Revision Surgery: Cemented Monoblock Stem Following Failure of Osteosynthesis in Extracapsular Hip Fractures
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Published:
Feb 24, 2025
Keywords:
Revision, failure, osteosynthesis
Main Article Content
Abstract
Introduction: This study presents our experience with revision surgery using total hip arthroplasty with a dual mobility acetabular cup and a cemented stem as a treatment for failed osteosynthesis in extracapsular fractures.
Materials and Methods: A series of 38 patients operated on by the same surgical team between January 2015 and December 2022 was evaluated. Demographic data and variables related to the patients’ clinical evolution up to their last follow-up after revision surgery were collected. Functional outcomes were assessed using the Harris Hip Score, the Barthel Index, and the Visual Analog Scale (VAS). Radiological outcomes were analyzed using the Brooker and Paprosky classifications. Procedure-related complications were also recorded.
Results: The mean patient age was 81.4 years, with an average follow-up period of 28 months. The mean time from osteosynthesis to revision surgery was 6.5 months. The most frequent femoral defects were classified as Paprosky grades I and IIA. The mean scores achieved were 86.2 (range: 65–96) on the Harris Hip Score, 91.2 (range: 70–95) on the Barthel Index, and 2.05 (range: 0–5) on the VAS. Complications included three cases of prosthetic dislocation (7.8%) and two cases of chronic infection (5.2%), both requiring surgical revision.
Conclusions: Salvage treatment for failed osteosynthesis in extracapsular hip fractures using total hiparthroplasty with a dual mobility acetabular cup and a cemented stem demonstrates favorable clinical and functional outcomes, with high implant survival rates.
Materials and Methods: A series of 38 patients operated on by the same surgical team between January 2015 and December 2022 was evaluated. Demographic data and variables related to the patients’ clinical evolution up to their last follow-up after revision surgery were collected. Functional outcomes were assessed using the Harris Hip Score, the Barthel Index, and the Visual Analog Scale (VAS). Radiological outcomes were analyzed using the Brooker and Paprosky classifications. Procedure-related complications were also recorded.
Results: The mean patient age was 81.4 years, with an average follow-up period of 28 months. The mean time from osteosynthesis to revision surgery was 6.5 months. The most frequent femoral defects were classified as Paprosky grades I and IIA. The mean scores achieved were 86.2 (range: 65–96) on the Harris Hip Score, 91.2 (range: 70–95) on the Barthel Index, and 2.05 (range: 0–5) on the VAS. Complications included three cases of prosthetic dislocation (7.8%) and two cases of chronic infection (5.2%), both requiring surgical revision.
Conclusions: Salvage treatment for failed osteosynthesis in extracapsular hip fractures using total hiparthroplasty with a dual mobility acetabular cup and a cemented stem demonstrates favorable clinical and functional outcomes, with high implant survival rates.
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Garrido Ferrer, J. F., Sánchez Losilla, C., Diranzo García, J., Estrems Díaz, V., & Hernández Ferrando, L. (2025). Revision Surgery: Cemented Monoblock Stem Following Failure of Osteosynthesis in Extracapsular Hip Fractures. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(1), 7-14. https://doi.org/10.15417/issn.1852-7434.2025.90.1.1903
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Clinical Research
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References
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United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
2. Ong KL, Mowat FS, Chan N, Lau E, Halpern MT, Kurtz SM. Economic burden of revision hip and knee
arthroplasty in Medicare enrollees. Clin Orthop Relat Res 2006;446:22-8. https://doi.org/10.1097/01.blo.0000214439.95268.59
3. Amanatullah DF, Howard JL, Siman H, Trousdale RT, Mabry TM, Berry DJ. Revision total hip arthroplasty in
patients with extensive proximal femoral bone loss using a fluted, tapered, modular femoral component. Bone Joint J 2015;97(3):312-7. https://doi.org/10.1302/0301-620X.97B3.34684
4. Sheth NP, Nelson CL, Paprosky WG. Femoral bone loss in revision total hip arthroplasty: evaluation and
management. J Am Acad Orthop Surg 2013;21(10):601-2. https://doi.org/10.5435/JAAOS-21-10-601
5. Yu W, Han X, Chen W, Mao S, Zhao M, Zhang X, et al. Conversion from a failed proximal femoral nail antirotation to a cemented or uncemented total hip arthroplasty device: a retrospective review of 198 hips with previous intertrochanteric femur fractures. BMC Musculoskelet Disord 2020;21(1):791.
https://doi.org/10.1186/s12891-020-03806-0
6. Zhang W, Xavier RPA, Decruz J, Chen YD, Park DH. Risk factors for mechanical failure of intertrochanteric
fractures after fixation with proximal femoral nail antirotation (PFNA II): a study in a southeast Asian population.
