DOI QR코드

DOI QR Code

Management of Severe Bone Defects in Femoral Revision following Total Hip Arthroplasty

  • Yicheng Li (Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University) ;
  • Li Cao (Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University)
  • 투고 : 2023.07.17
  • 심사 : 2023.08.09
  • 발행 : 2024.06.01

초록

Treatment of femoral bone defects continues to be a challenge in revision total hip arthroplasty (THA); therefore, meticulous preoperative evaluation of patients and surgical planning are required. This review provides a concise synopsis of the etiology, classification, treatment strategy, and prosthesis selection in relation to femoral bone loss in revision THA. A search of literature was conducted for identification of research articles related to classification of bone loss, management of femoral revision, and comparison of different types of stems. Findings of a thorough review of the included articles were as follows: (1) the Paprosky classification system is used most often when defining femoral bone loss, (2) a primary-length fully coated monoblock femoral component is recommended for treatment of types I or II bone defects, (3) use of an extensively porous-coated stem and a modular fluted tapered stem is recommended for management of types III or IV bone defects, and (4) use of an impaction grafting technique is another option for improvement of bone stock, and allograft prosthesis composite and proximal femoral replacement can be applied by experienced surgeons, in selected cases, as a final salvage solution. Stems with a tapered design are gradually replacing components with a cylindrical design as the first choice for femoral revision; however, further confirmation regarding the advantages and disadvantages of modular and nonmodular stems will be required through conduct of higher-level comparative studies.

