Revision of a Press Fit Biological Fixation Stem Fracture in a Dog

Abstract

This report describes a clinical case of a press fit biological fixation femoral implant neck fracture (fatigue failure) and its revisions in a dog. A total hip arthroplasty revision was performed. The stem was replaced with a bigger one through a V-shape osteotomy of the proximal–lateral aspect of the femur. Stabilization was accomplished using a locking plate and two over-the-plate cerclage wires. Subsidence of the femoral stem occurred following revision and was revised with a second revision in which a collared stem was used. Two revision surgeries were necessary to have a stable functional prosthesis with successful bone integration at 7 months postoperative revaluation. Major errors encountered in this case were placement of an undersized stem and an inadequate femoral canal stability/press-fit. Fracture of a BFX femoral stem neck has not been previously reported.

Keywords

Total Hip Replacement - arthroplasty - revision surgery - dogs - joint replacement

Author contribution

Massimo Petazzoni and Elena De Giacinto contributed to conception of study, study design, acquisition of data and data analysis and interpretation. Denis Marcellin-Little contributed to study design and data analysis and interpretation. Michael Kowaleski contributed to study design, acquisition of data and data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.

• References

• 1 Conzemius MG, Vandervoort J. Total joint replacement in the dog. Vet Clin North Am Small Anim Pract 2005; 35 (05) 1213-1231 , vii
• 2 Tomas A, Marcellin-Little DJ, Roe SC, Motsinger-Reif A, Lascelles BD. Relationship between mechanical thresholds and limb use in dogs with coxofemoral joint oa-associated pain and the modulating effects of pain alleviation from total hip replacement on mechanical thresholds. Vet Surg 2014; 43 (05) 542-548
• 3 Lascelles BD, Freire M, Roe SC, DePuy V, Smith E, Marcellin-Little DJ. Evaluation of functional outcome after BFX total hip replacement using a pressure sensitive walkway. Vet Surg 2010; 39 (01) 71-77
• 4 Montgomery RD, Milton JL, Pernell R, Aberman HM. Total hip arthroplasty for treatment of canine hip dysplasia. Vet Clin North Am Small Anim Pract 1992; 22 (03) 703-719
• 5 Fitzpatrick N, Pratola L, Yeadon R, Nikolaou C, Hamilton M, Farrell M. Total hip replacement after failed femoral head and neck excision in two dogs and two cats. Vet Surg 2012; 41 (01) 136-142
• 6 Kalis RH, Liska WD, Jankovits DA. Total hip replacement as a treatment option for capital physeal fractures in dogs and cats. Vet Surg 2012; 41 (01) 148-155
• 7 Gemmill TJ, Pink J, Clarke SP, McKee WM. Total hip replacement for the treatment of atraumatic slipped femoral capital epiphysis in dogs. J Small Anim Pract 2012; 53 (08) 453-458
• 8 Pozzi A, Kowaleski MP, Dyce J. , et al. Treatment of traumatic coxo-femoral luxation by cemented total hip arthroplasty. Vet Comp Orthop Traumatol 2004; 4: 198-203
• 9 Jankovits DA, Liska WD, Kalis RH. Treatment of avascular necrosis of the femoral head in small dogs with micro total hip replacement. Vet Surg 2012; 41 (01) 143-147
• 10 Olmstead ML. Canine cemented total hip replacements: state of the art. J Small Anim Pract 1995; 36 (09) 395-399
• 11 Marcellin-Little DJ, DeYoung BA, Doyens DH, DeYoung DJ. Canine uncemented porous-coated anatomic total hip arthroplasty: results of a long-term prospective evaluation of 50 consecutive cases. Vet Surg 1999; 28 (01) 10-20
• 12 Guerrero TG, Montavon PM. Zurich cementless total hip replacement: retrospective evaluation of 2nd generation implants in 60 dogs. Vet Surg 2009; 38 (01) 70-80
• 13 Olmstead ML. Total hip replacement. Vet Clin North Am Small Anim Pract 1987; 17 (04) 943-955
