Minimally-invasive re-stabilisation of loosened hip implants using percutaneous periprosthetic cement injections
a feasible option to reduce pain in frail patients
Kiki Q. de Smidt (Leiden University Medical Center)
Shaho Hasan (Leiden University Medical Center)
Perla J. Marang-van de Mheen (TU Delft - Technology, Policy and Management, Leiden University Medical Center)
Demien Broekhuis (Leiden University Medical Center)
Rob GHH Nelissen (Leiden University Medical Center)
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Abstract
Introduction: Loosening of hip implants causes severe pain and disability. Revision surgery, the standard treatment, carries high risks, especially for frail patients. Therefore, a less-invasive treatment option is needed for patients with incapacitating pain. We evaluated the safety and efficacy of percutaneous periprosthetic cement injection (PPCI) to restabilise loosened hip implants. Methods: All patients treated with PPCIs of hip implants between 2004 and 2020 were retrospectively included (median follow-up 24 months, IQR 11–51). Cement was injected in the periprosthetic space of the loosened hip implant under fluoroscopy. Patient characteristics and the Charlson Comorbidity Index (CCI) were measured. Pain reduction was measured by the Harris Hip pain-subscore and adverse events were recorded. Results: 34 patients were included (mean age 83 years, median CCI 6 points). 10 patients had a second PPCI after 12 months (median, IQR 7–27). 2 patients needed revision surgery. 30 patients had pain reduction and 4 had no pain reduction. Adverse events included femoral fissure during needle placement (n = 1) and progressive migration of a loosened acetabular cup (despite the cement injection; n = 2). Conclusions: PPCIs for loosened hip implants is feasible in frail patients with pain reduction in the majority of patients and has limited adverse events.
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