The outcome of revision total hip arthroplasty for instability.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: D. F. Amanatullah reports grants related to this study from OREF, OMEGA, and Peptidologics, royalties or licenses from Exactech and United, consulting fees from Stryker, Exactech, United, Medacta and DePuy, payment for expert testimony from Morrison and Feorste, and stock or stock options in nSight Surgical, QT Ultrasound, and Recoup Fitness, unrelated to this study. R. Apinyakul reports consulting fees from Zimmer Biomet, unrelated to this study. J. I. Huddleston reports royalties or licenses from DePuy, consulting fees from DePuy and Corin, and stock or stock options in Corin, all unrelated to this study. W. J. Maloney reports royalties or licenses from Stryker and Zimmer Biomet, payment for expert testimony in multiple medical malpractice cases, multiple patents related to arthroplasty, and stock or stock options in TJO, all unrelated to this study. W. J. Maloney is also President of the Knee Society. 20. Hip Int. 2020 Nov;30(6):725-730. doi: 10.1177/1120700019864867. Epub 2019 Jul 18. Outcomes and complications following non-oncologic total femoral replacement. Christ AB(1), Mendez L(1), Gausden EB(1), Blevins JL(1), Bostrom MP(1), Sculco PK(1). Author information: (1)Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA. BACKGROUND: Non-oncologic total femoral replacement (TFR) is utilised as a limb-salvage option in the setting of massive bone loss during revision total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, complication rates, including infection and reoperation, remain a concern. METHODS: In this study, 16 consecutive TFRs from a single institution with an average clinical follow-up of 4 years were retrospectively reviewed. Indications for TFR, previous surgeries, implants used, complications, reoperations, and ambulatory status at final follow-up were recorded. RESULTS: The reoperation rate was 50%, and those patients averaged 2 additional surgeries after TFR. The most common reason for reoperation was infection with a 33% incidence of a new periprosthetic infection and an overall infection rate of 44% (7/16). 6/7 were managed with irrigation and debridement and implant retention. Dual-mobility and constrained acetabular liners were used consistently, and no patient experienced a subsequent dislocation. At final follow-up, 81% were ambulatory but only 2 patients (13%) could walk without an assistive device. No patient required amputation. CONCLUSIONS: While TFR achieved limb salvage in all patients with fair clinical outcomes, patients were at high risk for new or persistent infection and reoperation. Dual-mobility and constrained acetabular liners were effective in preventing dislocation is this cohort. DOI: 10.1177/1120700019864867