[The challenge of revising a well-fixed curved calcar-guided short stem in total hip arthroplasty: Introduction of a new curved extraction chisel system].
Karl Philipp Kutzner, Karl Stoffel, Josef Hochreiter
{"title":"[The challenge of revising a well-fixed curved calcar-guided short stem in total hip arthroplasty: Introduction of a new curved extraction chisel system].","authors":"Karl Philipp Kutzner, Karl Stoffel, Josef Hochreiter","doi":"10.1007/s00064-022-00775-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Safe and bone-conserving extraction of a well-fixed curved short stem without the necessity of a transfemoral approach.</p><p><strong>Indications: </strong>The revision of a well-fixed curved short stem, for example, due to periprosthetic infection or malposition. Meticulous preparation of the cone and the lateral shoulder of the stem.</p><p><strong>Contraindications: </strong>Correct placement of the chuck not possible.</p><p><strong>Surgical technique: </strong>Choice of a standard approach to the hip joint. Luxation. Removal of the implanted head. Preparation of the proximal femur and removal of bone at the stem shoulder. Attachment of the chuck to the cone. Insertion of the \"prestarter\" chisels through the guided slots of the chuck, starting with the lateral chisel, followed by the ventral and dorsal chisel. The cut must point outwards away from the implant. Repetition of this procedure using the \"starter\" chisels in the same order. Removal of the chuck. Careful insertion of the \"final\" chisels in the same order. Trial of a stem extraction using an extraction tool. Optional repetition of the whole procedure. In order to avoid fractures, opening of the medial interface only after preparation laterally, ventrally and dorsally, by careful insertion of the medial chisels in the respective order alongside the calcar. Finally, extraction of the stem.</p><p><strong>Postoperative management: </strong>Postoperative protocol according to the respective revision implants and fixation technique used.</p><p><strong>Results: </strong>The described procedure has proven successful in clinical practice in the three author affiliations in a total of 14 cases. In 3 (21.4%) cases, despite the use of the extraction chisel system, an additional transfemoral approach or fenestration had to be performed to remove the short stem. Primary straight stems were used in over half of the cases (57.8%) as revision implants, whereas in 4 cases (36.4%) a cementless short stem could again be used.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"35 1","pages":"56-64"},"PeriodicalIF":1.0000,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894969/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Operative Orthopadie Und Traumatologie","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00064-022-00775-6","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
Objective: Safe and bone-conserving extraction of a well-fixed curved short stem without the necessity of a transfemoral approach.
Indications: The revision of a well-fixed curved short stem, for example, due to periprosthetic infection or malposition. Meticulous preparation of the cone and the lateral shoulder of the stem.
Contraindications: Correct placement of the chuck not possible.
Surgical technique: Choice of a standard approach to the hip joint. Luxation. Removal of the implanted head. Preparation of the proximal femur and removal of bone at the stem shoulder. Attachment of the chuck to the cone. Insertion of the "prestarter" chisels through the guided slots of the chuck, starting with the lateral chisel, followed by the ventral and dorsal chisel. The cut must point outwards away from the implant. Repetition of this procedure using the "starter" chisels in the same order. Removal of the chuck. Careful insertion of the "final" chisels in the same order. Trial of a stem extraction using an extraction tool. Optional repetition of the whole procedure. In order to avoid fractures, opening of the medial interface only after preparation laterally, ventrally and dorsally, by careful insertion of the medial chisels in the respective order alongside the calcar. Finally, extraction of the stem.
Postoperative management: Postoperative protocol according to the respective revision implants and fixation technique used.
Results: The described procedure has proven successful in clinical practice in the three author affiliations in a total of 14 cases. In 3 (21.4%) cases, despite the use of the extraction chisel system, an additional transfemoral approach or fenestration had to be performed to remove the short stem. Primary straight stems were used in over half of the cases (57.8%) as revision implants, whereas in 4 cases (36.4%) a cementless short stem could again be used.
期刊介绍：
Orthopedics and Traumatology is directed toward all orthopedic surgeons, trauma-tologists, hand surgeons, specialists in sports injuries, orthopedics and rheumatology as well as gene-al surgeons who require access to reliable information on current operative methods to ensure the quality of patient advice, preoperative planning, and postoperative care.
The journal presents established and new operative procedures in uniformly structured and extensively illustrated contributions. All aspects are presented step-by-step from indications, contraindications, patient education, and preparation of the operation right through to postoperative care. The advantages and disadvantages, possible complications, deficiencies and risks of the methods as well as significant results with their evaluation criteria are discussed. To allow the reader to assess the outcome, results are detailed and based on internationally recognized scoring systems.
Orthopedics and Traumatology facilitates effective advancement and further education for all those active in both special and conservative fields of orthopedics, traumatology, and general surgery, offers sup-port for therapeutic decision-making, and provides – more than 30 years after its first publication – constantly expanding and up-to-date teaching on operative techniques.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
