The anterior femoral cortical window as an alternative to an extended trochanteric osteotomy in revision hip arthroplasty surgery: the evolution of the surgical technique and outcomes in 22 consecutive cases.

IF 1.3 4区 医学 Q3 ORTHOPEDICS
David Morley, Michael C Wyatt, John van Dalen
{"title":"The anterior femoral cortical window as an alternative to an extended trochanteric osteotomy in revision hip arthroplasty surgery: the evolution of the surgical technique and outcomes in 22 consecutive cases.","authors":"David Morley, Michael C Wyatt, John van Dalen","doi":"10.1177/11207000241267704","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The anterior femoral cortical window is an attractive alternative to the extended trochanteric osteotomy when removing femoral cement in revision hip arthroplasty. CT-based additive manufacturing technology has now permitted the creation of patient-specific instrumented (PSI) jigs to facilitate this. The jig simplifies creation of the window, potentiating medullary exposure through an optimally-sized window and therefore cement removal. Between 2006 and 2021 this technique was used in 22 cases at a regional hospital in New Zealand (mean age 74; range 44 to 89 years). 16 cases were for aseptic loosening and 6 for infection. We describe the technique and our case series. Bone incorporation for the cortical window was assessed in all cases using CT imaging. Oxford scores were obtained at a minimum of 6 months after revision surgery. Of the 6 septic cases 5 went onto successful stage-2 procedures, the other to a Girdlestone procedure.</p><p><strong>Results: </strong>The mean rectangular shaped window size was 8 × 1.5 cm and in each case, this provided adequate intramedullary access. On average at minimum 5 months post-surgery, 84% bone incorporation of the cortical window occurred on CT (40-100%). The functional outcome Oxford hip score was 37 (range 22-48) for 10 cases. There were 2 cases with femoral component subsidence which then stabilised.</p><p><strong>Conclusions: </strong>This technique description and retrospective case series has shown the effectiveness of removing a distal femoral cement mantle in revision hip arthroplasty using an anterior femoral cortical window, recently optimised using a PSI jig. This technique is a straightforward alternative to a trochanteric osteotomy. Reliable bony integration of the cortical window occurred and functional outcomes were comparable with the mean score for revision hip procedures reported in the New Zealand Joint Registry.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"HIP International","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/11207000241267704","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: The anterior femoral cortical window is an attractive alternative to the extended trochanteric osteotomy when removing femoral cement in revision hip arthroplasty. CT-based additive manufacturing technology has now permitted the creation of patient-specific instrumented (PSI) jigs to facilitate this. The jig simplifies creation of the window, potentiating medullary exposure through an optimally-sized window and therefore cement removal. Between 2006 and 2021 this technique was used in 22 cases at a regional hospital in New Zealand (mean age 74; range 44 to 89 years). 16 cases were for aseptic loosening and 6 for infection. We describe the technique and our case series. Bone incorporation for the cortical window was assessed in all cases using CT imaging. Oxford scores were obtained at a minimum of 6 months after revision surgery. Of the 6 septic cases 5 went onto successful stage-2 procedures, the other to a Girdlestone procedure.

Results: The mean rectangular shaped window size was 8 × 1.5 cm and in each case, this provided adequate intramedullary access. On average at minimum 5 months post-surgery, 84% bone incorporation of the cortical window occurred on CT (40-100%). The functional outcome Oxford hip score was 37 (range 22-48) for 10 cases. There were 2 cases with femoral component subsidence which then stabilised.

Conclusions: This technique description and retrospective case series has shown the effectiveness of removing a distal femoral cement mantle in revision hip arthroplasty using an anterior femoral cortical window, recently optimised using a PSI jig. This technique is a straightforward alternative to a trochanteric osteotomy. Reliable bony integration of the cortical window occurred and functional outcomes were comparable with the mean score for revision hip procedures reported in the New Zealand Joint Registry.

在翻修髋关节置换手术中,股骨皮质前窗可替代延长转子截骨术:手术技术的演变和 22 例连续病例的疗效。
背景:在翻修髋关节置换术中清除股骨骨水泥时,股骨皮质前窗是一种极具吸引力的替代方法。目前,基于 CT 的快速成型技术已能制造出患者特异性器械夹具 (PSI),以实现这一目的。该夹具简化了开窗过程,通过最佳尺寸的开窗使髓质暴露更充分,从而达到清除骨水泥的目的。2006 年至 2021 年间,新西兰一家地区医院在 22 个病例(平均年龄 74 岁;44 至 89 岁不等)中使用了这种技术。其中16例为无菌性松动,6例为感染。我们将介绍这项技术和我们的病例系列。所有病例均通过CT成像评估了皮质窗的骨结合情况。翻修手术后至少 6 个月进行牛津评分。在6例化脓性病例中,5例成功进行了第二阶段手术,另1例进行了Girdlestone手术:平均矩形窗口大小为 8 × 1.5 厘米,每个病例都能提供足够的髓内通道。手术后至少 5 个月,CT 显示皮质窗的平均骨结合率为 84%(40%-100%)。10例患者的牛津髋关节功能评分为37分(范围为22-48分)。有2例股骨组件下沉,但随后趋于稳定:该技术描述和回顾性病例系列显示了在翻修髋关节置换术中使用股骨皮质前窗去除股骨远端骨水泥套的有效性,最近使用PSI夹具对该技术进行了优化。该技术可直接替代股骨转子截骨术。皮质窗实现了可靠的骨整合,功能结果与新西兰关节登记处报告的翻修髋关节手术平均得分相当。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
HIP International
HIP International 医学-整形外科
CiteScore
4.20
自引率
0.00%
发文量
70
审稿时长
2 months
期刊介绍: HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信