Salomon Kevin, Shen Victor, Sullivan Alex, Grayson Christopher, Lyons Steven, Palumbo Brian T
University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA.
Foundation for Orthopaedic Research and Education, 4115 W Spruce St, Tampa, FL, 33607, USA.
J Orthop. 2023 Jul 17;43:6-10. doi: 10.1016/j.jor.2023.07.012. eCollection 2023 Sep.
Revision of well-fixed cementless femoral stems is a challenging and time-consuming aspect of revision hip arthroplasty. The Watson Extraction System (WES) is a novel, size-specific 3-D fabricated instrument that mimics the outer geometry of the implanted femoral stem. The device acts to cut circumferentially around the stem as it is impacted into place, effectively disrupting the bone-implant interface.
This is a retrospective review assessing the experience of 3 fellowship-trained adult reconstruction surgeons who used the WES to extract 10 well-fixed femoral stems during rTHA between 11/7/2020 and 11/7/2022. Outcomes and measures included: ability to remove the stem without a femoral osteotomy, femoral stem extraction time, incidence of femoral fracture, stem type used for reconstruction, blood loss, total surgical time, post-operative complications.
No femoral osteotomies were required. The mean time for stem extraction was 7 min (range, 2-13), and there were 2 (20%) intra-operative femoral fractures. The stem type utilized for reconstruction included: 4 (40%) modular, tapered style stems, 3 (30%) antibiotic spacers, 2 (20%) primary style stems, and 1 (10%) ream and broach proximally porous stem. The mean blood loss was 425 ml (range, 200-800), total surgical time was 160 min (range, 107-232), and duration of follow-up was 7 months (range, 2-22 months).
The WES may mitigate the need for femoral osteotomy, reduce femoral stem extraction and overall intraoperative time, and decrease blood loss in rTHA. Further, reduced bone loss with use of this device may permit final reconstruction with a primary style stem.
翻修固定良好的非骨水泥型股骨柄是髋关节置换翻修手术中一项具有挑战性且耗时的工作。沃森取出系统（WES）是一种新型的、特定尺寸的三维打印器械，它模仿植入股骨柄的外部几何形状。该装置在将其打入就位时围绕股骨柄进行圆周切割，有效地破坏骨-植入物界面。
这是一项回顾性研究，评估了3名接受过成人重建 fellowship 培训的外科医生在2020年11月7日至2022年11月7日期间使用WES在翻修全髋关节置换术中取出10个固定良好的股骨柄的经验。结果和测量指标包括：无需股骨截骨即可取出股骨柄的能力、股骨柄取出时间、股骨骨折发生率、用于重建的股骨柄类型、失血量、总手术时间、术后并发症。
无需进行股骨截骨。股骨柄取出的平均时间为7分钟（范围为2 - 13分钟），术中发生2例（20%）股骨骨折。用于重建的股骨柄类型包括：4个（40%）模块化锥形柄、3个（30%）抗生素间隔物、2个（20%）初次使用型柄和1个（10%）近端扩髓及拉削的多孔柄。平均失血量为425毫升（范围为200 - 800毫升），总手术时间为160分钟（范围为107 - 232分钟），随访时间为7个月（范围为2 - 22个月）。
WES可能减少股骨截骨的需求，缩短股骨柄取出时间和总体手术时间，并减少翻修全髋关节置换术中的失血量。此外，使用该装置减少的骨量丢失可能允许使用初次使用型柄进行最终重建。
