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Fracture of cobalt chrome, fully-coat beaded femoral revision long stem, a clinical outcomes study
BACKGROUND: Femoral bone loss during revision total hip arthroplasty poses a challenging problem. Bypass fixation over the diaphysis has achieved clinical success in cases of proximal femoral bone loss. Fracture of cementless, fully bead-coated femoral stem is an uncommon complication. The purpose o...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Chang Gung University
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6138770/ https://www.ncbi.nlm.nih.gov/pubmed/29673552 http://dx.doi.org/10.1016/j.bj.2018.02.001 |
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author | Chang, Chih-Hsiang Lin, Po-Chun Shih, Cheng-Min Chen, Chun-Chieh Hsieh, Pang-Hsin Shih, Hsin-Nung |
author_facet | Chang, Chih-Hsiang Lin, Po-Chun Shih, Cheng-Min Chen, Chun-Chieh Hsieh, Pang-Hsin Shih, Hsin-Nung |
author_sort | Chang, Chih-Hsiang |
collection | PubMed |
description | BACKGROUND: Femoral bone loss during revision total hip arthroplasty poses a challenging problem. Bypass fixation over the diaphysis has achieved clinical success in cases of proximal femoral bone loss. Fracture of cementless, fully bead-coated femoral stem is an uncommon complication. The purpose of this study is to analyze the patients with and without fracture stem and find out the possible risk factors. METHODS: From 2006 to 2012, a total of 251 revision long stems (Zimmer, Warsaw, IN) were implanted. In the same period, 17 broken stems that underwent treatment were included for analysis. Patients' demographic data, pattern of femoral bone loss, stem size, medial calcar support in the proximal region of the stem, and the timing of stem breakage were collected and analyzed. RESULTS: The stem size in patients with a broken stem was smaller (p < 0.001), and medial calcar defect was 12.4% and 100% (p < 0.001), respectively. The bone defect was greater in broken group (p = 0.024). The mean duration between revision surgery and stem breakage was 58.07 ± 36.98 months. Smaller stem size, greater bone defect, and inadequate medial calcar bone support were major risk factors for stem breakage. CONCLUSIONS: Bypass fixation in the distal diaphysis with a long stem prosthesis without adequate bone support over medial calcar area may cause stress concentration in the long stem and a fatigue fracture. Use of a smaller prosthesis is the major risk of stem broken. It is essential to repair the proximal femoral bone deficiency and implant selection for better metaphyseal engagement to prevent further stem complications. LEVEL OF EVIDENCE: Level III, case control study. |
format | Online Article Text |
id | pubmed-6138770 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Chang Gung University |
record_format | MEDLINE/PubMed |
spelling | pubmed-61387702018-09-27 Fracture of cobalt chrome, fully-coat beaded femoral revision long stem, a clinical outcomes study Chang, Chih-Hsiang Lin, Po-Chun Shih, Cheng-Min Chen, Chun-Chieh Hsieh, Pang-Hsin Shih, Hsin-Nung Biomed J Original Article BACKGROUND: Femoral bone loss during revision total hip arthroplasty poses a challenging problem. Bypass fixation over the diaphysis has achieved clinical success in cases of proximal femoral bone loss. Fracture of cementless, fully bead-coated femoral stem is an uncommon complication. The purpose of this study is to analyze the patients with and without fracture stem and find out the possible risk factors. METHODS: From 2006 to 2012, a total of 251 revision long stems (Zimmer, Warsaw, IN) were implanted. In the same period, 17 broken stems that underwent treatment were included for analysis. Patients' demographic data, pattern of femoral bone loss, stem size, medial calcar support in the proximal region of the stem, and the timing of stem breakage were collected and analyzed. RESULTS: The stem size in patients with a broken stem was smaller (p < 0.001), and medial calcar defect was 12.4% and 100% (p < 0.001), respectively. The bone defect was greater in broken group (p = 0.024). The mean duration between revision surgery and stem breakage was 58.07 ± 36.98 months. Smaller stem size, greater bone defect, and inadequate medial calcar bone support were major risk factors for stem breakage. CONCLUSIONS: Bypass fixation in the distal diaphysis with a long stem prosthesis without adequate bone support over medial calcar area may cause stress concentration in the long stem and a fatigue fracture. Use of a smaller prosthesis is the major risk of stem broken. It is essential to repair the proximal femoral bone deficiency and implant selection for better metaphyseal engagement to prevent further stem complications. LEVEL OF EVIDENCE: Level III, case control study. Chang Gung University 2018-02 2018-03-30 /pmc/articles/PMC6138770/ /pubmed/29673552 http://dx.doi.org/10.1016/j.bj.2018.02.001 Text en © 2018 Chang Gung University. Publishing services by Elsevier B.V. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Article Chang, Chih-Hsiang Lin, Po-Chun Shih, Cheng-Min Chen, Chun-Chieh Hsieh, Pang-Hsin Shih, Hsin-Nung Fracture of cobalt chrome, fully-coat beaded femoral revision long stem, a clinical outcomes study |
title | Fracture of cobalt chrome, fully-coat beaded femoral revision long stem, a clinical outcomes study |
title_full | Fracture of cobalt chrome, fully-coat beaded femoral revision long stem, a clinical outcomes study |
title_fullStr | Fracture of cobalt chrome, fully-coat beaded femoral revision long stem, a clinical outcomes study |
title_full_unstemmed | Fracture of cobalt chrome, fully-coat beaded femoral revision long stem, a clinical outcomes study |
title_short | Fracture of cobalt chrome, fully-coat beaded femoral revision long stem, a clinical outcomes study |
title_sort | fracture of cobalt chrome, fully-coat beaded femoral revision long stem, a clinical outcomes study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6138770/ https://www.ncbi.nlm.nih.gov/pubmed/29673552 http://dx.doi.org/10.1016/j.bj.2018.02.001 |
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