Successful hip revision surgery following refracture of a modern femoral stem using a cortical window osteotomy technique:A case report and review of literature

BACKGROUND The ExeterTM Universal cemented femoral component is widely used for total hip replacement surgery.Although there have been few reports of femoral component fracture,removal of a broken femoral stem can be a challenging procedure.CASE SUMMARY A 54-year-old man with a Dorr A femur sustained a refracture of a primary ExeterTM stem,two years after receiving a revision using a cement-within-cement technique(CWC)through an extended trochanteric osteotomy(ETO).The technical problems related to the CWC technique and the ETO played a major role in the stem fatigue refracture.We performed revision surgery and removed the distal cement using a cortical femoral window technique,followed by reimplantation with an uncemented,modular,distally-fixed uncemented stem.The patient experienced an uneventful postoperative recovery.CONCLUSION Re-fracture of a modern femoral ExeterTM stem is a rare event,but technical complications related to revision surgery can lead to this outcome.The cortical window osteotomy technique can facilitate the removal of a broken stem and cement,allowing for prosthetic reimplantation under direct vision and avoiding ETO-related complications.

Experiences in total knee arthtroplasty after distal femoral varus osteotomy

Introduction: There is only little information available about total knee arthroplasty (TKA) following distal femoral varus osteotomy (DFVO). The aim of our study was to show our experiences and mid-term results of TKA after a previous DFVO. Material and method: In a retrospective study we identified 36 consecutive patients who had undergone TKA after a previous distal femoral varus osteotomy. The average duration of follow-up after the TKA was 8.2 years (min: 5.0, max: 9.2). X-rays were taken in 2 planes before TKA, 1 week after TKA and at latest follow-up. Tibiofemoral alignment was measured on weightbearing long-leg anteroposterior radiographs. Ra- diolucent lines at latest follow-up were documented. Functional evaluations were performed preoperatively and postoperatively (at the time of latest follow-up). Results: The mean Knee Society knee score in- creased from 42 points before the arthroplasty to 91.3 points after the arthroplasty. The mean Knee Society function score increased from 27.4 points preoperatively to 93.2 points postoperatively. The mean overall Knee Society score increased from 91.3 points preoperatively to 163.4 points postoperatively. The mean radiographic alignment was 4.5? of valgus (10? of varus to 19? of valgus) before TKA and 3.1? of valgus (range, 3? of varus to 6? of valgus) at the time of latest follow-up. Postoperative complications included one deep vein thrombosis with non-lethal pulmonary embolism, one wound infection requiring revision and one septic loosening. Discussion: It is possible to perform TKA following DFVO with good mid-term results. In comparison to the literature there is no higher risk of complications in TKA following DFVO in comparison to primary TKA.

Surgical treatment of femoral deformities in polyostotic fibrous dysplasia and McCune-Albright syndrome:A literature review

BACKGROUND Surgical correction of femoral deformities in polyostotic fibrous dysplasia(PFD)or McCune-Albright syndrome(MAS),such as coxa vara or shepherd’s crook deformity,is a challenge.AIM To evaluate the treatment of patients with femoral deformities caused by PDF or MAS treated by osteotomies and stabilized with different methods,by analyzing the most relevant studies on the topic.METHODS A literature search was performed in Medline database(PubMed).Articles were screened for patients affected by PFD or MAS surgically managed by osteotomies and stabilized with different methods.RESULTS The initial search produced 184 studies,with 15 fulfilling the eligibility criteria of our study.Selected articles(1987-2019)included 111 patients overall(136 femurs).CONCLUSION Based on our results,the preferred method to stabilize corrective osteotomies is intramedullary nailing with neck cross pinning.When the deformity is limited to the proximal part of the femur,a screw or blade plate may be used,although there is a high risk of fracture below the plate.When the femur is entirely involved,a two-stage procedure may be considered.

Intraoperative Goal-Directed Therapies in Femoral and Pelvic Osteotomies in Children and In-Hospital Postoperative Outcomes

Background: Femoral and pelvic osteotomies are potential hemorrhagic interventions where transfusion requirements can be necessary. Objective: We undertook a secondary analysis of patients who underwent femoral and pelvic osteotomy in the initial cohort. The objective of this secondary analysis was to describe intraoperative and postoperative outcomes and to describe intraoperative management in these patients in terms of blood product management and fluid and hemodynamic therapy with the aim of implementing optimization management protocols for postoperative outcome improvement. Methods: A secondary analysis of patients who underwent femoral and pelvic osteotomy surgery was included in the initial retrospective study. Results: There were eighteen patients with a mean age of 104 ± 47.1 months. Four (22.2%) patients had intraoperative and/or postoperative complications. One patient (5.6%) had an intraoperative hemorrhagic shock, two patients (11.1%) had postoperative neurologic failure, and one patient (5.6%) had postoperative wound sepsis. The transfusion rate was 50% in nine patients. Conclusion: Femoral and pelvic osteotomies are interventions where blood, transfusion and fluid requirements can be increased;thus, this implies the necessity of a global patient blood management protocol with point-of-care tests and fluid- and hemodynamic-guided protocols with validated tools in children for intraoperative and postoperative outcome optimization.