UNASSIGNED: Femoral bone defect in hip arthroplasty revision surgery represents a complex problem, and the treatment is a challenge for orthopedic surgeons called to assess the residual bone stock in an altered anatomy and obtain stability for the new implant. Classification systems available are mostly based on X-rays two-dimensional images and lack of accuracy and reproducibility and comprehensive therapeutic algorithms. However, there is no record of any classification based on computed tomography (CT)-scan images or three-dimensional (3D) modeling modern techniques. We aimed to review the current literature around femoral defect classifications (FDCs) analyzing their different rationale basis, reliability and accuracy, and their benefit in clinical practice. Moreover, we highlighted the role of CT scan-based 3D modeling techniques in the setting of femoral bone defects and revision hip arthroplasty.
UNASSIGNED: A narrative review was conducted. The articles were selected from the PubMed and Scopus medical database updated to March 2023. All Level-I to IV studies in the English language were considered for inclusion. The research was performed using relevant search term items: \"femoral defects\", \"classification\", \"radiographic\", \"revision hip arthroplasty\", \"CT scan\" and \"3D\" and we included only articles that evaluated the accuracy or reliability (or both) of the different femoral bone defects classification system.
UNASSIGNED: Our search yielded 408 results, of which 17 were deemed highly relevant. We found seven X-ray-based classification systems which have been attempted to quantify the degree of bone loss with low to good reproducibility. The most used classification system for femoral bone defects were the AAOS and Paprosky classification, which also offers a clinical therapeutic algorithm. In 2021, the FDC interestingly showed a new simple classification system with sub-optimal reproducibility and a practical therapeutic algorithm. Despite the numerous classification system of femoral defects, none of them comprehends the use of CT scan and 3D imaging technologies.
UNASSIGNED: Traditional X-rays-based classification system are still widely used event if their intra-observer and inter-observer reliability is sub-optimal. 3D modeling techniques represent an important diagnostic tool that could improve the understanding of bone defects and residual bone supportive structures, allowing to elaborate new, more precise, classification systems.

UNASSIGNED: Increasingly hip replacements at young age exposes the patient to an increased risk of failure of the implant over the years. In case of failure, revision specific stems were designed to overcome bone loss. Modularity of these devices is an important resource for the surgeon as they allow the new implant to be better adapted to the patient\'s anatomy. The purpose of this systematic review is to provide data about the outcome at long-term follow-up (>8 years) of hip modular revision femoral stems.
UNASSIGNED: This systematic review and meta-analysis were conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. PubMed and Google Scholar databases were systematically and independently searched, according to the inclusion and exclusion criteria. Two reviewers performed the data extraction independently. In case of disagreement, the senior authors were sought to resolve the divergences. Quality of the involved studies was evaluated with National Institute for Health and Care Excellence (NICE) guidelines (eight-item list) and the Newcastle-Ottawa scale (NOS). Primary and secondary outcomes were evaluated. The statistical analysis of this meta-analysis was performed by using Excel Microsoft and the software STATA.
UNASSIGNED: The primary outcome was the re-revision rate of modular revision stems at long-term follow-up. It ranged from 1.4% to 45.6%: random effect pooled estimate was 5.5% [95% confidence interval (CI): 4% to 7%], with a I2 of 12.3% (P=0.332). Mean Harris Hip Score (HHS) was 83 [min: 79; max: 87.6; standard deviation (SD): 3.55]. Secondary evaluated outcomes were: subsidence >5 mm, rate of periprosthetic infection or fractures (intra- and post-operative) and dislocations. The mean value for the NICE tool was 5.5 (SD: 1.13) and 7.3 (SD: 0.79) for the NOS tool. The survival rate was >90% at long-term follow-up (min: 60%; max: 97%).
UNASSIGNED: The modular femoral revision stems have demonstrated good long-term reliability and efficacy. This meta-analysis demonstrates that the re-revision rate after 8 years of follow-up is low and 90% of the implants did not fail.

