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Transfemoral Approach in Revision Hip Arthroplasty: A Prospective Analysis of 36 Cases: Radiological and Functional Results at a Minimum 2 Years Follow-up

Background and Objectives: One of the most difficult aspects of hip revision is to remove the stem from the femoral canal with or without cement while maintaining the maximal amount of bone stock to obtain the best possible press-fit of the revision prosthesis. The transfemoral approach ensures dire...

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Autores principales: Georgeanu, Vlad Alexandru, Atasiei, Tudor, Predescu, Vlad, Gheorghiu, Nicolae, Feier, Andrei Marian, Russu, Octav Marius
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8879778/
https://www.ncbi.nlm.nih.gov/pubmed/35208559
http://dx.doi.org/10.3390/medicina58020237
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author Georgeanu, Vlad Alexandru
Atasiei, Tudor
Predescu, Vlad
Gheorghiu, Nicolae
Feier, Andrei Marian
Russu, Octav Marius
author_facet Georgeanu, Vlad Alexandru
Atasiei, Tudor
Predescu, Vlad
Gheorghiu, Nicolae
Feier, Andrei Marian
Russu, Octav Marius
author_sort Georgeanu, Vlad Alexandru
collection PubMed
description Background and Objectives: One of the most difficult aspects of hip revision is to remove the stem from the femoral canal with or without cement while maintaining the maximal amount of bone stock to obtain the best possible press-fit of the revision prosthesis. The transfemoral approach ensures direct access to the medullary canal so that the content removal is completed under direct control, while protecting the bone. This type of approach is particularly efficient for special conditions, such as deformation of the proximal femoral region, broken stems, or the presence of cement over a long distance distal to the prosthesis. The aim of this study was to evaluate the main advantages of transtrochanteric approach in hip revisions. Materials and Methods: Our series included 36 revisions performed using the transfemoral approach. We have analyzed the following postoperative radiological aspects: the length of the fixation zone distal to the osteotomized bone fragment (OBF), the gap between the OBF and the diaphysis, stem subsidence over time, and OBF consolidation. Results: The results were very good, both in terms of the rate of intraoperative complications and postoperative evolution. The fixation zone length was 4.2 cm on average (range: 2 to 5.8 cm). The distal gap between the OBF and the diaphysis was 1.2 cm on average (range: 0 to 2.3 cm). Stem subsidence was noted in four cases (11.1%). In all cases, stem subsidence occurred between three and six months and was 6 to 8 mm without affecting hip stability. OBF consolidation was radiologically confirmed for all cases at one year follow-up. Clinical assessment based on the Harris Hip Score showed an overall improvement from 43.2 preoperatively to 79.7 at 12 months and 83 at two years, respectively. The most important rate of progress was between 6 months and 12 months. Conclusions: The transtrochanteric approach has been shown to be very efficient for hip revisions. Understanding the hip biomechanics, applying a less aggressive surgical technique, and using efficient fixation methods such as cables significantly improved the results.
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spelling pubmed-88797782022-02-26 Transfemoral Approach in Revision Hip Arthroplasty: A Prospective Analysis of 36 Cases: Radiological and Functional Results at a Minimum 2 Years Follow-up Georgeanu, Vlad Alexandru Atasiei, Tudor Predescu, Vlad Gheorghiu, Nicolae Feier, Andrei Marian Russu, Octav Marius Medicina (Kaunas) Article Background and Objectives: One of the most difficult aspects of hip revision is to remove the stem from the femoral canal with or without cement while maintaining the maximal amount of bone stock to obtain the best possible press-fit of the revision prosthesis. The transfemoral approach ensures direct access to the medullary canal so that the content removal is completed under direct control, while protecting the bone. This type of approach is particularly efficient for special conditions, such as deformation of the proximal femoral region, broken stems, or the presence of cement over a long distance distal to the prosthesis. The aim of this study was to evaluate the main advantages of transtrochanteric approach in hip revisions. Materials and Methods: Our series included 36 revisions performed using the transfemoral approach. We have analyzed the following postoperative radiological aspects: the length of the fixation zone distal to the osteotomized bone fragment (OBF), the gap between the OBF and the diaphysis, stem subsidence over time, and OBF consolidation. Results: The results were very good, both in terms of the rate of intraoperative complications and postoperative evolution. The fixation zone length was 4.2 cm on average (range: 2 to 5.8 cm). The distal gap between the OBF and the diaphysis was 1.2 cm on average (range: 0 to 2.3 cm). Stem subsidence was noted in four cases (11.1%). In all cases, stem subsidence occurred between three and six months and was 6 to 8 mm without affecting hip stability. OBF consolidation was radiologically confirmed for all cases at one year follow-up. Clinical assessment based on the Harris Hip Score showed an overall improvement from 43.2 preoperatively to 79.7 at 12 months and 83 at two years, respectively. The most important rate of progress was between 6 months and 12 months. Conclusions: The transtrochanteric approach has been shown to be very efficient for hip revisions. Understanding the hip biomechanics, applying a less aggressive surgical technique, and using efficient fixation methods such as cables significantly improved the results. MDPI 2022-02-04 /pmc/articles/PMC8879778/ /pubmed/35208559 http://dx.doi.org/10.3390/medicina58020237 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Georgeanu, Vlad Alexandru
Atasiei, Tudor
Predescu, Vlad
Gheorghiu, Nicolae
Feier, Andrei Marian
Russu, Octav Marius
Transfemoral Approach in Revision Hip Arthroplasty: A Prospective Analysis of 36 Cases: Radiological and Functional Results at a Minimum 2 Years Follow-up
title Transfemoral Approach in Revision Hip Arthroplasty: A Prospective Analysis of 36 Cases: Radiological and Functional Results at a Minimum 2 Years Follow-up
title_full Transfemoral Approach in Revision Hip Arthroplasty: A Prospective Analysis of 36 Cases: Radiological and Functional Results at a Minimum 2 Years Follow-up
title_fullStr Transfemoral Approach in Revision Hip Arthroplasty: A Prospective Analysis of 36 Cases: Radiological and Functional Results at a Minimum 2 Years Follow-up
title_full_unstemmed Transfemoral Approach in Revision Hip Arthroplasty: A Prospective Analysis of 36 Cases: Radiological and Functional Results at a Minimum 2 Years Follow-up
title_short Transfemoral Approach in Revision Hip Arthroplasty: A Prospective Analysis of 36 Cases: Radiological and Functional Results at a Minimum 2 Years Follow-up
title_sort transfemoral approach in revision hip arthroplasty: a prospective analysis of 36 cases: radiological and functional results at a minimum 2 years follow-up
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8879778/
https://www.ncbi.nlm.nih.gov/pubmed/35208559
http://dx.doi.org/10.3390/medicina58020237
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