키워드

참고문헌

  1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780-5. https://doi.org/10.2106/JBJS.F.00222 
  2. Patel A, Pavlou G, Mujica-Mota RE, Toms AD. The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset. Bone Joint J. 2015;97-B:1076-81. https://doi.org/10.1302/0301-620X.97B8.35170 
  3. Ong KL, Mowat FS, Chan N, Lau E, Halpern MT, Kurtz SM. Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res. 2006;446:22-8. https://doi.org/10.1097/01.blo.0000214439.95268.59 
  4. Dixon T, Shaw M, Ebrahim S, Dieppe P. Trends in hip and knee joint replacement: socioeconomic inequalities and projections of need. Ann Rheum Dis. 2004;63:825-30. https://doi.org/10.1136/ard.2003.012724 
  5. Vanhegan IS, Malik AK, Jayakumar P, Ul Islam S, Haddad FS. A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff. J Bone Joint Surg Br. 2012;94:619-23. https://doi.org/10.1302/0301-620X.94B5.27073 
  6. Paprosky WG, Greidanus NV, Antoniou J. Minimum 10-year-results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res. 1999;(369):230-42. https://doi.org/10.1097/00003086-199912000-00024 
  7. Otero JE, Martin JR, Rowe TM, Odum SM, Mason JB. Radiographic and clinical outcomes of modular tapered fluted stems for femoral revision for Paprosky III and IV femoral defects or Vancouver B2 and B3 femoral fractures. J Arthroplasty. 2020;35:1069-73. https://doi.org/10.1016/j.arth.2019.11.039 
  8. Richards CJ, Duncan CP, Masri BA, Garbuz DS. Femoral revision hip arthroplasty: a comparison of two stem designs. Clin Orthop Relat Res. 2010;468:491-6. https://doi.org/10.1007/s11999-009-1145-7 
  9. Clohisy JC, Calvert G, Tull F, McDonald D, Maloney WJ. Reasons for revision hip surgery: a retrospective review. Clin Orthop Relat Res. 2004;(429):188-92. https://doi.org/10.1097/01.blo.0000150126.73024.42 
  10. Dobzyniak M, Fehring TK, Odum S. Early failure in total hip arthroplasty. Clin Orthop Relat Res. 2006;447:76-8. https://doi.org/10.1097/01.blo.0000203484.90711.52 
  11. Huang Y, Shao H, Zhou Y, Gu J, Tang H, Yang D. Femoral bone remodeling in revision total hip arthroplasty with use of modular compared with monoblock tapered fluted titanium stems: the role of stem length and stiffness. J Bone Joint Surg Am. 2019;101:531-8. https://doi.org/10.2106/JBJS.18.00442 
  12. D'Antonio J, McCarthy JC, Bargar WL, et al. Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1993;(296):133-9. 
  13. Tetreault MW, Shukla SK, Yi PH, Sporer SM, Della Valle CJ. Are short fully coated stems adequate for "simple" femoral revisions? Clin Orthop Relat Res. 2014;472:577-83. https://doi.org/10.1007/s11999-013-3167-4 
  14. Khanuja HS, Issa K, Naziri Q, Banerjee S, Delanois RE, Mont MA. Results of a tapered proximally-coated primary cementless stem for revision hip surgery. J Arthroplasty. 2014;29:225-8. https://doi.org/10.1016/j.arth.2013.04.025 
  15. Romagnoli S, Marullo M, Corbella M, Zero E, Parente A, Bargagliotti M. Conical primary cementless stem in revision hip arthroplasty: 94 consecutive implantations at a mean follow-up of 12.7 years. J Arthroplasty. 2021;36:1080-6. https://doi.org/10.1016/j.arth.2020.10.006 
  16. McAuley JP, Engh CA Jr. Femoral fixation in the face of considerable bone loss: cylindrical and extensively coated femoral components. Clin Orthop Relat Res. 2004;(429):215-21. https://doi.org/10.1097/01.blo.0000150274.21573.f4 
  17. Davidson D, Pike J, Garbuz D, Duncan CP, Masri BA. Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am. 2008;90:2000-12. https://doi.org/10.2106/JBJS.H.00331 
  18. Pinaroli A, Lavoie F, Cartillier JC, Neyret P, Selmi TA. Conservative femoral stem revision: avoiding therapeutic escalation. J Arthroplasty. 2009;24:365-73. https://doi.org/10.1016/j.arth.2007.12.002 
  19. Skibicki HE, Post ZD, Kay AB, et al. A role for modern primary cementless femoral stems in revision hip arthroplasty. J Arthroplasty. 2021;36:3269-74. https://doi.org/10.1016/j.arth.2021.04.042 
  20. Cavagnaro L, Formica M, Basso M, Zanirato A, Divano S, Felli L. Femoral revision with primary cementless stems: a systematic review of the literature. Musculoskelet Surg. 2018;102:1-9. https://doi.org/10.1007/s12306-017-0487-7 
  21. Sporer SM, Paprosky WG. Revision total hip arthroplasty: the limits of fully coated stems. Clin Orthop Relat Res. 2003;(417):203-9. https://doi.org/10.1097/01.blo.0000096803.78689.0c 
  22. Chung LH, Wu PK, Chen CF, Chen WM, Chen TH, Liu CL. Extensively porous-coated stems for femoral revision: reliable choice for stem revision in Paprosky femoral type III defects. Orthopedics. 2012;35:e1017-21. https://doi.org/10.3928/01477447-20120621-13 
  23. Ding ZC, Ling TX, Yuan MC, et al. Minimum 8-year follow-up of revision THA with severe femoral bone defects using extensively porous-coated stems and cortical strut allografts. BMC Musculoskelet Disord. 2020;21:218. https://doi.org/10.1186/s12891-020-03250-0 
