Femoral impaction bone grafting (IBG) is widely used in revision total hip arthroplasty (rTHA) for cases with severe bone loss. The purpose of this systematic review and meta-analysis was to assess survivorship and patient-reported outcomes (PROMs) following femoral IBG.

The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting on femoral IBG in revision THA with a minimum follow-up of 12 months were included. A random-effects model and the inverse-variance weighting method were used for meta-analysis. Heterogeneity was assessed using Higgins and Thompson's I2 statistic and Cochran's Q test.

The systematic search included a total of 45 studies, comprising 4,102 hips in 3,805 patients. The overall 10-year survivorship for femoral IBG was 95% (CI [confidence interval] 92 to 97), with significant data heterogeneity (I2 = 79%, P < 0.01). Patients who had higher Endo-Klinik (EK) grades of femoral bone loss (III and IV) had significantly lower 10-year survival rates (90.9 versus 97.4% for EK grades I and II, P = 0.048). Neither patient age (≥ 65 years: 94.5 versus < 65 years: 96.6%, P = 0.230) nor stem length (short stems: 95.5 versus long stems: 94.8%, P = 0.86) significantly affected 10-year survival outcomes. Patient-reported outcomes (PROMs) included the Harris hip score, which notably improved post-surgery (SMD [standardized mean difference]: 10.7, 95% CI: 8.26 to 13.05, I2 = 99%).

Hip revision arthroplasty with femoral IBG demonstrates high long-term (10-year) survivorship rates (95%, 92 to 97%, I2 = 79%) and significant improvements in patient-reported outcomes, specifically the Harris Hip Score (I2 = 92%), especially in cases with moderate bone loss (Endo-Klinik stages I and II). There was a lower survivorship (90%) in hips with severe bone defects (Endo-Klinik stages III and IV), regardless of additional fixation.

This retrospective study evaluates the efficacy of hybrid total hip replacement (THR) in patients aged 50 to 70 years who have experienced failures following proximal femoral nail antirotation (PFNA) procedures. By addressing a significant gap in the current medical literature-characterized by inadequate data and inconsistencies regarding the effectiveness of hybrid THRs in revision settings-this research aims to provide valuable insights into the long-term viability and clinical outcomes of hybrid THR for this demographic.

In this retrospective observational study, we investigated 185 individuals aged 50 to 70 years who underwent hybrid THRs following PFNA procedures across two specialized Joint Surgery Centers. The primary objective of this study was to evaluate implant longevity, which was assessed using the Kaplan-Meier method, with a particular focus on revision surgeries. Additionally, we aimed to analyze secondary outcomes, including patient-reported experiences quantified by the EuroQol Visual Analogue Scale (EQ-VAS) and the Likert pain scale. Furthermore, this study sought to quantify the rates of major orthopedic complications within this patient cohort.

A total of 124 individuals (124 THRs) were assessed, resulting in a median follow-up duration of 10 years (range: 3-15 years). The 10-year survivorship, defined as the rate of survival without revision for any reason, was found to be 87.1% (78.5%-90.1%). Stratified survival analysis by age groups (50-60 years and 60-70 years) revealed that the 50-60-year group had significantly higher survival rates compared to the 60-70-year group (p = 0.00026). Postoperative pain scores averaged 3.0 (95% CI, 2.9-3.1), indicating a significant reduction in pain. Furthermore, patient satisfaction was high, with an average satisfaction score of 3.7 (95% CI, 3.6-3.8). The mean EQ-VAS score was 77.4 (95% CI, 76.4-78.3), reflecting favorable post-surgical health perceptions. Among the 124 patients, 13 experienced a total of 19 implant-related complications, leading to an incidence rate of 10.4% for major orthopedic complications.

