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Trabecular metal screw implanted for avascular necrosis of the femoral head may complicate subsequent arthroplasty surgery

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

A trabecular metal screw has been suggested to treat avascular osteonecrosis of the femoral head. Non-surgical management with partial weight bearing can only be selected for early stages and very small lesions. Even in such cases, it has been proven to be ineffective in 80–90 % of patients. Conversely, the results with trabecular metal implants are not always clinically satisfactory, and some patients can show emerging pain and activity limitations that could require conversion to a total hip arthroplasty. Hereby we report the results of 6 patients who underwent this implant and describe the histopathology of the bone at the femoral neck and to speculate on the causes of complications encountered during arthroplasty surgery. The necrosis was stopped in 1 case, and 5 hips showed disease progression. Two protrusions of the screw apex were observed. In one case, rupture of the greater trochanter during prosthesis implant occurred. After trabecular metal implants for avascular osteonecrosis, some patients can require conversion to a total hip arthroplasty. Two patients had an intraoperative fracture with detachment of the greater trochanter that required wiring. Complications related to implant removal can be encountered, and the orthopedic surgeon should be aware of removal techniques.

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References

  1. Lieberman JR, Berry DJ, Mont MA, Aaron RK, Callaghan JJ, Rajadhyaksha AD et al (2003) Osteonecrosis of the hip: management in the 21st century. Instr Course Lect 52:337–355

    PubMed  Google Scholar 

  2. Aaron RK (1998) Osteonecrosis: etiology, pathophysiology and diagnosis. The adult hip. Philadelphia: Lippincott-Raven 1998:451–466

    Google Scholar 

  3. Mont (1995) Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 77(3):459–474

    CAS  PubMed  Google Scholar 

  4. Aldridge JM 3rd, Urbaniak JR (2004) Avascular necrosis of the femoral head: etiology, pathophysiology, classification, and current treatment guidelines. Am J Orthop (Belle Mead NJ) 33(7):327–332

    Google Scholar 

  5. Mont MA, Carbone JJ, Fairbank AC (1996) Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop Relat Res 324:169–178

    Article  PubMed  Google Scholar 

  6. Camp JF, Colwell CW Jr (1986) Core decompression of the femoral head for osteonecrosis. J Bone Joint Surg Am 68(9):1313–1319

    CAS  PubMed  Google Scholar 

  7. Sugioka Y, Katsuki I, Hotokebuchi T (1982) Transtrochanteric rotational osteotomy of the femoral head for the treatment of osteonecrosis. Follow-up statistics. Clin Orthop Relat Res 169:115–126

    PubMed  Google Scholar 

  8. Drescher W, Furst M, Hahne HJ, Helfenstein A, Petersen W, Hassenpflug J (2003) Survival analysis of hips treated with flexion osteotomy for femoral head necrosis. J Bone Joint Surg Br 85(7):969–974

    Article  CAS  PubMed  Google Scholar 

  9. Plakseychuk AY, Kim SY, Park BC, Varitimidis SE, Rubash HE, Sotereanos DG (2003) Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Am 85A(4):589–596

    Google Scholar 

  10. Malizos KN, Soucacos PN, Beris AE (1995) Osteonecrosis of the femoral head. Hip salvaging with implantation of a vascularized fibular graft. Clin Orthop Relat Res 314:67–75

    PubMed  Google Scholar 

  11. Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA (1995) Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips. J Bone Joint Surg Am 77(5):681–694

    CAS  PubMed  Google Scholar 

  12. Sotereanos DG, Plakseychuk AY, Rubash HE (1997) Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head. Clin Orthop Relat Res 344:243–256

    PubMed  Google Scholar 

  13. Plakseychuk AY, Shah M, Varitimidis SE, Rubash HE, Sotereanos D (2001) Classification of osteonecrosis of the femoral head. Reliability, reproducibility, and prognostic value. Clin Orthop Relat Res 386:34–41

