ABSTRACT
INTRODUCTION:: Historically the removal of fractured stems was associated with complex revision and loss of bone stock. This study describes a minimally invasive procedure for extraction of the distal part of a broken cemented stem that does not compromise the bone stock and results with the cement-in-cement reconstruction technique. MATERIALS AND METHOD:: 7 patients with an average age of 74 years who underwent total hip replacement (THR) revision for fracture of femoral stems were included. The average follow-up was 8.7 years. For the removal of the distal fragment of the broken stem, a set of instruments have been manufactured using a coupling through the wrought of a thread over the fractured face of the stem. 6 cases were reconstructed using a cement-in-cement technique. In 1 case an extended trochanteric osteotomy was required. RESULTS:: There were no complications associated with the surgical technique. Early rehabilitation and standing were achieved in all patients at 48 hours postoperatively. No patient required a blood transfusion. No clinical or radiological loosening was detected at final follow-up. CONCLUSIONS:: Different methods have been described for the extraction of distal fragments of a broken femoral stem. The majority include the use of femoral osteotomies, bone windows and knee arthrotomies. These techniques are associated with bone loss and bleeding. The advantages of the method described are, its low complexity, low-cost, accelerated functional recovery and the preservation of bone stock with the possibility of performing cement-in-cement reconstruction techniques.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/instrumentation , Hip Prosthesis/adverse effects , Postoperative Complications/surgery , Prosthesis Failure/adverse effects , Reoperation/methods , Aged , Arthroplasty, Replacement, Hip/methods , Bone Cements/therapeutic use , Female , Femur/surgery , Fractures, Bone/surgery , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures , Osteotomy/methods , Postoperative Complications/diagnosis , Postoperative Complications/etiology , RadiographyABSTRACT
Introducción: Se han logrado excelentes resultados con los tallos pulidos, cementados con tecnicas modernas, aun en pacientes jovenes, aunque su combinacion con superficie ceramica solo se ha comunicado en forma aislada. El objetivo de este estudio es analizar los resultados y las complicaciones de una serie de artroplastias de cadera con superficie ceramicaceramica, y tallos pulidos y conicos cementados con tecnicas de segunda y tercera generacion. Materiales y Métodos: Se evaluaron los resultados, las complicaciones relacionadas con el par de friccion y la supervivencia de 277 pacientes tratados con artroplastias de cadera con tallos pulidos y conicos cementados, en forma moderna, asociados a un par de friccion ceramica-ceramica. La edad promedio fue 56 anos; y el seguimiento minimo, de 6 anos. Resultados: No se detectaron aflojamientos radiologicos, migraciones, ni radiolucencias. La incidencia de infeccion fue del 1,3%. La incidencia de complicaciones por causas atribuibles a la cupla ceramica fue del 4%, y la de revision, del 1,4%. La supervivencia a siete anos, considerando revision por cualquier motivo fue del 95,8% (IC95% 94-99%), y considerando el aflojamiento aseptico, del 100%. Todos los casos de luxacion produjeron impregnacion metalica de la cabeza ceramica y esta fue la causa mas frecuente de revision. La incidencia de sonidos ha sido excepcionalmente baja comparada con las de otras series con fijacion no cementada. Conclusión: La asociacion de cementado moderno y tallos pulidos y conicos con superficies ceramicas ha demostrado ser una alternativa atractiva con una supervivencia a siete anos del 95%, sin aflojamientos asepticos. Nivel de Evidencia: IV
Introduction: Polished cemented stems with modern cementing techniques have shown excellent results even in young patients; nevertheless their results in combination with ceramic bearings are not known due to the lack of reports. We analyzed the results and complications of hip hybrid arthroplasties combining second- and third-generation cemented polished tapered stems and ceramic-ceramic bearings. Methods: Results, complications related to ceramic surfaces and survival rate of 277 patients treated with hip arthroplasties with polished stems cemented with modern techniques were evaluated. The mean age was 56 years and the minimum follow-up was 6 years. Results: No radiographic loosening, migration or radiolucencies were detected. The infection rate was 1.3%. The complication rate due to ceramic bearing was 4%, revision was required in 1.4%. Seven-year survival with revision for any reason as the endpoint was 95.8% (95%CI, 94-99%) whereas it reached 100% for aseptic loosening. Dislocation with metal impregnation was responsible of almost all revisions caused from complications related to bearing surfaces. The incidence of squeaking has been exceptionally low compared to other series with cementless fixation. Conclusion: The combination of modern cementing techniques of polished stems with ceramic on ceramic bearings has proven to be an attractive alternative with a 7-year survival of 95%, and no aseptic loosening. Level of Evidence: IV