Hybrid THR shows durable efficacy in patients aged 50-70 with failed PFNA, achieving high revision-free survival and improved postoperative outcomes. Younger patients (50-60 years) had superior survival, while Staphylococcus/Enterococcus infections worsened prognosis. Non-infected individuals aged 50-60 achieved optimal 10-year survival. Complications like stem loosening were reduced, but cement degradation and infection risks remain challenges. Future efforts should target age-specific protocols and infection mitigation.

Distal femoral replacement (DFR) is a salvage option for massive femoral bone loss and is often performed in revision total knee arthroplasty (rTKA) that have undergone multiple prior procedures. This study aimed to report on a large cohort of DFRs performed at a tertiary referral institution regarding survivorship and risk factors for aseptic loosening, specifically the impact of a previously instrumented femoral canal.

Between 2016 and 2021, 105 patients undergoing rTKA to DFR with a minimum 2-year follow-up were identified. Kaplan-Meier estimates assessed survivorship free from all-cause reoperation, all-cause revision, and revision for aseptic loosening. Logistic regressions were conducted to assess potential risk factors for radiographic loosening and the need for revision.

Prior femoral canal instrumentation was identified in 59% of cases, and 54% had undergone multiple prior procedures. The 2-year survivorship free from revision for aseptic loosening was 93%. The 2-year survivorship free from all-cause reoperation was 87% for native canals and 59% for previously instrumented canals (P = 0.008). The 2-year survivorship free from all-cause revision was 100 and 81%, respectively (P = 0.014). Regression analysis found re-rTKA (odds ratio [OR] = 18.3, P = 0.006), prior femoral canal instrumentation (OR = 14.6, P = 0.01), and prior femoral canal cementation (OR = 8.2, P = 0.007) to be risk factors for aseptic loosening.

A DFR for rTKA had high 2-year survivorship free from revision for aseptic loosening (93%). Regression analyses revealed multiple risk factors for aseptic femoral component loosening with a previously instrumented femoral canal, resulting in a 2.8-times higher rate of reoperation, a 10.5-times higher rate of all-cause revision, and an 11-times higher rate of aseptic loosening. Future research on fixation strategies in sclerotic, previously instrumented femoral canals should be prioritized to reduce the risk of fixation failure in this high-risk cohort.

Metaphyseal cones with cemented stems can be successfully utilized in most revision total knee arthroplasties (TKAs). However, if the diaphysis has been previously violated, fixation of the cemented stem, which is important for cone ingrowth and construct survival, can be compromised. The initial results of our novel technique combining diaphyseal impaction bone-grafting with a metaphyseal cone were promising but required additional study. The purpose of the present study was to assess results of this technique in a larger cohort.

A metaphyseal cone combined with diaphyseal impaction grafting and a cemented stem was utilized in 88 revision TKAs at our institution, including 35 from our prior study. The mean age at the time of revision was 67 years, and 67% of patients were male. Patients had had a mean of 4 prior knee arthroplasty procedures. The 2 most common reasons for revision were aseptic loosening (78%) and 2-stage reimplantation for periprosthetic joint infection (PJI) (19%). The mean follow-up was 4 years.

At the time of the latest follow-up, no cone-impaction grafting constructs required re-revision for aseptic loosening. Five-year survivorship free from any revision of the cone-impaction grafting construct and free from any reoperation was 95% and 65%, respectively. A total of 25 knees (28%) underwent reoperation, with the 2 most common indications being PJI and periprosthetic fracture. All cones were osseointegrated, and all bone graft appeared stable or incorporated. One patient had radiographic evidence of tibial component loosening despite a well-fixed cone; however, this patient was asymptomatic and had not undergone revision at 9 years.

When presented with a sclerotic, polished diaphyseal canal with deficient cancellous bone and concomitant metaphyseal bone loss, our technique of combining diaphyseal impaction grafting with a metaphyseal cone proved extremely durable in this larger series of patients. No cone-impaction grafting constructs required re-revision for aseptic loosening.

Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

To report clinical and radiographic outcomes of revision total hip arthroplasty (THA) through the direct anterior approach (DAA) using primary stems.

