Authors: Paul F Lachiewicz Elizabeth S Soileau
Publish Date: 2014/05/22
Volume: 473, Issue: 2, Pages: 549-554
Abstract
Femoral revision using fully coated femoral components offers distinct advantages in patients with notable bone loss With the increasing concerns being raised about the problems of stem modularity the results and complications of revision arthroplasty using devices with limited modularity are importantWe therefore asked 1 What is the frequency of infection aseptic loosening and reoperations after use of these components 2 What is the frequency of intraoperative fracture of the femur when using these components and are there any identifiable factors related to these fractures 3 What is the 10year survivorship of these components and are there any identifiable factors related to survival and rerevisionWe retrospectively reviewed prospectively obtained data on 96 patients undergoing 104 revisions with fully coated components of two different manufacturers six patients had died 6 and six were lost to followup 6 before 2 years Data on intraoperative fracture aseptic loosening and reoperation were analyzed Ninetytwo hips with a minimum followup of 2 years mean 8 years range 2–16 years were evaluated for radiographic evidence of loosening Intraoperative fracture frequency and KaplanMeier survivorship was calculated to 10 years for the entire cohort of 104 hips Demographic radiographic and operative factors associated with implant survival and intraoperative fracture were analyzed using chisquare and Wilcoxon testsThere were three infections nine hips 10 had femoral component loosening six rerevised and there were seven other reoperations Intraoperative complications in 17 hips 17 11 diaphyseal fractures four perforations two proximal fractures were treated with allograft strut and cable fixation in 14 hips Intraoperative femoral complication was more likely with the use of a curved stem 17 of 76 22 curved 0 of 28 straight stems p = 0005 With failure defined as femoral component revision for aseptic loosening or radiographic evidence of loosening implant survival was 88 at 10 years Those femurs with Paprosky Grades 3B and 4 defects had a higher risk of loosening 3 of 10 for Grades 3B and 4 versus 6 of 94 hips 6 for Grades 1 2 3A p = 003Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment drug or device Readers are encouraged to always seek additional information including FDA approval status of any drug or device before clinical use
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