Wednesday, January 18, 2012

Exchanging only the femoral head in a revsion surgery.

This is a follow on to the post last nite http://www.mydepuyhiprecall.com/2012/01/what-parts-are-replaced-in-revsion.html . We had a question from one of our revision readers as their surgeon just replaced the femoral head.  I found some journal articles where the cup and the liner were replaced but not just the ball (femoral head.)  So surprise!  that surgery not only exists, it seems it is recommended in certain circumstances!

 I actually found 3 publications where just the femoral head (ball) has been exchanged.  This is a relatively new finding.  Hope this helps you!

Int Orthop. 2011 Feb;35(2):261-5. Epub 2010 Nov 19.

Strategies for head and inlay exchange in revision hip arthroplasty.

Source

Orthopedic Hospital Vienna-Speising, Speisingerstr. 109, 1130, Vienna, Austria. martin.pospischill@oss.at

Abstract

Due to the increasing number of total hip arthroplasties performed during the last three decades and the limited long-term survival, mainly because of wear, the number of revisions has increased during the last two years. If the implant itself is still considered to be stable, only head and inlay exchange is necessary. This requires comprehensive knowledge of the characteristics of the articulating materials by the surgeon as the wrong choice of wear couple can lead to early failure for a second time. The aim of this paper is to present considerations and strategies for head and inlay exchange in case of failure, either due to wear of the articulation material or of other indications for revision hip arthroplasty.

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J Arthroplasty. 2009 Jun;24(4):625-30. Epub 2008 Jun 4.

Modular femoral head and liner exchange for the unstable total hip arthroplasty.

Source

Orange Orthopedic Medical Group, Orange, CA, USA.

Abstract

Outcomes of femoral head and nonconstrained liner exchange in treating hip instability were evaluated. Forty-eight modular component exchanges performed in 45 patients for recurrent hip dislocations were retrospectively reviewed. Mean follow-up was 4.7 years. Overall success rate was 73% (35/48 hips). Thirty-two (67%) of 48 hips experienced no further dislocations. Three patients had 1 dislocation each with no subsequent dislocations. Ten patients (13 hips) had additional surgery to stabilize their hips (27% failure rate). Demographic, clinical, and implant variables were not associated with outcome. Isolated modular component exchange can be successful in treating recurrent hip dislocations; however, a significant failure rate, not easily predicted, exists. This represents the largest series of modular head and nonconstrained liner exchange for hip dislocation (122/125).

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Chirurg. 1999 Nov;70(11):1353-6.

[Rare indication for a simple hip prosthesis with an extra-large femoral head following multiple failed exchange operations].

[Article in German]

Source

ENDO-Klinik, Gemeinnützige Betriebsgesellschaft mbH, Hamburg.

Abstract

In certain rare cases of failure following multiple exchange arthroplasty at the hip, it is possible to create a strong and reliable connection between the pelvis and the femur, without replacing the acetabulum, by fitting a custom-made extra-large femoral head into the existing and stable large cavity. Two cases in which this method was used are described here and recommended for consideration in similar situations

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