The authors assessed a consecutive series of revision THAs operated by DAA using primary (cemented and uncemented) stems between 1/1/2010 and 30/06/2017. The initial cohort comprised 47 patients (50 hips), aged 65 ± 10 years with BMI of 25 ± 4 kg/m2. Clinical assessment included modified Harris Hip Score (mHHS) and satisfaction with surgery. Radiographic assessment included radiolucent lines > 2 mm, bone remodelling, cortical hypertrophy, pedestal formation, and osteolysis. Linear regression analyses were performed.

Of the 50 hips (47 patients) in the initial cohort, intraoperative complications that did not require re-revision occurred in 5 hips. At a follow-up of > 2 years: 5 hips (10%) were lost to follow-up and 3 hips (6%) required stem re-revision, leaving a final cohort of 42 hips (40 patients). Postoperative complications that did not require re-revision occurred in 4 hips (8%). At 4.3 ± 1.6 years, post-revision mHHS was 89 ± 14 (range 47-100) and 38 patients were satisfied or very satisfied with revision surgery. Bone remodelling was observed in 8 hips (16%), cortical hypertrophy in 6 hips (12%), grade I heterotopic ossification in 7 hips (14%), and grade II in 1 hip (2%). There were no cases of radiolucent lines, pedestal formation, or osteolysis. Regression analyses revealed that post-revision mHHS was not associated with any variable.

Revision THA performed through the DAA using primary stems grants satisfactory clinical and radiographic outcomes at a minimum follow-up of two years.

The popularity of uncemented stems in revision total hip arthroplasty (THA) has increased in the last decade.

To assess the outcomes of both cemented and uncemented stems after mid-term follow up.

This study was performed following both the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement and the Cochrane Handbook for systematic reviews and meta-analysis guidelines. Articles were chosen irrespective of country of origin or language utilized for the article full texts. This paper included studies that reviewed revision THA for both cemented or uncemented long stems.

Three eligible studies were included in the meta-analysis. Analysis was conducted by using Review Manager version 5.3. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used random-effect models. There were no significant differences found for intraoperative periprosthetic fractures [risk ratio (RR) = 1.25; 95% confidence interval (CI): 0.29-5.32; P = 0.76], aseptic loosening (RR = 2.15, 95%CI: 0.81-5.70; P = 0.13), dislocation rate (RR = 0.50; 95%CI: 0.10-2.47; P = 0.39), or infection rate (RR = 0.99, 95%CI: 0.82-1.19; P = 0.89), between the uncemented and the cemented long stems for revision THA after mid-term follow-up.

This study has evaluated the mid-term outcomes of both cemented and uncemented stems at first-time revision THA. In summary, there were no significant differences in the dislocation rate, aseptic loosening, intraoperative periprosthetic fracture and infection rate between the two cohorts.

Periprosthetic joint infection (PJI) is the most serious complication of total hip arthroplasty. The treatment is usually revision in either 1 or 2 stages. This study analyses revision with impaction bone grafting for periprosthetic joint infection of the hip and compares 1- and 2-stage strategies.

We reviewed 55 consecutive cases (54 patients) of revision arthroplasty for PJI carried out at our hospital between 2002 and 2016. Of these, 46 were 2-stage procedures. 21 had vancomycin mixed in with the bone graft, and all had gentamycin-containing bone cement. The total perioperative blood loss, duration of operation, and length of hospital stay were recorded. Clinical and radiological results were analysed for 48 hips at 2-16 years follow-up.

No PJI remained at follow-up. 3 patients (6%) had undergone revision for all causes. 1 had radiological signs of mechanical loosening but was not revised. 2-stage procedures had a significantly longer operating time (409 vs. 238 min) and hospital stay (34 vs. 13 days), greater blood loss (2764 vs. 1638 ml), and lower mean functional hip score (15.9 vs. 17.5) at follow-up than the one-stage procedures.