    Article  PubMed  Google Scholar 

  14. Tsao AK, Roberson JR, Christie MJ, Dore DD, Heck DA, Robertson DD et al (2005) Biomechanical and clinical evaluations of a porous tantalum implant for the treatment of early-stage osteonecrosis. J Bone Joint Surg Am 87(Suppl 2):22–27

    Article  PubMed  Google Scholar 

  15. Veillette CJ, Mehdian H, Schemitsch EH, McKee MD (2006) Survivorship analysis and radiographic outcome following tantalum rod insertion for osteonecrosis of the femoral head. J Bone Joint Surg Am 88(Suppl 3):48–55

    Article  PubMed  Google Scholar 

  16. Shuler MS, Rooks MD, Roberson JR (2007) Porous tantalum implant in early osteonecrosis of the hip: preliminary report on operative, survival, and outcomes results. J Arthroplasty 22(1):26–31

    Article  PubMed  Google Scholar 

  17. Stulberg BN, Davis AW, Bauer TW, Levine M, Easley K (1991) Osteonecrosis of the femoral head. A prospective randomized treatment protocol. Clin Orthop Relat Res 268:140–151

    PubMed  Google Scholar 

  18. Koo KH, Kim R, Ko GH, Song HR, Jeong ST, Cho SH (1995) Preventing collapse in early osteonecrosis of the femoral head. A randomised clinical trial of core decompression. J Bone Joint Surg Br 77(6):870–874

    CAS  PubMed  Google Scholar 

  19. Fairbank AC, Bhatia D, Jinnah RH, Hungerford DS (1995) Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg Br 77(1):42–49

    CAS  PubMed  Google Scholar 

  20. Smith SW, Fehring TK, Griffin WL, Beaver WB (1995) Core decompression of the osteonecrotic femoral head. J Bone Joint Surg Am 77(5):674–680

    CAS  PubMed  Google Scholar 

  21. Louie BE, McKee MD, Richards RR, Mahoney JL, Waddell JP, Beaton DE et al (1999) Treatment of osteonecrosis of the femoral head by free vascularized fibular grafting: an analysis of surgical outcome and patient health status. Can J Surg 42(4):274–283

    CAS  PubMed Central  PubMed  Google Scholar 

  22. Berend KR, Gunneson EE, Urbaniak JR (2003) Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. J Bone Joint Surg Am 85-A(6):987–993

    PubMed  Google Scholar 

  23. Vail TP, Urbaniak JR (1996) Donor-site morbidity with use of vascularized autogenous fibular grafts. J Bone Joint Surg Am 78(2):204–211

    CAS  PubMed  Google Scholar 

  24. Tang CL, Mahoney JL, McKee MD, Richards RR, Waddell JP, Louie B (1998) Donor site morbidity following vascularized fibular grafting. Microsurgery 18(6):383–386

    Article  CAS  PubMed  Google Scholar 

  25. Aluisio FV, Urbaniak JR (1998) Proximal femur fractures after free vascularized fibular grafting to the hip. Clin Orthop Relat Res 356:192–201

    Article  PubMed  Google Scholar 

  26. Schemitsch EH (1996) Cementless total hip arthroplasty in patients with avascular necrosis. In: Canadian Orthopaedic Association proceedings of the Canadian Orthopaedic Association meeting, Quebec

  27. Trabecular Metal™ Osteonecrosis Intervention Implant. Zimmer, Allendale, New Jersey, USA

  28. Pedersen (1997) Finite element characterization of a porous tantalum material for treatment of avascular necrosis. Trans Orthop Res Soc 22:598

    Google Scholar 

  29. Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ (1999) Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br 81(5):907–914

    Article  CAS  PubMed  Google Scholar 

  30. Bobyn JD, Poggie RA, Krygier JJ, Lewallen DG, Hanssen AD, Lewis RJ et al (2004) Clinical validation of a structural porous tantalum biomaterial for adult reconstruction. J Bone Joint Surg Am 86-A(Suppl 2):123–129

    PubMed  Google Scholar 

  31. Tanzer M, Karabasz D, Krygier JJ, Cohen R, Bobyn JD (2005) The Otto Aufranc Award: bone augmentation around and within porous implants by local bisphosphonate elution. Clin Orthop Relat Res 441:30–39

