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...

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...

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...

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...

Now that orthopedic surgeons have an established standard of care for infected total hip arthroplasty, one expert is advocating they now focus on finding a cure for the 4% to 5% of cases that become reinfected. According to Clive P. Duncan, MD, FRCS(C), two-stage revision using a temporary prosthesis made of...

Notes on -
- evaluation of the painful THR
- indications for revision:
- evaluation for loosening:
Examination
Pre-op planning
Surgical Technique
Wheeless' Textbook of Orthopaedics

Conclusions Acetabular reconstruction with impaction bone grafting and a cemented cup is a reliable technique with a 10-year survival rate of 88% in patients with extensive acetabular deficiencies.
Revisions of extensive acetabular defects with impaction grafting and a cement cup. van Egmond N, De Kam DC, Gardeniers JW, Schreurs BW. Clin Orthop Relat Res....

We studied the histology of the cement-bone interface and the regenerated synovium in ten aseptically loosened arthroplasties in rheumatoid patients. In two patients we found rheumatoid nodules at the cement-bone interface and marked lymphoplasmacytic infiltration in another three. Failed joints in osteoarthritic patients did not show these changes, and it...

Background Orthopaedic surgeons frequently encounter patients with ankylosing spondylitis who would benefit from various types of lower limb operations; however, some of these patients present challenges for anesthesiologists.
Case Description We report the case of a 65-year-old patient with a fractured femoral component 30 years after a cemented THA. The patient had severe...