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. 2019 Oct 2;11(3):8263.
doi: 10.4081/or.2019.8263. eCollection 2019 Sep 24.

Is cemented revision total hip arthroplasty a reasonable treatment option in an elderly population?

Philipp Born  1 , Isabella Manzoni  1 , Thomas Ilchmann  1   2 , Martin Clauss  1   3
Affiliations

Is cemented revision total hip arthroplasty a reasonable treatment option in an elderly population?

Philipp Born et al. Orthop Rev (Pavia). .

Abstract

Revision THA is increasingly performed especially in the elderly population. The surgeon's challenge is to provide a solution that supports immediate full weight-bearing, despite poor bone quality. Shape-closed revision stems facilitate that by combining cement fixation with additional press-fit anchoring. The design tolerates varying cement mantle thickness and inconsistent cancellous bone lining of the femoral canal. Following that philosophy, we present our mid-term results using a long version of a cemented Charnley- Kerboull type stem. From 2010 to 2017, 38 long Charnley-Kerboull revision stems (Centris®, Mathys European Orthopaedics, Bettlach, Switzerland) were implanted and followed prospectively. Surgery was performed via a Hardinge approach in supine position with a third generation cementing technique. Patients were mobilized using full-weight bearing as early as possible. Survival was determined for stem revision for aseptic loosening and stem and/or cup revision for any reason. 20 stems had a minimum follow-up (f/u) of 2 years and were included for further radiological analysis. Detailed subsidence analysis as an early predictor for later aseptic loosening was performed using EBRA-FCA software. Further, the presence of osteolysis and cement debonding was evaluated. Mean follow- up was 4 years. No patient was lost to f/u.18 died of causes unrelated to THA. Stem survival was 100%. Survival for any re-operation was 82.2% (two early infections, one soft-tissue debridement, one cup exchange for recurrent dislocations). None of the cases revised for septic loosening showed signs of persistent infection at final f/u. EBRA-FCA revealed two oligosymptomatic cases of subsidence of 5mm and 6mm over a course of 2 and 12 months, respectively, with stable implants thereafter. Neither required revision. There was no development of osteolysis or debonding. The stem provides a reliable early fullweight bearing solution for revision THA with excellent mid-term survival in an elderly population. Even in two cases where subsidence was present, mobility was not impaired and re-revision could be avoided.

Keywords: Charnley-Kerboul; French Paradox; Revision; THA; cemented; elderly patients.

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Conflict of interest statement

Conflict of interest: the authors declare no potential conflict of interest.

Figures

Figure 1.
Figure 1.
A) Charnley-Kerboull revision stem (Centris®, Mathys, Switzerland). B) Thin cement mantle surrounding the stem with additional press-fit fixation (red arrows).
Figure 2.
Figure 2.
Kaplan-Meier stem survival for any revision: 82.2% at 4 years (95% CI: 69.1-95.3%).
Figure 3.
Figure 3.
Potentially iatrogenic periprosthetic fracture (C), as the femur broke around a diaphyseal cortical window (A). ORIF failed at two months, due to plate avulsion off the proximal fragment (E). Re-ORIF (F) resulted into uneventful healing (G).
Figure 4.
Figure 4.
Subsidence analysis with EBRA-FCA software: Two cases of subsidence of (A) 5mm over 2 months and (B) 6mm over 12 months with stable implants thereafter.
See this image and copyright information in PMC

References

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