Abstract
Background
Well-fixed cementless stems are sometimes needed to be extracted in patients with complications including periprosthetic infection, stem-neck breakage or trunnionosis. The purpose of this study was to report the clinical outcome in patients undergoing re-implantation surgery following removal of a well-fixed porous-coated cementless stem by the femoral longitudinal split (FLS) procedure(Fig.1, Fig.2).
Methods
We conducted a retrospective study and radiographic review of 16 patients who had undergone re-implantation following the FLS procedure to remove a well-fixed stem due to periprosthetic infection, stem-neck breakage or trunnionosis. The study group consisted of 2 men and 14women with an average age of 68.4 years. Mean follow-up was 33.1± 25.0 months. Operation time, intraoperative bleeding, complications, causes of re-operation and clinical score were evaluated and the Kaplan-Meier method was used to evaluate the longevity of the stem.
Results
The average operation time was 272±63 minutes and intraoperative bleeding was 420±170 ml. Although postoperative dislocation occurred in 5 hips and sinking of the stem was found in 3 hips after surgery, no progression of the stem sinking was observed and the clinical JOA and JHEQ scores were both improved after re-implantation surgery. Re-implantation surgery with Zweymüller-type stems, which are shorter than those removed, revealed evidence of osseointegration of the stem without femoral fracture. Kaplan-Meier survival analysis of stem revision for any reason as the end point revealed 70.3% survival at 9 years (Fig.3).
Conclusion
The FLS procedure is expected to confer successful clinical results without loosening of the stem, following safe extraction of well-fixed porous-coated cementless stems without fracture and will allow re-implantation with shorter cementless stems than those removed.
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