UNASSIGNED: Modular neck adapters allow different length and offset changes to reach a stable total hip arthroplasty (THA) and permit a quick partial hip revision procedure without removing the existing components. The literature is poor on this matter and about the long-term related outcomes. This narrative review summarizes the most recent literature about these devices as an option of surgical treatment in partial total hip arthroplasty revision (THAr) focusing on indications, clinical and radiological outcomes, and related complications.
UNASSIGNED: The narrative review of the current available literature was conducted in December 2022 through electronic database. The terms used were: \"Head neck taper\" OR \"Merete BioBall\" AND \"revision Total Hip Arthroplasty (MeSH Terms)\". The timeframe was limited between 01/01/2000 and 01/12/2022. The studies regarding the clinical use of the Merete BioBall® system in hip revision surgery were included, while all the papers concerning modular stem prosthesis were excluded.
UNASSIGNED: The surgical procedure is safe, quick and allows the surgeon to correct a well-fixed stem version, length and offset, besides retensioning soft tissues. Clinical and radiological outcomes are good with low complications rates.
UNASSIGNED: The modular neck adapter system seems to be a good surgical procedure for recurrent dislocation of THA, especially in case of a second THAr surgery. However, the main indication of adapter use remains the isolated acetabular cup revision. The related complications are rare: the worst is the re-dislocation due to an insufficient stem version and length correction. Re-dislocation rates reported in literature vary from 5.2% to 15%. Corrosion or fretting of the modular system are not reported in literature.

BACKGROUND: Modular femoral components allow for patient-specific restoration of hip joint geometry and the reconstruction of extensive bone defects in revision total hip arthroplasty (THA); however, potential problems of modular implants such as taper corrosion and the risk of implant fracture continue to be of concern. The aim of the present study was to evaluate the clinical and radiological results of a cementless modular revision stem following revision surgery due to aseptic loosening and periprosthetic fracture and to assess patient-reported outcome measures (PROMs) in these patients at mid-term follow-up.
METHODS: In this study, a consecutive cohort of 75 patients who underwent primary revision THA at our institution using a modular cementless stem design (MRP-TITAN stem) was retrospectively evaluated at a mean follow-up of 7.7 years. Kaplan-Meier survivorship analyses were performed with revision of the femoral component for any reason as the end point. The Harris-Hip Score, the UCLA Activity Score, the Forgotten Joint Score and the SF-12 Score were used for clinical assessment. We used the Wilcoxon signed rank test to compare pre- and postoperative clinical scores.
RESULTS: Overall stem survival with the endpoint stem re-revision for any reason was 85.4% at a mean follow-up of 7.7 years (range 2.4-14 years). Stem survival was 89.5% in the aseptic loosening group and 78.3% in the periprosthetic fracture group with no statistically significant difference between both groups (p = 0.107). One patient had to be revised due to taper fracture. PROMs improved significantly up to the latest follow-up, and radiographic evaluation showed full osseointegration of all stems in this cohort.
CONCLUSIONS: Revision THA using a modular cementless titanium revision stem demonstrated adequate clinical and radiological results at mid- to long-term follow-up in this cohort. Cementless revision stems are a useful treatment option to restore the anatomy, especially in deformed hips and in complex revision hip arthroplasty. However, there are some significant disadvantages related to an increased risk of mechanical failure such as corrosion/fretting damage and implant fracture. Future high-quality prospective studies with longer follow-up are necessary to confirm the supposed advantages.