Revision total hip arthroplasty for PJI with vancomycin-loaded impaction bone grafting is a safe method that achieves both the restoration of bone stock and resolution of the infection. This single-stage procedure could therefore be the new gold standard for treatment of non-complicated PJI in the hip.

Background and purpose - Uncemented stems are gradually replacing cemented stems in hip revision surgery. We compared the risk of re-revision between uncemented and cemented revision stems and assessed whether the different fixation methods are used in similar femoral bone defects.Patients and methods - 867 patients operated on with uncemented or cemented stems in first-time hip revision surgery due to aseptic loosening performed 2006-2016 were identified in the Swedish Hip Arthroplasty Register. Preoperative femoral bone defect size was assessed on radiographs of all patients. Cox regression models were fitted to estimate the adjusted risk of re-revision during different postoperative time periods. Re-revision of any component for any reason, and stem re-revision, as well as risk of cause-specific re-revision was estimated.Results - Most patients in both fixation groups had Paprosky class IIIA femoral bone defects prior to surgery, but there were more severe bone defects in the cemented group. The adjusted risk of re-revision of any component for any reason was higher in patients with uncemented compared with those with cemented revision stems during the first 3 years after index surgery (hazard ratio [HR] 4, 95% confidence interval [CI] 2-9). From the 4th year onward, the risk of re-revision of any component for any reason was similar (HR 0.5, CI 0.2-1.4). Uncemented revision stems conferred a higher risk of dislocation compared with cemented stems (HR 5, CI 1.2-23) during the first 3 years.Interpretation - Although not predominantly used in more complex femoral defects, uncemented revision stem fixation confers a slightly higher risk of re-revision during the first years, but this risk is attenuated after longer follow-up.

The management of periprosthetic joint infection (PJI) of the hip is a challenging procedure. One-stage exchange is carried out in specialist centres with comparable infection free survival rates. However, there is a paucity of long-term results of this approach in young patients.

All patients undergoing one-stage exchange due to PJI with a known causative organism ⩽45 years of age with a minimum of 10-year follow-up (mean 15 years; range 10-24 years) were enrolled in this retrospective study. Patients older than 45 years of age or patients with a two-stage procedure were excluded from the study. The primary outcome measure was failure rate with special focus on reinfection at latest follow-up. Failure was defined as revision surgery for infection. Furthermore, functional outcome using the Harris Hip Score was determined initially and at latest follow-up. 26 patients fulfilled the inclusion criteria and were available for final follow-up.

The study cohort consists of 16 male and 10 female patients with a mean age of 36.8 years (range 20-45 years) and a mean BMI of 29.8 kg/m2 (range 20.7-40.6 kg/m2). Prior to the single-stage procedure, the patients underwent an average of 3.1 previous surgical interventions (range 1-9). The mean hospital stay after septic revision was 19.7 days (11-33 days). Most infections were caused by Staphylococcus epidermidis (n = 8, 30.8%), followed by Staph. aureus (n = 7, 26.9%) and Propionibacterium acnes (n = 6, 23.1%). At latest follow-up, the overall survival rate was 76.9 %, while infection control could be achieved in 96.2%. At final examination, the mean Harris Hip Score improved from 46.2 to 78.9 (range 18.0-99; SD, 22.6).

Single-stage revision surgery for the management of PJI in patients ⩽45 years is a successful treatment option with high infection control, even after long-term follow-up.

This study reviewed literature published in the last 10 years to investigate the reasons for revision failure. A total of 9952 revisions were identified and it was determined that the number one cause of failure was aseptic loosening (23.19%), followed by instability (22.43%) and infection (22.13%). Further analysis of applicable revisions investigated BMI and age at the failure rates. The rate of rerevision in obese patients was markedly higher (p < 0.01) compared to non-obese patients and individuals receiving a revision THA under the age of 55 are at a higher risk of rerevision (p < 0.01).