Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Chang, Chih-Hsiang, Lin, Po-Chun, Shih, Cheng-Min, Chen, Chun-Chieh, Hsieh, Pang-Hsin, Shih, Hsin-Nung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Chang Gung University 2018
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
_version_ 1783355396342153216
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
work_keys_str_mv AT changchihhsiang fractureofcobaltchromefullycoatbeadedfemoralrevisionlongstemaclinicaloutcomesstudy
AT linpochun fractureofcobaltchromefullycoatbeadedfemoralrevisionlongstemaclinicaloutcomesstudy
AT shihchengmin fractureofcobaltchromefullycoatbeadedfemoralrevisionlongstemaclinicaloutcomesstudy
AT chenchunchieh fractureofcobaltchromefullycoatbeadedfemoralrevisionlongstemaclinicaloutcomesstudy
AT hsiehpanghsin fractureofcobaltchromefullycoatbeadedfemoralrevisionlongstemaclinicaloutcomesstudy
AT shihhsinnung fractureofcobaltchromefullycoatbeadedfemoralrevisionlongstemaclinicaloutcomesstudy