Dataset Information

Long Cephalomedullary Nails Can Be a Cheap and Effective Interval Revision Prosthesis in Infected Hip Replacements That Require Proximal Femoral Replacement: A Small Case Series.

ABSTRACT: Hip prosthetic joint infection management is complex and expensive, especially in severe bone loss. Reducing the price of interval prosthesis when performing staged revision could minimize costs without compromising outcomes. We present 2 similar techniques developed independently that use an antibiotic-coated cephalomedullary nail with a total hip arthroplasty bearing (head and cemented acetabular component) attached to it as an interval proximal femoral replacement prosthesis. Using this technique, the femoral implant cost was reduced up to 10-fold. All patients have recovered well with resolution of infection and functional recovery similar to patients undergoing proximal femoral replacement. In one case, the lag screw (femoral neck) fractured at 5 months prompting the second-stage revision. This complication should be considered when deciding the timing of second-stage revisions in these cases.

SUBMITTER: Ramasamy B

PROVIDER: S-EPMC10568308 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Long Cephalomedullary Nails Can Be a Cheap and Effective Interval Revision Prosthesis in Infected Hip Replacements That Require Proximal Femoral Replacement: A Small Case Series.

Ramasamy Boopalan B Hammat Aaron Scott AS Nelson Renjy R Callary Stuart Adam SA Chan Ping Keung PK Solomon Lucian Bogdan LB

Arthroplasty today 20231003

Hip prosthetic joint infection management is complex and expensive, especially in severe bone loss. Reducing the price of interval prosthesis when performing staged revision could minimize costs without compromising outcomes. We present 2 similar techniques developed independently that use an antibiotic-coated cephalomedullary nail with a total hip arthroplasty bearing (head and cemented acetabular component) attached to it as an interval proximal femoral replacement prosthesis. Using this techn ...[more]

PMID: 37841451

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Project description:BackgroundInternal fixation with cephalomedullary nails has been widely used in the treatment of intertrochanteric femoral fractures (IFF). Yet, the difference in efficacy and safety between the commonly used integrated dual-screw cephalomedullary nail (InterTAN) and single-screw cephalomedullary nail remains inconclusive. Thus we performed the present systematic review and meta-analysis.MethodsRandomized controlled trials (RCTs) or observational studies comparing InterTAN with proximal femoral nail anti-rotation (PFNA), the Asian PFNA (PFNA-II), or the Gamma3 nail in treating IFF were searched on PubMed, EMBASE, Web of Science and Cochrane Library from inception to April 30, 2023. The differences in perioperative parameters and clinical and radiological outcomes were evaluated by mean difference (MD) with 95% confidence interval (95%CI). The risks of various complications and mortality were assessed by risk ratio (RR) with 95%CI.ResultsTwenty-three studies comprising 3566 patients were included. Compared with single-screw cephalomedullary nails (PFNA/PFNA-II, Gamma3), InterTAN conferred significantly reduced risk of implant failures (RR = 0.37, 95%CI 0.26 to 0.51, P < 0.001), hip and thigh pain (RR = 0.70, 95%CI 0.55 to 0.90, P = 0.006) and all-cause revision/reoperation (RR = 0.38, 95%CI 0.26 to 0.57, P < 0.001). Moreover, patients treated with InterTAN had significantly higher 1-year Harris Hip Score (MD = 0.82, 95%CI 0.20-1.44, P = 0.010) and shorter time to union/healing (MD = - 0.66 days, 95%CI - 1.16 to - 0.16, P = 0.009). Femoral neck shortening, time to full bearing, and incidences of non-union, infection, deep venous thrombosis, and mortality were comparable between both groups.ConclusionsThe integrated dual-screw InterTAN construct has superior performance in reducing risks of complications and improving clinical and functional outcomes in the treatment of IFF. More well-designed, high-quality RCTs are warranted to confirm these findings.

Project description:ObjectiveCephalomedullary nails (CMN) are implants with a high success rate in the surgical treatment of trochanteric fractures. The aim of this study is to compare the radiological outcomes and mechanical complications of femoral trochanteric fractures treated with three different CMNs.MethodsIntertrochanteric fractures in patients aged 50 years and older treated with CMN between January 2016 and December 2021 were reviewed retrospectively. A total of 158 cases meeting the criteria were included to final analysis. Cases were divided into three groups based on the type of nail used (helical blade: group 1, n = 54; screw: group 2, n = 53; winged screw: group 3, n = 51). Demographic characteristics, mechanical complications, reduction quality, tip-apex distances (TAD) and Cleveland zones were compared between the groups. Femoral neck shortening, varus collapse, lag sliding, changes in abductor length were compared between study groups. Factors affecting mechanical complications were also analyzed.ResultsStudy groups were homogenic in terms of demographic characteristics, fracture type and reduction quality. Regarding mechanical complications, no statistically significant difference was found between groups. All three implants had similar outcomes on femoral neck shortening, varus collapse and lag sliding. Pooled analysis of 158 cases showed that mechanical complications increase as the quality of reduction decreases (p = 0.000) same applies when TAD alters from the desired range (p = 0.025) and with non-optimally implanted blade according to Cleveland zones (p = 0, 000).ConclusionThe radiological outcomes and mechanical complications of helical blade, screw type blade and winged screw type blade proximal femoral nails are similar in selected group. Regardless of the device type, it is necessary to obtain high reduction quality, obtain TAD within described range and optimally place the blade according to Cleveland Zones to reduce the failure rate and avoid complications.

Dataset Information

Long Cephalomedullary Nails Can Be a Cheap and Effective Interval Revision Prosthesis in Infected Hip Replacements That Require Proximal Femoral Replacement: A Small Case Series.

Publications

Long Cephalomedullary Nails Can Be a Cheap and Effective Interval Revision Prosthesis in Infected Hip Replacements That Require Proximal Femoral Replacement: A Small Case Series.

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