Arch Orthop Trauma Surg 2021;141(4):569-75. https://doi.org/10.1007/s00402-020-03399-2
7. Goffin JM, Pankaj P, Simpson A, Seil R, GerichTG. Does bone compaction around the helical blade of a proximal
femoral nail antirotation (PFNA) decrease the risk of cut-out? Bone Joint Res 2013;2(5):79-83. https://doi.org/10.1302/2046-3758.25.2000150
8. Towle KM, Monnot AD. An assessment of gender-specific risk of implant revision after primary total hip
arthroplasty: a systematic review and meta-analysis. J Arthroplasty 2016;31(12):2941-8. https://doi.org/10.1016/j.arth.2016.07.047
9. Taylor JW, Frampton C, Rothwell AG. Long-term survival of total hip arthroplasty using implants from different
manufacturers. J Arthroplasty 2018;33(2):491-5. https://doi.org/10.1016/j.arth.2016.07.047
10. Zeng X, Zhan K, Zhang L, Zeng D, Yu W, Zhang X, et al. Conversion to total hip arthroplasty after failed proximal femoral nail antirotations or dynamic hip screw fixations for stable intertrochanteric femur fractures: a retrospective study with a mínimum follow-up of 3 years. BMC Musculoskelet Disord 2017;18(1):1-7.
https://doi.org/10.1186/s12891-017-1415-6
11. Marquina-Moraleda V, Diranzo J, Estrems V, Marco L, Jara F, Hernández L. Resultados clínicos en cirugía de
revisión protésica de cadera con defectos acetabulares leves: estudio comparativo retrospectivo de cotilos con doble movilidad y cotilos monopolares. Acta Ortop Mex 2023;37(4):221-6. https://doi.org/10.35366/113616
12. Diranzo-García J, Hernández-Ferrando L, Estrems-Díaz V, Castillo-Ruipérez L, Zarzuela-Sánchez VM, Bru-Pomer
A. Cirugía de revisión femoral con vástagos monobloque de recubrimiento completo. Resultados a largo plazo de 78 casos. Acta Ortop Mex 2021;35(1).33-9. https://doi.org/10.35366/100928
13. Mahomed NN, Arndt DC, McGrory BJ, Harris WH. The Harris hip score: comparison of patient self-report with
surgeon assessment. J Arthroplasty 2001;16(5):575-80. https://doi.org/10.1054/arth.2001.23716
14. Cid-Ruzafa J, Damián-Moreno J. Valoración de la discapacidad física: el índice de Barthel. Rev Esp Salud
Pública 1997;71(2):127-37. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_abstract&pid=S1135-
57271997000200004&lng=es&nrm=iso&tlng=es
15. De Cassai A, Boscolo A, Tonetti T, Ban I, Ori C. Assignment of ASA-physical status relates to anesthesiologists’
experience: a survey-based national-study. Korean J Anesthesiol 2019;72(1):53-9. https://doi.org/10.4097/kja.d.18.00224
16. Della Valle CJ, Paprosky WG. The femur in revision total hip arthroplasty evaluation and classification. Clin Orthop Relat Res 2004;(420):55-62. https://doi.org/10.1097/00003086-200403000-00009
17. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement.
Incidence and a method of classification. J Bone Joint Surg Am 1973;55(8):1629-32. PMID: 4217797
18. Girard J, Roche O, Wavreille G, Canovas F, Le Béguec P. Stem subsidence after total hip revision: 183 cases at 5.9 years follow-up. Orthop Traumatol Surg Res 2011;97(2):121-6. https://doi.org/10.1016/j.otsr.2010.10.006
19. Engh CA, Bobyn JD. The influence of stem size and extent of porous coating on femoral bone resorption after
primary cementless hip arthroplasty. Clin Orthop Relat Res 1988;(231):7-28. PMID: 3370887
20. Anglen JO, Weinstein JN. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice: a review of the American Board of Orthopaedic Surgery database. J Bone Joint Surg Am 2008;90(4):700-7.
