The management of femoral bone loss is challenging during revision hip arthroplasty. In patients with Paprosky grade IIIB and IV defects, obtaining fixation and rotational stability using traditional surgical constructs is difficult. The use of a custom-made internal proximal femoral replacement prostheses has been proposed as a solution in patients, with severe femoral bone stock loss. However, there is a paucity in the literature on their use and long-term outcomes. We report on the clinical and radiological results of our cohort. We retrospectively reviewed all patients who underwent internal proximal femoral replacement for revision hip arthroplasty between April 1996 and April 2019. All patients had at least 2 years of follow-up time. 160 patients underwent limb salvage at our institution using internal proximal femoral replacement. The mean follow-up was 79.7 months (S.D 41.3). Indications for revision included periprosthetic fractures, aseptic loosening, and deep infection. The mean Oxford hip score increased from 13.8 (0–22) to 31.5 (18–43) (paired t-test, p < 0.001). Kaplan-Meier prosthesis survival analysis with revision as the endpoint was 87% at 5 years. None required revision of the femoral stem. There were four dislocations (5%) and there was failure to eradicate the deep infection in four. This technique allows instant distal fixation, allowing for early mobilisation. Long-term clinical and radiological outcomes are encouraging and the complication rates are acceptable for this patient group.
Temporary spanning fixation aims to provide bony stability whilst allowing access and resuscitation of traumatised soft-tissues. Conventional monolateral fixators are prone to half-pin morbidity in feet, variation in construct stability and limited weight-bearing potential. This study compares traditional delta-frame fixators to a circular trauma frame; a virtual tibial ring block spanned onto a fine-wire foot ring fixation. The two cohorts were compared for demographics and fracture patterns. The quality of initial reduction and the maintenance of reduction until definitive surgery was assessed by two authors and categorised into four domains. Secondary measures included fixator costs, time to definitive surgery and complications.Introduction
Materials and Methods
Additive manufacturing has enabled a radical change in how surgeons reconstruct massive acetabular defects in revision hip surgery. We report on the early clinical and radiological results from our methods for surgical planning, design, and implantation of 3D printed trabecular titanium implants in a cohort of patients with large unclassifiable pelvic defects. We set up a prospective investigation involving 7 consecutive patients. Inclusion criteria was the following: 1) A history of previous total hip replacement; and 2) Current imaging showing at least a Paprosky 3B defect. Planned acetabular inclination and version was 40° and 20° respectively. Post operatively all patients had a CT scan which was analysed with software to determine component position and compared to planned. Outpatient review was done at 2 weeks (For wound), 6 weeks (for weight bearing and fixation) and 52 weeks (for fixation and infection) post-operative. The median age at surgery was: 65 years (40–78). The median bone defect volume was 140cm3. Median surgery length was 5.2 hours (3–6.25). Median blood loss was 1300mL (450– 2000). Radiologically, components were stable and no screw breakages were identified. Achieved inclination was 41.0° (29.0–55.6) and achieved version was 15.8° (3.8–43.6). Median Oxford Hip score improved from 9 (2–44) to 25 (18–32). We have demonstrated a new series of pre, intra and post-operative methods for reconstruction of unclassifiable acetabular bony defects. Initial clinical and radiological results are excellent considering the severity of the bony defects. We recommend the use of our or similar methods when trying to reconstruct these defects.
