English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

F emoral bone loss is frequently encountered during revision THA. The key is determining the quality and quantity of bone loss, as well as quality and quantity of remaining host bone. In contemporary North American practices, diaphyseal fixation with either an extensively porous-coated stem or titanium modular fluted tapered (TMFT) stem is the standard of care for the majority of hips with bone defects rated Paprosky Type IIIB or less. The basic principle in both techniques is the importance of obtaining immediate axial and rotational stability. The two main clinical concerns with extensively porous-coated stems are intraoperative periprosthetic femoral fracture and stress shielding over time. In response to these concerns, the interest in TMFT stems is increasing, and the indications for their use seem to be expanding [1]. The real controversy is in those patients with Paprosky Type IV defects in whom rotational stability in the diaphysis would not be possible to obtain. In this difficult setting, consideration has traditionally been given to allograftprosthetic composites (APCs), impaction bone grafting with long cemented stems, proximal femoral replacements, and more recently, TMFT stems. In this intriguing paper by Kim et al., the authors studied 130 patients (140 hips) with Paprosky Type IIIB (54%) and Type IV (46%) defects who underwent revision THA. Even though all patients had less than 2 cm of available isthmic bone, the surgeons used extensively porous-coated stems. However, cortical strut allografts (one strut in 10%, two struts in 75%, and three struts in 15%) were used to provide primary stability for the extensively porous-coated stems. At a mean followup of 16 years, the authors found that all allografts had incorporated, and 87% of stems had radiographic evidence of bony ingrowth. This CORR Insights is a commentary on the article ‘‘High Survivorship With Cementless Stems and Cortical Strut Allografts for Large Femoral Bone Defects in Revision THA’’ by Kim and colleagues available at: DOI: 10.1007/s11999-015-4358-y. The author certifies that he, or any members of his immediate family, have no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers and do not reflect the opinion or policy of CORR or the Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999-0154358-y. M. P. Abdel MD (&) Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA e-mail: abdel.matthew@mayo.edu CORR Insights Published online: 13 June 2015 The Association of Bone and Joint Surgeons1 2015

CORR Insights®: High Survivorship With Cementless Stems and Cortical Strut Allografts for Large Femoral Bone Defects in Revision THA