  24. Palumbo BT, Morrison KL, Baumgarten AS, Stein MI, Haidukewych GJ, Bernasek TL. Results of revision total hip arthroplasty with modular, titanium-tapered femoral stems in severe proximal metaphyseal and diaphyseal bone loss. J Arthroplasty. 2013;28:690-4. https://doi.org/10.1016/j.arth.2012.08.019 
  25. Desai RR, Malkani AL, Hitt KD, Jaffe FF, Schurman JR 2nd, Shen J. Revision total hip arthroplasty using a modular femoral implant in Paprosky type III and IV femoral bone loss. J Arthroplasty. 2012;27:1492-8.e1. https://doi.org/10.1016/j.arth.2012.03.039 
  26. Chang JD, Kim TY, Rao MB, Lee SS, Kim IS. Revision total hip arthroplasty using a tapered, press-fit cementless revision stem in elderly patients. J Arthroplasty. 2011;26:1045-9. https://doi.org/10.1016/j.arth.2011.03.020 
  27. Uriarte I, Moreta J, Cortes L, Bernuy L, Aguirre U, Martinez de Los Mozos JL. Revision hip arthroplasty with a rectangular tapered cementless stem: a retrospective study of the SLRPlus stem at a mean follow-up of 4.1 years. Eur J Orthop Surg Traumatol. 2020;30:281-9. https://doi.org/10.1007/s00590-019-02578-1 
  28. Korovessis P, Repantis T. High medium-term survival of Zweymuller SLR-plus stem used in femoral revision. Clin Orthop Relat Res. 2009;467:2032-40. https://doi.org/10.1007/s11999-009-0760-7 
  29. Wang J, Dai WL, Lin ZM, Shi ZJ. Revision total hip arthroplasty in patients with femoral bone loss using tapered rectangular femoral stem: a minimum 10 years' follow-up. Hip Int. 2020;30:622-8. https://doi.org/10.1177/1120700019859809 
  30. Ling RS. Femoral component revision using impacted morsellised cancellous graft. J Bone Joint Surg Br. 1997;79:874-5. https://doi.org/10.1302/0301-620x.79b5.8078 
  31. Rogers BA, Sternheim A, De Iorio M, Backstein D, Safir O, Gross AE. Proximal femoral allograft in revision hip surgery with severe femoral bone loss: a systematic review and meta-analysis. J Arthroplasty. 2012;27:829-36.e1. https://doi.org/10.1016/j.arth.2011.10.014 
  32. Ling RS, Timperley AJ, Linder L. Histology of cancellous impaction grafting in the femur. A case report. J Bone Joint Surg Br. 1993;75:693-6. https://doi.org/10.1302/0301-620X.75B5.8376422 
  33. Board TN, Rooney P, Kay PR. Strain imparted during impaction grafting may contribute to bony incorporation: an in vitro study of the release of BMP-7 from allograft. J Bone Joint Surg Br. 2008;90:821-4. https://doi.org/10.1302/0301-620X.90B6.20234 
  34. Hadley ML, Shirley MB, Pulido LF, Lewallen DG. Intussusception allograft prosthetic composites in total hip arthroplasty: a salvage operation for extensive femoral bone loss. J Arthroplasty. 2023;38:1827-38. https://doi.org/10.1016/j.arth.2023.03.038 
  35. Viste A, Perry KI, Taunton MJ, Hanssen AD, Abdel MP. Proximal femoral replacement in contemporary revision total hip arthroplasty for severe femoral bone loss: a review of outcomes. Bone Joint J. 2017;99-B:325-9. https://doi.org/10.1302/0301-620X.99B3.BJJ-2016-0822.R1 
  36. Yacovelli S, Ottaway J, Banerjee S, Courtney PM. Modern revision femoral stem designs have no difference in rates of subsidence. J Arthroplasty. 2021;36:268-73. https://doi.org/10.1016/j.arth.2020.07.078 
  37. Russell RD, Pierce W, Huo MH. Tapered vs cylindrical stem fixation in a model of femoral bone deficiency in revision total hip arthroplasty. J Arthroplasty. 2016;31:1352-5. https://doi.org/10.1016/j.arth.2015.12.008 
  38. Zhang Y, Zhang Y, Sun JN, Hua ZJ, Chen XY, Feng S. Comparison of cylindrical and tapered stem designs for femoral revision hip arthroplasty. BMC Musculoskelet Disord. 2020;21:411. https://doi.org/10.1186/s12891-020-03461-5 
  39. Weeden SH, Paprosky WG. Minimal 11-year follow-up of extensively porous-coated stems in femoral revision total hip arthroplasty. J Arthroplasty. 2002;17(4 Suppl 1):134-7. https://doi.org/10.1054/arth.2002.32461 
  40. Sivananthan S, Lim CT, Narkbunnam R, Sox-Harris A, Huddleston JI 3rd, Goodman SB. Revision hip arthroplasty using a modular, cementless femoral stem: intermediate-term follow-up. J Arthroplasty. 2017;32:1245-9. https://doi.org/10.1016/j.arth.2016.10.033 
  41. Pelt CE, Madsen W, Erickson JA, Gililland JM, Anderson MB, Peters CL. Revision total hip arthroplasty with a modular cementless femoral stem. J Arthroplasty. 2014;29:1803-7. https://doi.org/10.1016/j.arth.2014.04.042 
  42. Regis D, Sandri A, Bonetti I, Braggion M, Bartolozzi P. Femoral revision with the Wagner tapered stem: a ten- to 15-year follow-up study. J Bone Joint Surg Br. 2011;93:1320-6. https://doi.org/10.1302/0301-620X.93B10.25927 Erratum in: J Bone Joint Surg Br. 2011;93:1679. 
  43. Abdel MP, Cottino U, Larson DR, Hanssen AD, Lewallen DG, Berry DJ. Modular fluted tapered stems in aseptic revision total hip arthroplasty. J Bone Joint Surg Am. 2017;99:873-81. https://doi.org/10.2106/JBJS.16.00423 
  44. Huang Y, Zhou Y, Shao H, Gu J, Tang H, Tang Q. What is the difference between modular and nonmodular tapered fluted titanium stems in revision total hip arthroplasty. J Arthroplasty. 2017;32:3108-13. https://doi.org/10.1016/j.arth.2017.05.021