• 14 Hummel DW, Lanz OI, Werre SR. Complications of cementless total hip replacement. A retrospective study of 163 cases. Vet Comp Orthop Traumatol 2010; 23 (06) 424-432
• 15 DeYoung DJ, DeYoung BA, Aberman HA, Kenna RV, Hungerford DS. Implantation of an uncemented total hip prosthesis. Technique and initial results of 100 arthroplasties. Vet Surg 1992; 21 (03) 168-177
• 16 Marcellin-Little DJ, DeYoung DJ, Thrall DE, Merrill CL. Osteosarcoma at the site of bone infarction associated with total hip arthroplasty in a dog. Vet Surg 1999; 28 (01) 54-60
• 17 Peck JN, Liska WD, DeYoung DJ. , et al. Clinical application of total hip replacement. In: Peck JN, Marcellin-Little DJ, eds. Advances in Small Animal Total Joint Replacement. West Sussex, UK: Wiley; 2012:69–108
• 18 Piermattei DL, Johnson K. . Approach to the craniodorsal aspect of the hip joint through a craniolateral incision. In: Piermattei DL, ed. An Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. 4th ed. Philadelphia: W.B. Saunders; 2004:290–5
• 19 Roe SC, Sidebotham C, Marcellin-Little DJ. Acetabular cup liner and prosthetic head exchange to increase the head diameter for management of recurrent luxation of a prosthetic hip in two dogs. Vet Comp Orthop Traumatol 2015; 28 (01) 60-66
• 20 Peck JN, Marcellin-Little DJ. . Revision strategies for total hip replacement. In: Peck JN, Marcellin-Little DJ, eds. Advances in Small Animal Total Joint Replacement. West Sussex, UK: Wiley; 2012:109–30
• 21 Tencer AF, Claudi B, Pearce S, Bucholz RW, Johnson KD. Development of a variable stiffness external fixation system for stabilization of segmental defects of the tibia. J Orthop Res 1984; 1 (04) 395-404
• 22 Muir P, Johnson KA, Markel MD. Area moment of inertia for comparison of implant cross-sectional geometry and bending stiffness. Vet Comp Orthop Traumatol 1995; 8: 146-152
• 23 Hallab NJ, Jacobs JJ. . Orthopedic applications. In: Ratner BD, Hoffman AS, Schoen FJ, Lemons JE, eds. Biomaterials Science: An Introduction to Materials in Medicine. 3rd ed. Waltham, MA: Academic Press; 2013:841–82
• 24 Wycisk E, Solbach A, Siddique S. , et al. Effects of defects in laser additive manufactured Ti-6Al-4V on fatigue properties. Phys Procedia 2014; 56: 371-378
• 25 Bray JP, Kersley A, Downing W. , et al. Clinical outcomes of patient-specific porous titanium endoprostheses in dogs with tumors of the mandible, radius, or tibia: 12 cases (2013-2016). J Am Vet Med Assoc 2017; 251 (05) 566-579
• 26 Necula RD, Sabou FLP, Turcu A. , et al. Femoral component breakage in primary reverse hybrid hip replacement – a case report. Bull Transilv Univ Brasov Ser VI Med Sci 2016; 9: 13-16
• 27 Kowaleski MP. . Biomechanical considerations in total hip replacement. In: Peck JN, Marcellin-Little DJ, eds. Advances in Small Animal Total Joint Replacement. West Sussex, UK: Wiley; 2012:53–68
• 28 Masri BA, Meek RM, Duncan CP. Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 2004; ; ( (420) 80-95
• 29 Hagel A, Siekmann H, Delank KS. Periprosthetic femoral fracture - an interdisciplinary challenge. Dtsch Arztebl Int 2014; 111 (39) 658-664
• 30 Petazzoni M, Buiatti M, Mortellaro CM. Periprosthetic fracture in a cat. Veterinaria 2016; 6: 375-383
• 31 Dennis MG, Simon JA, Kummer FJ, Koval KJ, DiCesare PE. Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques. J Arthroplasty 2000; 15 (04) 523-528
• 32 Rashmir-Raven AM, DeYoung DJ, Abrams Jr CF, Aberman HA, Richardson DC. Subsidence of an uncemented canine femoral stem. Vet Surg 1992; 21 (05) 327-331
• 33 McCulloch RS, Roe SC, Marcellin-Little DJ, Mente PL. Resistance to subsidence of an uncemented femoral stem after cerclage wiring of a fissure. Vet Surg 2012; 41 (01) 163-167