant.

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Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma

Abstract: EPR is an effective salvage procedure for failed fixation of traumatic proximal femoral fractures. Immediate weightbearing and a good functional outcome can be expected in this difficult group of patients.

Cited by 40 publications

References 10 publications

Outcome of total hip arthroplasty as a salvage procedure for failed infected internal fixation of hip fractures

Outcome of total hip arthroplasty as a salvage procedure for failed infected internal fixation of hip fractures

What Was the Survival of Megaprostheses in Lower Limb Reconstructions After Tumor Resections?

Non-neoplastic indications and outcomes of the proximal and distal femur megaprosthesis: a critical review

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