OBJECTIVE: To evaluate the effectiveness of prophylactic closed incision negative pressure wound therapy (ciNPWT) compared to conventional dressings in the prevention of periprosthetic joint infection (PJI) post hip and knee revision arthroplasty surgery.
METHODS: Five databases (MEDLINE, Embase., Emcare, CINAHL and Scopus) were searched with no date or language limits. Two independent reviewers assessed articles against the inclusion criteria and methodological quality of the 3 included studies. Data was extracted using a customised data tool and included the intervention, study methods and outcomes of interest. A meta-analysis was performed, and results presented in narrative form with forest plots.
RESULTS: The three studies, one randomized control trial and two quasi-experimental studies, included 136 intervention and 228 control participants (Sample 364). The PJI rate decreased in the ciNPWT cohort compared to the conservative dressing cohort (2 [1.47%] vs 27 [11.84%]). The reoperation rate was lower in the ciNPWT cohort versus the conventional cohort (4 [2.94%] vs 35 [15.35%]). The rate of wound complications was significantly decreased in the ciNPWT cohort compared to the conventional dressing cohort (14 [10.29%] v 85 [37.28), p=<0.001).
CONCLUSIONS: Prophylactic application of ciNPWT may be effective in reducing wound complications, PJI and reoperation post hip and knee revision arthroplasty surgery. The added cost of ciNPWT may be justified in the reduction of wound complications, PJI and reoperation. Ongoing trials determining if the prophylactic application of ciNPWT post hip and knee revision arthroplasty surgery is beneficial in preventing PJI particularly in high risk patients with additional comorbidities are warranted.

Failure to restore the femoral offset of the native hip is a potential cause of dysfunctional hip arthroplasty. The aim of this study was to report our experience of using a modular head-neck adapter in revision THA, specifically analyzing its usefulness as a tool to correct a slightly diminished femoral offset.
This was a retrospective single-center study including all hip revisions performed at our institution from January 2017 to March 2022 where the BioBallTM head-neck metal adapter was used. The preoperative and one year follow-up modified Merle d\'Aubigné hip score was used to evaluate functional outcomes.
Of a total of 34 cases included for revision, the head-neck adapter system was used specifically in six patients (17.6%) to increase femoral offset, retaining both the acetabular and femoral components. In this subgroup of patients, mean offset decrease after primary THA was 6.6 mm (4.0-9.1), equivalent to a mean 16.3% femoral offset reduction. The median modified Merle d\'Aubigné score went from 13.3 preoperatively to 16.2 at one year follow-up.
The use of a head-neck adapter is a safe and reliable procedure that may allow the surgeon to easily correct a slightly diminished femoral offset in a dysfunctional THA without the need to revise well-fixed prosthetic components.

BACKGROUND: To implement a goal-directed fluid therapy (GDFT) protocol using crystalloids in hip revision arthroplasty surgery within a quality management project at a tertiary hospital using a monocentric, prospective observational study.
METHODS: Adult patients scheduled for elective hip revision arthroplasty surgery were screened for inclusion in this prospective study. Intraoperatively stroke volume (SV) was optimized within a previously published protocol using uncalibrated pulse contour analysis and balanced crystalloids. Quality of perioperative GDFT was assessed by protocol adherence, SV increase as well as the rate of perioperative complications. Findings were then compared to two different historical groups of a former trial: one receiving GDFT with colloids (prospective colloid group) and one standard fluid therapy (retrospective control group) throughout surgery. Statistical analysis constitutes exploratory data analyses and results are expressed as median with 25th and 75th percentiles, absolute and relative frequencies, and complication rates are further given with 95% confidence intervals for proportions using the normal approximation without continuity correction.
RESULTS: Sixty-six patients underwent GDFT using balanced crystalloids and were compared to 130 patients with GDFT using balanced colloids and 130 controls without GDFT fluid resuscitation. There was a comparable increase in SV (crystalloids: 65 (54-74 ml; colloids: 67.5 (60-75.25 ml) and total volume infused (crystalloids: 2575 (2000-4210) ml; colloids: 2435 (1760-3480) ml; and controls: 2210 (1658-3000) ml). Overall perioperative complications rates were similar (42.4% (95%CI 30.3-55.2%) for crystalloids and 49.2% (95%CI 40.4-58.1%) for colloids and lower compared to controls: 66.9% (95%CI 58.1-74.9)). Interestingly, a reduced number of hemorrhagic complications was observed within crystalloids: 30% (95%CI 19.6-42.9); colloids: 43% (95%CI 34.4-52.0); and controls: 62% (95%CI 52.6-69.9). There were no differences in the rate of admission to the post-anesthesia care unit or intensive care unit as well as the length of stay.
CONCLUSIONS: Perioperative fluid management using a GDFT protocol with crystalloids in hip revision arthroplasty surgery was successfully implemented in daily clinical routine. Perioperative complications rates were reduced compared to a previous management without GDFT and comparable when using colloids.
BACKGROUND: ClinicalTrials.gov identifier: NCT01753050.

