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Second stage revision total hip replacement to proximal femoral endoprosthetic replacement for infection using MUTARS proximal femoral endoprosthesis (Implantcast)

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Learn the Second stage revision total hip replacement to proximal femoral endoprosthetic replacement for infection using MUTARS proximal femoral endoprosthesis (Implantcast) surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Second stage revision total hip replacement to proximal femoral endoprosthetic replacement for infection using MUTARS proximal femoral endoprosthesis (Implantcast) surgical procedure.

Periprosthetic joint infection (PJI) is a devastating complication of prosthetic joint replacement, accounting for 13.8% of 15,923 of re-revision total hip arthroplasties performed in the UK in 2018, as detailed in the 16th annual National Joint registry report. More common indications for revision surgery include aseptic loosening (43.5%), pain (16.9%), instability (14.4%), osteolysis (14%), and other important but less common indications for re-revision include implant wear (12.6%) and periprosthetic fracture (10.1%). Both instability and infection are much more common indications for a second revision than first revision hip replacement, highlighting the increased risk of instability and infection following the first revision of a hip replacement compared to that of primary hip replacement

(https://reports.njrcentre.org.uk/Portals/0/PDFdownloads/NJR%2016th%20Annual%20Report%202019.pdf).

Surgical management involves identification of the infecting pathogens and optimisation of the host prior to major surgery, which may involve debridement and implant retention, or a single or two-staged revision procedure. Staged revision surgery remains the gold standard of care for multiply revised infected hip replacements. At the first stage the prosthetic components are explanted and the involved soft-tissues are radically debrided. The joint is temporarily stabilised with either an articulating cement spacer, as in this case, or non-articulating spacer for approximately three months. At the second stage, following repeat debridement, the joint is reconstructed.

To minimise the risk of PJI relapse I prefer a silver coated modular proximal femoral endoprosthesis with cemented medullary stems (MUTARS, Implantcast, Buxtehude, Germany). To minimise the risk of acetabular failure due to aseptic loosening I use a trabecular metal revision system (Trabecular Metal Acetabular Revision System, TMARS, Zimmer Biomet, Warsaw, Indiana, US) which allows the use of a full range of liners, augments, cages to address almost all acetabular defects. To minimise the risk of dislocation I have chosen a dual-mobility articulation in this case.

Readers will also find the following techniques of interest:

Revision Total Hip replacement: Stryker custom acetabulum and SERF Dual mobility Hip (De Puy)

Revision Total Hip replacement: Direct exchange Link MP revision stem for periprosthetic fracture

Total Hip replacement(2 stage revision): Combined intra-pelvic and extended trochanteric osteotomy approach

Total Hip replacement (revision): Direct exchange to Rimfit socket (Stryker) with ‘X-change’ Rim-Mesh (Stryker) and impaction bone grafting

I am grateful to Mr Mike Parry FRCS (Tr & Orth) for the images used in this technique.

Author:Jonathan Stevenson FRCS (TR & Orth)

Institution: Royal Orthopaedic Hospital, Birmingham, UK

Surgical Steps

Welcome to the surgical steps quiz.

This tests your ability to recall the correct order in which the key steps of an operation should be performed.

There will be various legitimate variations in this order but the quiz doesn’t reflect this.
Your reference point for the steps quiz is just our operative technique.
It’s one starting point in helping you to learn the technique.

  • You simply “drag & drop” the boxes containing the descriptions of the steps into the order you think fits and submit for marking.
  • If you get it correct first time you will be presented your certificate at the end of the quiz.
  • If you need to do more work on the steps you access your marked version by clicking the“re-sit the quiz” button.
  • This will show the steps you ordered correctly highlighted in green and the incorrect ones in red.
  • The correct green steps are fixed and won’t move.
  • The red steps move differently after your initial attempt and swap locations with the step they are dragged and dropped onto .
  • Finally resubmit the quiz once again.
  • The quiz will let you keep going until you get all the steps in the right order.
  • The correct green steps are fixed and won’t move.
  • The red steps move differently after your initial attempt and swap locations with the step they are dragged and dropped onto .
  • Finally resubmit the quiz once again.
  • The quiz will let you keep going until you get all the steps in the right order.

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Surgical Steps

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