    Article  PubMed  Google Scholar 

  32. Cornell CN, Lane JM (1998) Current understanding of osteoconduction in bone regeneration. Clin Orthop Relat Res 355(Suppl):S267–S273

    Article  PubMed  Google Scholar 

  33. Urbaniak JR, Harvey EJ (1998) Revascularization of the femoral head in osteonecrosis. J Am Acad Orthop Surg 6(1):44–54

    CAS  PubMed  Google Scholar 

  34. Aldegheri R, Taglialavoro G, Berizzi A (2007) The tantalum screw for treating femoral head necrosis: rationale and results. Strategies Trauma Limb Reconstr 2(2–3):63–68

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Mont MA, Marulanda GA, Jones LC, Saleh KJ, Gordon N, Hungerford DS, Steinberg ME (2006) Systematic analysis of classification systems for osteonecrosis of the femoral head. J Bone Joint Surg Am 88(Suppl 3):16–26

    Google Scholar 

  36. Steinberg ME, Steinberg DR (2004) Classification systems for osteonecrosis: an overview. Orthop Clin North Am 35(3):273–283

    Article  PubMed  Google Scholar 

  37. Steinberg ME, Hayken GD, Steinberg DR (1995) A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 77(1):34–41

    CAS  PubMed  Google Scholar 

  38. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51(4):737–755

    CAS  PubMed  Google Scholar 

  39. Mortazavi SM, Greenky M, Bican O et al (2011) Total hip arthroplasty after prior surgical treatment of hip fracture: is it always challenging? J Arthroplasty 27(1):31–36

    Article  PubMed  Google Scholar 

  40. Hungerford DS, Mont MA (1998) The natural history of untreated asymptomatic hips in patients who have non-traumatic osteonecrosis. J Bone Joint Surg Am 80(5):765–766

    CAS  PubMed  Google Scholar 

  41. Castro FP Jr, Barrack RL (2000) Core decompression and conservative treatment for avascular necrosis of the femoral head: a meta-analysis. Am J Orthop (Belle Mead NJ) 29(3):187–194

    Google Scholar 

  42. Scully SP, Aaron RK, Urbaniak JR (1998) Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis. J Bone Joint Surg Am 80(9):1270–1275

    CAS  PubMed  Google Scholar 

  43. Lavernia CJ, Sierra RJ (2000) Core decompression in atraumatic osteonecrosis of the hip. J Arthroplasty 15(2):171–178

    Article  CAS  PubMed  Google Scholar 

  44. Brown TD, Pedersen DR, Baker KJ, Brand RA (1993) Mechanical consequences of core drilling and bone-grafting on osteonecrosis of the femoral head. J Bone Joint Surg Am 75(9):1358–1367

    CAS  PubMed  Google Scholar 

  45. Varitimidis SE, Dimitroulias AP, Karachalios TS, Dailiana ZH, Malizos KN (2009) Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis: 26 hips followed for an average of 3 years. Acta Orthop 80(1):20–25

    Article  PubMed Central  PubMed  Google Scholar 

  46. Tanzer JDB, Krygier JJ, Karabasz D (2008) Histopathologic retrieval analysis of clinically failed porous tantalum osteonecrosis implants. J Bone Joint Surg Am 90:1282–1289

    Article  CAS  PubMed  Google Scholar 

  47. Fernandez-Fairen M, Murcia A, Iglesias R, Querales V, Sevilla P, Gil J (2008) Osteointegration of porous tantalum stems implanted in avascular necrosis of the hip. Acta Ortop Mex 22(4):215–221

    PubMed  Google Scholar 

  48. Ronga (2006) Bone ingrowth in high porous tantalum biomaterial: a morphological study in a case series of human avascular necrosis of femoral head. J Bone Joint Surg Br 88(III):422

    Google Scholar 

  49. Bobyn JDTK, Hacking SA, Tanzer M, Krygier JJ (1999) Tissue response to porous tantalum acetabular cups: a canine model. J Arthroplasty 14:347–354