https://doi.org/10.2106/JBJS.G.00517
21. Mulroy WF, Harris WH. Revision total hip arthroplasty with the use of so-called second-generation cementing
techniques for aseptic loosening of the femoral component. A fifteen-year-average follow-up study. J Bone Joint
Surg Am 1996;78(3):325-30. https://doi.org/10.2106/00004623-199603000-00002
22. Kavanagh BF, Ilstrup DM, Fitzgerald RH. Revision total hip arthroplasty. J Bone Joint Surg Am 1985;67(4):517-26. PMID: 3980495
23. Pellicci PM, Wilson PD Jr, Sledge CB, Salvati EA, Ranawat CS, Poss R, et al. Long-term results of revision total
hip replacement. J Bone Joint Surg Am 1985;67(4):513-6. PMID: 3980494
24. Berry DJ, Harmsen WS, Ilstrup D, Lewallen DG, Cabanela ME. Survivorship of uncemented proximally porouscoated femoral components. Clin Orthop Relat Res 1995;(319):168-77. PMID: 7554627
25. Li Y, Zhang Y, Yu M, Huang T, Li K, Ye J, et al. Favorable revision-free survivorship of cemented arthroplasty
following failed proximal femoral nail antirotation: A case series with a median follow-up of 10 years. BMC
Musculoskelet Disord 2022;23(1):1024. https://doi.org/10.1186/s12891-022-05995-2
26. Krishnamurthy AB, MacDonald SJ, Paprosky WG. 5- to 13-year follow-up study on cementless femoral
components in revision surgery. J Arthroplasty 1997;12(8):839-47. https://doi.org/10.1016/s0883-5403(97)90152-2
27. Weeden SH, Paprosky WG. Minimal 11-year follow-up of extensively porous coated stems in femoral revisión total hip arthroplasty. J Arthroplasty 2002;17(4 Suppl 1):134-7. https://doi.org/10.1054/arth.2002.32461
28. Lachiewicz PF, Soileau ES. What is the survivorship of fully coated femoral components in revision hip
arthroplasty? Clin Orthop Relat Res 2015;473:549-54. https://doi.org/10.1007/s11999-014-3689-4
United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
2. Ong KL, Mowat FS, Chan N, Lau E, Halpern MT, Kurtz SM. Economic burden of revision hip and knee
arthroplasty in Medicare enrollees. Clin Orthop Relat Res 2006;446:22-8. https://doi.org/10.1097/01.blo.0000214439.95268.59
3. Amanatullah DF, Howard JL, Siman H, Trousdale RT, Mabry TM, Berry DJ. Revision total hip arthroplasty in
patients with extensive proximal femoral bone loss using a fluted, tapered, modular femoral component. Bone Joint J 2015;97(3):312-7. https://doi.org/10.1302/0301-620X.97B3.34684
4. Sheth NP, Nelson CL, Paprosky WG. Femoral bone loss in revision total hip arthroplasty: evaluation and
management. J Am Acad Orthop Surg 2013;21(10):601-2. https://doi.org/10.5435/JAAOS-21-10-601
5. Yu W, Han X, Chen W, Mao S, Zhao M, Zhang X, et al. Conversion from a failed proximal femoral nail antirotation to a cemented or uncemented total hip arthroplasty device: a retrospective review of 198 hips with previous intertrochanteric femur fractures. BMC Musculoskelet Disord 2020;21(1):791.
https://doi.org/10.1186/s12891-020-03806-0
6. Zhang W, Xavier RPA, Decruz J, Chen YD, Park DH. Risk factors for mechanical failure of intertrochanteric
fractures after fixation with proximal femoral nail antirotation (PFNA II): a study in a southeast Asian population.
Arch Orthop Trauma Surg 2021;141(4):569-75. https://doi.org/10.1007/s00402-020-03399-2
7. Goffin JM, Pankaj P, Simpson A, Seil R, GerichTG. Does bone compaction around the helical blade of a proximal
femoral nail antirotation (PFNA) decrease the risk of cut-out? Bone Joint Res 2013;2(5):79-83. https://doi.org/10.1302/2046-3758.25.2000150
8. Towle KM, Monnot AD. An assessment of gender-specific risk of implant revision after primary total hip
arthroplasty: a systematic review and meta-analysis. J Arthroplasty 2016;31(12):2941-8. https://doi.org/10.1016/j.arth.2016.07.047
9. Taylor JW, Frampton C, Rothwell AG. Long-term survival of total hip arthroplasty using implants from different
manufacturers. J Arthroplasty 2018;33(2):491-5. https://doi.org/10.1016/j.arth.2016.07.047
10. Zeng X, Zhan K, Zhang L, Zeng D, Yu W, Zhang X, et al. Conversion to total hip arthroplasty after failed proximal femoral nail antirotations or dynamic hip screw fixations for stable intertrochanteric femur fractures: a retrospective study with a mínimum follow-up of 3 years. BMC Musculoskelet Disord 2017;18(1):1-7.
