Revision total hip arthroplasty after removal of a fractured well-fixed extensively porous-coated femoral component using a trephine.
When fracture of an extensively porous-coated femoral component occurs, its removal at revision total hip arthroplasty (THA) may require a femoral osteotomy and the use of a trephine. The remaining cortical bone after using the trephine may develop thermally induced necrosis. A retrospective review identified 11 fractured, well-fixed, uncemented, extensively porous-coated femoral components requiring removal using a trephine with a minimum of two years of follow-up. The mean time to failure was 4.6 years (1.7 to 9.1, standard deviation (sd) 2.3). These were revised using a larger extensively porous coated component, fluted tapered modular component, a proximally coated modular component, or a proximal femoral replacement. The mean clinical follow-up after revision THA was 4.9 years (2 to 22, sd 3.1). The mean diameter of the femoral component increased from 12.7 mm (sd 1.9) to 16.2 mm (sd 3.4; p > 0.001). Two revision components had radiographic evidence of subsidence that remained radiographically stable at final follow-up. The most common post-operative complication was instability affecting six patients (54.5%) on at least one occasion. A total of four patients (36.4%) required further revision: three for instability and one for fracture of the revision component. There was no statistically significant difference in the mean Harris hip score before implant fracture (82.4; sd 18.3) and after trephine removal and revision THA (81.2; sd 14.8, p = 0.918). These findings suggest that removal of a fractured, well-fixed, uncemented, extensively porous-coated femoral component using a trephine does not compromise subsequent fixation at revision THA and the patient's pre-operative level of function can be restored. However, the loss of proximal bone stock before revision may be associated with a high rate of dislocation post-operatively.
Stanford University, 450 Broadway Street, Redwood City, California 94063, USA.
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DF
Amanatullah
Mayo Clinic, 200 First Street SW, Gonda 14, Rochester, Minnesota 55906, USA.
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H
Siman
Mayo Clinic, 200 First Street SW, Gonda 14, Rochester, Minnesota 55906, USA.
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GD
Pallante
Massachusetts General Hospital, 55 Fruit Street, Suite 2C, Boston, Massachusetts 02114, USA.
D B
DB
Haber
Mayo Clinic, 200 First Street SW, Gonda 14, Rochester, Minnesota 55906, USA.
R J
RJ
Sierra
Mayo Clinic, 200 First Street SW, Gonda 14, Rochester, Minnesota 55906, USA.
R T
RT
Trousdale
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D020099:Coated Materials, Biocompatible; D020878:Device Removal / Q000379:methods*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D016062:Porosity; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies
D020099:Coated Materials, Biocompatible
Femoral component fracture; Porous-coated; Revision THA; Trephine; Uncemented