    Article  CAS  PubMed  Google Scholar 

  50. Kang Y, Zhang ZJ, Zhao XY, Zhang ZQ, Sheng PY, Liao WM (2013) Total hip arthroplasty for vascular necrosis of the femoral head in patients with systemic lupus erythematosus: a midterm follow-up study of 28 hips in 24 patients. Eur J Orthop Surg Traumatol 23(1):73–79

    Article  PubMed  Google Scholar 

  51. Kumar R, Aggarwal A, Krishnan V, Gopinathan N, Chakraborty S (2013) Femoroacetabular Impingement and comparison of radiological indexes: a study on 50 cases. Musculoskelet Surg 1–6. doi:10.1007/s12306-013-0244-5

  52. Nanni M, Perna F, Calamelli C, Donati D, Ferrara O, Parlato A, D’Arienzo M, Faldini C (2013) Wound drainages in total hip arthroplasty: to use or not to use? Review of the literature on current practice. Musculoskelet Surg 1–7. doi:10.1007/s12306-013-0270-3

  53. Zhang Y, Li L, Shi ZJ, Wang J, Li ZH (2013) Porous tantalum rod implant is an effective and safe choice for early-stage femoral head necrosis: a meta-analysis of clinical trials. Eur J Orthop Surg Traumatol 23(2):211–217

    Article  PubMed  Google Scholar 

  54. Wang T, Wang W, Yin ZS (2013) Treatment of osteonecrosis of the femoral head with thorough debridement, bone grafting and bone-marrow mononuclear cells implantation. Eur J Orthop Surg Traumatol 1–6. doi:10.1007/s00590-012-1161-2

  55. Lamo-Espinosa J, Duart Clemente J, Díaz-Rada P, Pons-Villanueva J, Valentí-Nín JR (2013) The Burch-Schneider antiprotrusio cage: medium follow-up results. Musculoskelet Surg 97(1):31–37

    Article  CAS  PubMed  Google Scholar 

  56. Imarisio D, Trecci A, Sabatini L, Uslenghi M, Leone C, Scagnelli R (2013) Cementless total hip replacement for severe developmental dysplasia of the hip: our experience in Crowe’s group IV. Musculoskelet Surg 97(1):25–30

    Article  PubMed  Google Scholar 

  57. Benthien JP, Siepen W (2012) Early failure of a non-cemented femoral stem after minimal-invasive total hip arthroplasty: cause analysis and classification. Musculoskelet Surg 1–4. doi:10.1007/s12306-012-0202-7

  58. Thabet AM, Catagni MA, Guerreschi F (2012) Total hip replacement fifteen years after pelvic support osteotomy (PSO): a case report and review of the literature. Musculoskelet Surg 96(2):141–147

    Article  PubMed  Google Scholar 

  59. Owens JB, Ely EE, Guilliani NM, Suarez JC, Patel PD (2012) Removal of trabecular metal osteonecrosis intervention implant and conversion to primary total hip arthroplasty. J Arthroplasty 27(6):1251–1253

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, Center of Integrated Research (CIR), University Campus Bio-Medico of Rome, Rome, Italy

    N. Papapietro, A. Di Martino, G. Niccoli, A. Palumbo, G. Salvatore & V. Denaro

  2. University San Pablo—CEU, Campus Monteprincipe, Madrid, Spain

    F. Forriol

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  1. N. Papapietro
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  2. A. Di Martino
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  3. G. Niccoli
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  4. A. Palumbo
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  5. G. Salvatore
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  6. F. Forriol
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  7. V. Denaro
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Correspondence to A. Di Martino.

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Papapietro, N., Di Martino, A., Niccoli, G. et al. Trabecular metal screw implanted for avascular necrosis of the femoral head may complicate subsequent arthroplasty surgery. Eur J Orthop Surg Traumatol 24, 931–938 (2014). https://doi.org/10.1007/s00590-013-1275-1

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  • DOI: https://doi.org/10.1007/s00590-013-1275-1

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