Revision Hip Replacement (Subscribe)  

Femoral offset influences the forces at the hip and the implant stresses after revision THR. For extended bone defects, these forces may cause considerable bending moments within the implant, possibly leading to implant failure. This study investigates the influences of femoral anteversion and offset on stresses in the Wagner SL...

Background Several studies suggest that histologic findings from tissues obtained at revision arthroplasty for failed metal-on-metal (MOM) total hip implants may reflect an immune reaction to particles or ions in some patients. However, only a limited number of cases without MOM implants were reported as controls in those studies.
Questions/purposes The purpose of...

The treatment of asymptomatic osteolysis among well-fixed cementless cups remains controversial. To compare the effectiveness of different treatment strategies, an objective technique for evaluating bone remodeling would be useful. By matching and comparing serial CT images with the aid of a computer-assisted imaging program, we developed a method to evaluate...

Wheeless Textbook of Orthopaedics (THR) - Loosening of Uncemented Acetabular Components: (press fit acetabular components) - normal bone ingrowth: - generally for bone ingrowth to occur, the component must lie with 50 micrometers of the...

Healing of acetabular bone grafts may be difficult to assess in conventional radiographs. We used PET to analyze healing of morselized bone allografts, impacted in large osteolytic acetabular defects at revision arthroplasty.
NTERPRETATION: We found PET to be a sensitive and useful method for evaluation of the spatial and temporal development...

A 52 yr old lady presented to the complex joint clinic complaining of right thigh pain for the past 2 months. The pain is exacerbated by rising from a sitting position, walking and especially when turning or changing direction when walking. It is a constant dull ache. She is now...

Paul E. Di Cesare, MD Co-Director, Arthritis Service Director, Cartilage & Bone Research Center Hospital for Joint Diseases Orthopaedic Institute New York
Removal of well-fixed or loose, cemented (polymethylmethacrylate) total hip components presents many challenges to the orthopaedic surgeon. In cases of loose components with extensive bone-cement radiolucencies, extraction may not be too difficult because...

Removal of the femoral stem can be challenging for the orthopaedic surgeon. The decision between performing an extended trochanteric osteotomy (ETO) or trying to remove the femoral stem without an osteotomy and taking the risk of an intraoperative fracture is often hard to make.
Purpose of the study was thus to...

Porous surfaces are intended to enhance osteointegration of cementless implants. Tantalum has been introduced in an effort to enhance osseointegration potential of uncemented components. We therefore compared the clinical outcome of acetabular components with two different porous surfaces.
The titanium and tantalum groups had a mechanical failure rate (clinical plus radiographic)...

CONCLUSIONS: Cementing the cage to the pelvis can offer an advantage for treating severe acetabular defects. Trabecular metal augmentation appears to provide better initial mechanical stability than a structural allograft, but successful allograft reconstruction may restore bone stock.
Does a cemented cage improve revision THA for severe acetabular defects? Hansen E, Shearer...

For various reasons the tapered, fluted, modular titanium (TFMT) stem has become our component of choice over cylindrical, nonmodular cobalt chrome (CNCC) components for THA revision. We therefore asked whether the TFMT femoral components better achieved three important goals of revision arthroplasty than CNCC stems: (1) improving quality of life;...

Isolated acetabular revision can be associated with variable patient outcomes; there is a risk of hip instability. We evaluated 42 isolated acetabular revision operations and investigated the impact of patient age, diagnosis, bone stock, bone loss, bone augmentation, and obesity on pain and the Harris hip score. Preoperative radiographs were...

Perivascular and diffuse lymphocytic inflammation are not specific for failed metal-on-metal hip implants. Fujishiro T, Moojen DJ, Kobayashi N, Dhert WJ, Bauer TW. Clin Orthop Relat Res. 2011 Apr;469(4):1127-33. (full text)

Intraoperative frozen section (FS) consultation is used in evaluating possible infection in cases of hip and knee revision arthroplasty, serving as an adjunct to preoperative and intraoperative studies. We examined our experience for more than 11 years to determine if FS examination had value when sections were sent unselectively. As...

This outline reviews many of the classification schemes that aid in treatment decisions in revision total hip arthroplasty.