https://doi.org/10.1186/s12891-017-1415-6
11. Marquina-Moraleda V, Diranzo J, Estrems V, Marco L, Jara F, Hernández L. Resultados clínicos en cirugía de
revisión protésica de cadera con defectos acetabulares leves: estudio comparativo retrospectivo de cotilos con doble movilidad y cotilos monopolares. Acta Ortop Mex 2023;37(4):221-6. https://doi.org/10.35366/113616
12. Diranzo-García J, Hernández-Ferrando L, Estrems-Díaz V, Castillo-Ruipérez L, Zarzuela-Sánchez VM, Bru-Pomer
A. Cirugía de revisión femoral con vástagos monobloque de recubrimiento completo. Resultados a largo plazo de 78 casos. Acta Ortop Mex 2021;35(1).33-9. https://doi.org/10.35366/100928
13. Mahomed NN, Arndt DC, McGrory BJ, Harris WH. The Harris hip score: comparison of patient self-report with
surgeon assessment. J Arthroplasty 2001;16(5):575-80. https://doi.org/10.1054/arth.2001.23716
14. Cid-Ruzafa J, Damián-Moreno J. Valoración de la discapacidad física: el índice de Barthel. Rev Esp Salud
Pública 1997;71(2):127-37. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_abstract&pid=S1135-
57271997000200004&lng=es&nrm=iso&tlng=es
15. De Cassai A, Boscolo A, Tonetti T, Ban I, Ori C. Assignment of ASA-physical status relates to anesthesiologists’
experience: a survey-based national-study. Korean J Anesthesiol 2019;72(1):53-9. https://doi.org/10.4097/kja.d.18.00224
16. Della Valle CJ, Paprosky WG. The femur in revision total hip arthroplasty evaluation and classification. Clin Orthop Relat Res 2004;(420):55-62. https://doi.org/10.1097/00003086-200403000-00009
17. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement.
Incidence and a method of classification. J Bone Joint Surg Am 1973;55(8):1629-32. PMID: 4217797
18. Girard J, Roche O, Wavreille G, Canovas F, Le Béguec P. Stem subsidence after total hip revision: 183 cases at 5.9 years follow-up. Orthop Traumatol Surg Res 2011;97(2):121-6. https://doi.org/10.1016/j.otsr.2010.10.006
19. Engh CA, Bobyn JD. The influence of stem size and extent of porous coating on femoral bone resorption after
primary cementless hip arthroplasty. Clin Orthop Relat Res 1988;(231):7-28. PMID: 3370887
20. Anglen JO, Weinstein JN. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice: a review of the American Board of Orthopaedic Surgery database. J Bone Joint Surg Am 2008;90(4):700-7.
https://doi.org/10.2106/JBJS.G.00517
21. Mulroy WF, Harris WH. Revision total hip arthroplasty with the use of so-called second-generation cementing
techniques for aseptic loosening of the femoral component. A fifteen-year-average follow-up study. J Bone Joint
Surg Am 1996;78(3):325-30. https://doi.org/10.2106/00004623-199603000-00002
22. Kavanagh BF, Ilstrup DM, Fitzgerald RH. Revision total hip arthroplasty. J Bone Joint Surg Am 1985;67(4):517-26. PMID: 3980495
23. Pellicci PM, Wilson PD Jr, Sledge CB, Salvati EA, Ranawat CS, Poss R, et al. Long-term results of revision total
hip replacement. J Bone Joint Surg Am 1985;67(4):513-6. PMID: 3980494
24. Berry DJ, Harmsen WS, Ilstrup D, Lewallen DG, Cabanela ME. Survivorship of uncemented proximally porouscoated femoral components. Clin Orthop Relat Res 1995;(319):168-77. PMID: 7554627
25. Li Y, Zhang Y, Yu M, Huang T, Li K, Ye J, et al. Favorable revision-free survivorship of cemented arthroplasty
following failed proximal femoral nail antirotation: A case series with a median follow-up of 10 years. BMC
Musculoskelet Disord 2022;23(1):1024. https://doi.org/10.1186/s12891-022-05995-2
26. Krishnamurthy AB, MacDonald SJ, Paprosky WG. 5- to 13-year follow-up study on cementless femoral
components in revision surgery. J Arthroplasty 1997;12(8):839-47. https://doi.org/10.1016/s0883-5403(97)90152-2
27. Weeden SH, Paprosky WG. Minimal 11-year follow-up of extensively porous coated stems in femoral revisión total hip arthroplasty. J Arthroplasty 2002;17(4 Suppl 1):134-7. https://doi.org/10.1054/arth.2002.32461
28. Lachiewicz PF, Soileau ES. What is the survivorship of fully coated femoral components in revision hip
arthroplasty? Clin Orthop Relat Res 2015;473:549-54. https://doi.org/10.1007/s11999-014-3689-4