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Endofemoral Shooting Technique for Removing Well-fixed Cementless Stems

BACKGROUND: The removal of a well-fixed cementless stem poses technical challenges. The aim of this study was to evaluate the outcomes of our endofemoral extraction technique established in 2001. METHODS: Between January 2001 and December 2016, 118 consecutive revisions following bipolar or total hi...

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Autores principales: Oe, Kenichi, Iida, Hirokazu, Toyoda, Takashi, Nakamura, Tomohisa, Okamoto, Naofumi, Saito, Takanori
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9399389/
https://www.ncbi.nlm.nih.gov/pubmed/36032794
http://dx.doi.org/10.1016/j.artd.2022.07.007
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author Oe, Kenichi
Iida, Hirokazu
Toyoda, Takashi
Nakamura, Tomohisa
Okamoto, Naofumi
Saito, Takanori
author_facet Oe, Kenichi
Iida, Hirokazu
Toyoda, Takashi
Nakamura, Tomohisa
Okamoto, Naofumi
Saito, Takanori
author_sort Oe, Kenichi
collection PubMed
description BACKGROUND: The removal of a well-fixed cementless stem poses technical challenges. The aim of this study was to evaluate the outcomes of our endofemoral extraction technique established in 2001. METHODS: Between January 2001 and December 2016, 118 consecutive revisions following bipolar or total hip arthroplasty, which required cementless femoral stem removal, were performed at our institution. This retrospective study evaluated 106 patients (108 hips) who were followed up for a mean of 9.2 years (range, 5-20 years). The patients included 15 men and 91 women with a mean age of 65 years (range, 33-87 years). Endofemoral extracted stem removal was performed as follows. Multiple Kirschner wires were sequentially inserted into the interface between the implant and cortical bone, after which the implant was detached using a thin chisel. After the cementless stem was removed, it was replaced with a cemented stem using an autograft, as needed. Radiological loosening of the femoral stem was defined as definite or probable loosening, based on the criteria of Harris et al. Prosthesis survival was analyzed using the Kaplan-Meier method, with the endpoint set as repeat revision surgery for stem loosening or femoral fracture. RESULTS: Re-revision surgery was performed in 7 hips. Stem loosening was observed in 4 hips, and the mean subsidence was 0.3 mm (0-3 mm). The 10-year survival rate was 97.7% (95% confidence interval, 93.2-100). CONCLUSIONS: Our technique for removing well-fixed cementless stems yielded successful results.
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spelling pubmed-93993892022-08-25 Endofemoral Shooting Technique for Removing Well-fixed Cementless Stems Oe, Kenichi Iida, Hirokazu Toyoda, Takashi Nakamura, Tomohisa Okamoto, Naofumi Saito, Takanori Arthroplast Today Original Research BACKGROUND: The removal of a well-fixed cementless stem poses technical challenges. The aim of this study was to evaluate the outcomes of our endofemoral extraction technique established in 2001. METHODS: Between January 2001 and December 2016, 118 consecutive revisions following bipolar or total hip arthroplasty, which required cementless femoral stem removal, were performed at our institution. This retrospective study evaluated 106 patients (108 hips) who were followed up for a mean of 9.2 years (range, 5-20 years). The patients included 15 men and 91 women with a mean age of 65 years (range, 33-87 years). Endofemoral extracted stem removal was performed as follows. Multiple Kirschner wires were sequentially inserted into the interface between the implant and cortical bone, after which the implant was detached using a thin chisel. After the cementless stem was removed, it was replaced with a cemented stem using an autograft, as needed. Radiological loosening of the femoral stem was defined as definite or probable loosening, based on the criteria of Harris et al. Prosthesis survival was analyzed using the Kaplan-Meier method, with the endpoint set as repeat revision surgery for stem loosening or femoral fracture. RESULTS: Re-revision surgery was performed in 7 hips. Stem loosening was observed in 4 hips, and the mean subsidence was 0.3 mm (0-3 mm). The 10-year survival rate was 97.7% (95% confidence interval, 93.2-100). CONCLUSIONS: Our technique for removing well-fixed cementless stems yielded successful results. Elsevier 2022-08-15 /pmc/articles/PMC9399389/ /pubmed/36032794 http://dx.doi.org/10.1016/j.artd.2022.07.007 Text en © 2022 The Authors https://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 Research
Oe, Kenichi
Iida, Hirokazu
Toyoda, Takashi
Nakamura, Tomohisa
Okamoto, Naofumi
Saito, Takanori
Endofemoral Shooting Technique for Removing Well-fixed Cementless Stems
title Endofemoral Shooting Technique for Removing Well-fixed Cementless Stems
title_full Endofemoral Shooting Technique for Removing Well-fixed Cementless Stems
title_fullStr Endofemoral Shooting Technique for Removing Well-fixed Cementless Stems
title_full_unstemmed Endofemoral Shooting Technique for Removing Well-fixed Cementless Stems
title_short Endofemoral Shooting Technique for Removing Well-fixed Cementless Stems
title_sort endofemoral shooting technique for removing well-fixed cementless stems
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9399389/
https://www.ncbi.nlm.nih.gov/pubmed/36032794
http://dx.doi.org/10.1016/j.artd.2022.07.007
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