A modular cementless stem vs. cemented long-stem prostheses in revision surgery of the hip

Abstract

Background and purpose Modular cementless revision prostheses are being used with increasing frequency. In this paper, we review risk factors for the outcome of the Link MP stem and report implant survival compared to conventional cemented long-stem hip revision arthroplasties.Patients and methods We used data recorded in the Swedish Hip Arthroplasty Register. 812 consecutive revisions with the MP stem (mean follow-up time 3.4 years) and a control group with 1,073 cemented long stems (mean follow-up time 4.2 years) were included. Kaplan-Meier analysis was used to determine implant survival. The Cox regression model was used to study risk factors for reoperation and revision.Results The mean age at revision surgery for the MP stem was 72 (SD 11) years. Decreasing age (HR = 1.1, 95% CI: 1–1.1), multiple previous revisions (HR = 2.6, 95% CI: 1.1–6.2), short stem length (HR = 2.4, 95% CI: 1.1–5.2), standard neck offset (HR = 5, 95% CI: 1.5–17) and short head-neck length (HR = 5.3, 95% CI 1.4–21) were risk factors for reoperation. There was an overall increased risk of reoperation (HR = 1.7, 95% CI: 1.3–2.4) and revision (HR = 1.9, 95% CI: 1.2–3.1) for the MP prostheses compared to the controls.Interpretation The cumulative survival with both reoperation and revision as the endpoint was better for the cemented stems with up to 3 years of follow-up. Thereafter, the survival curves converged, mainly because of increasing incidence of revision due to loosening in the cemented group. We recommend the use of cemented long stems in patients with limited bone loss and in older patients.

The effect of a biphasic injectable bone substitute on the interface strength in a rabbit knee prosthesis model

“…Limitations exist, especially regarding donor site morbidity and a limited supply. In primary and revision arthroplasties, alternatives include allografts, bone cement, or the use of long-stemmed prostheses [1,2]. By using allograft bone, a potential risk for blood-borne diseases such as hepatitis and HIV is introduced.…”

Revision total hip arthroplasty in patients with extensive proximal femoral bone loss using a fluted tapered modular femoral component

“…In patients with substantial bone loss, several strategies have been used, including long cemented stems, impaction bone grafting and various types of uncemented component, including extensively coated and distally locked stems. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] However, none of these strategies have completely eliminated problems with fixation in patients with severe loss of proximal femoral bone stock. Fluted, tapered femoral stems engage the diaphyseal cortex, creating axial and rotational stability, [19][20][21][22] and were designed to achieve immediate stability even in the presence of extensive metadiaphyseal bone loss.…”

Salvage of failed hip osteosynthesis for fractures with modular hip prosthesis

“…In addition, individual adjustment of leg length, offset, and anteversion can be obtained. Modular stems are designed to bypass the regions of proximally deficient bone and achieve stability and fixation in more distal femoral bone [6,[8][9][10]14]. The ideal goals of this treating strategy are the earlier mobilization of the patient and a safer, more predictable outcome.…”