Successful reimplantation surgery after extraction of well-fixed cementless stems by femoral longitudinal split procedure

Abstract

Background: Well-fixed cementless stems sometimes need to be extracted in patients with complications including periprosthetic infection, stem-neck breakage, or trunnionosis. The purpose of this study was to report the clinical outcome in patients undergoing reimplantation surgery after removal of a well-fixed porous-coated cementless stem by the femoral longitudinal split (FLS) procedure. Methods: We conducted a retrospective study and radiographic review of 16 patients who had undergone reimplantation following the FLS procedure to remove a well-fixed stem due to periprosthetic infection, stem-neck breakage, or trunnionosis. The study group consisted of 2 men and 14 women with an average age of 68.4 years. Mean follow-up was 44.6 months. The Kaplan-Meier method was used to evaluate the longevity of the stem. Results: The average operation time was 272 ± 63 minutes and intraoperative bleeding was 420 ± 170 mL. Although postoperative dislocation occurred in 5 hips and subsidence of the stem was found in 2 hips after surgery, no progressive subsidence was observed and the clinical JOA and JHEQ scores were both improved after reimplantation surgery. Reimplantation surgery with Zweymüller-type stems revealed evidence of osseointegration of the stem without femoral fracture. Kaplan-Meier survival analysis of stem revision for any reason as the end point revealed 70.0% survival at 9 years. Conclusions: In this study, we experienced some complications in patients with trunnionosis or periprosthetic infections. However, the FLS procedure is expected to confer successful clinical results without loosening of the reimplanted cementless stem, after safe extraction of well-fixed porous-coated cementless stems without fracture. Keywords: Revision, THA, Longitudinal split osteotomy, Cementless stem, Extraction