Significant key points for a successful revision surgery in hip arthroplasty are as follows: identification of the implants, preoperative clinical diagnoses, planning (including alternatives) as well as establishing a surgical strategy, selection of revision implants and provision with special tools, secure fixation of acetabular and femoral components and the reconstruction of a stable joint without risk of dislocation or impingement. It seems to be obvious that most problems can be avoided by clear and concise decision-making. Some tips and tricks are also presented.
UNASSIGNED: Die Eckpunkte für eine erfolgreiche Revisionsendoprothetik sind Identifikation der Implantate, präoperative klinische Diagnostik, Planung (einschließlich Alternativen) und Strategie, Weichteilmanagement, Auswahl der Revisionsimplantate und Bereitstellung von speziellen Instrumentarien, die sichere Fixation der azetabulären und femoralen Komponenten sowie abschließend die Herstellung stabiler Gelenkverhältnisse ohne Risiko für Luxation oder Impingement. Bei der Analyse von Komplikationen fällt immer wieder auf, wie sehr Probleme bei richtiger perioperativer Entscheidungsfindung vermeidbar gewesen wären. Tipps und Tricks für die Revisionsendoprothetik werden im nachfolgend dargestellt.

BACKGROUND: Accurate assessment of acetabular defects and designing precise and feasible surgical plans are essential for positive outcomes of hip revision arthroplasty. Additive manufacturing (AM) is a novel technique to print physical object models. We propose a three-dimensional acetabular bone defect classification system aided with AM model, and further assess its reliability and validity under blinded conditions.
METHODS: We reviewed 104 consecutive patients who underwent hip revision arthroplasty at our department between January 2014 and December 2019, of whom 45 had AM models and were included in the reliability and validity tests. Three orthopedic surgeons retrospectively evaluated the bone defects of these 45 patients with our proposed classification, made surgical plans, and repeated the process after 2 weeks. The reliability and validity of the classification results and corresponding surgical plans were assessed using the intra-class correlation coefficient or kappa correlation coefficient.
RESULTS: The reliability and validity of the classification results were excellent. The mean initial intra-class correlation coefficient for inter-observer reliability was 0.947, which increased to 0.972 when tested a second time. The intra-observer reliability ranged from 0.958 to 0.980. Validity of the classification results also showed a high kappa correlation coefficient of 0.951-0.967. When considering corresponding surgical plans, the reliability and validity were also excellent, with intra-class correlation coefficients and kappa correlation coefficients measuring all over 0.9.
CONCLUSIONS: This three-dimensional acetabular defect classification has excellent reliability and validity. Using this classification system and AM models, accurate assessment of bone defect and reliable surgical plans could be achieved. This classification aided with AM is a promising tool for surgeons for preoperative evaluation.

UNASSIGNED: The aim was to test the hypothesis that during transfemoral implantation of a conical revision stem, the fixation of the stem at the distal tip leads to a low rate of periprosthetic fractures.
UNASSIGNED: Two hundred eighty-two stem revisions by a transfemoral approach in cases of Paprosky Type II and IIIA-defects (with a sufficient isthmus) were carried out and analyzed during and radiographically after the surgery for unintentional periprosthetic fractures below the osteotomy.
UNASSIGNED: In all cases, fixation was always achieved at the tip of the distal component in the isthmus of the femur. No periprosthetic fractures were observed.
UNASSIGNED: When the isthmus of the femur is intact, a transfemoral implantation of a tapered revision stem at the distal end reduces the risk of periprosthetic fractures by preventing bypassing the isthmus with the stem. Knowing the difference between the nominal diameter and the diameter at the distal start of the conical zone can help to create this fixation technique resulting in short revision stems.