Distal femoral stem-bone anchorage of a cementless revision total hip arthroplasty

Weiss, Rüdiger J; Strömwall, Fredrik; Beckman, Mats O.; Hansson, Karl; Stark, André

doi:10.3109/17453670903039403

Cited by 12 publications

(9 citation statements)

References 19 publications

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“…For the remainder of the observation period the risk seems similar. Even though the choice of fixation method is ultimately surgeon-dependent, the increased use of uncemented revision stems might be due to the fact that modular stems offer the option of distal anchoring within intact bone, and several opportunities exist to vary the proximal part in order to achieve optimal soft tissue tension, anteversion, and offset (Weiss et al 2009). Another explanation could be that primary cemented stems have higher risk of aseptic loosening compared with uncemented (Mäkelä et al 2008(Mäkelä et al , 2011, which is why it would be logical to assume that uncemented revision stems would decrease the risk of subsequent revisions in the case of aseptic loosening, a phenomenon that has been observed among revision stems in previous studies (Weiss et al 2011, Tyson et al 2019.…”

Section: Discussionmentioning

confidence: 99%

Uncemented or cemented stems in first-time revision total hip replacement? An observational study of 867 patients including assessment of femoral bone defect size

et al. 2020

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Background and purpose — Uncemented stems are gradually replacing cemented stems in hip revision surgery. We compared the risk of re-revision between uncemented and cemented revision stems and assessed whether the different fixation methods are used in similar femoral bone defects. Patients and methods — 867 patients operated on with uncemented or cemented stems in first-time hip revision surgery due to aseptic loosening performed 2006–2016 were identified in the Swedish Hip Arthroplasty Register. Preoperative femoral bone defect size was assessed on radiographs of all patients. Cox regression models were fitted to estimate the adjusted risk of re-revision during different postoperative time periods. Re-revision of any component for any reason, and stem re-revision, as well as risk of cause-specific re-revision was estimated. Results — Most patients in both fixation groups had Paprosky class IIIA femoral bone defects prior to surgery, but there were more severe bone defects in the cemented group. The adjusted risk of re-revision of any component for any reason was higher in patients with uncemented compared with those with cemented revision stems during the first 3 years after index surgery (hazard ratio [HR] 4, 95% confidence interval [CI] 2–9). From the 4th year onward, the risk of re-revision of any component for any reason was similar (HR 0.5, CI 0.2–1.4). Uncemented revision stems conferred a higher risk of dislocation compared with cemented stems (HR 5, CI 1.2–23) during the first 3 years. Interpretation — Although not predominantly used in more complex femoral defects, uncemented revision stem fixation confers a slightly higher risk of re-revision during the first years, but this risk is attenuated after longer follow-up.

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Section: Discussionmentioning

confidence: 99%

Uncemented or cemented stems in first-time revision total hip replacement? An observational study of 867 patients including assessment of femoral bone defect size

et al. 2020

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“…Several designs of tapered and modular fluted stems have been developed. The aim is to provide immediate axial and rotational stability distally in the femur, where the bone is less compromised by the loosening process ( Wirtz et al 2000 , Kwong et al 2003 , Schuh et al 2004 , McInnis et al 2006 , Tamvakopoulos et al 2007 , Rodriguez et al 2009 , Weiss et al 2009 ). In revisions, bone loss and deformity are not always predictable.…”

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confidence: 99%

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

Weiss¹,

Stark²,

Kärrholm³

2011

Acta Orthopaedica

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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.

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“…Two stems (9%) with subsidence > 5 mm in the cementless group of our study were non-progressive and subsided within the first year of the revision surgery. Our findings provide evidence that most subsidence of cementless stems occurs during the first year2425. Since the incidence of subsidence was calculated on the basis of plain radiographic evaluation and not radiostereometric analysis, there is a chance that this may have been underreported.…”

Section: Discussionmentioning

confidence: 78%

Medium-term Outcomes of Cemented Prostheses and Cementless Modular Prostheses in Revision Total Hip Arthroplasty

Wang

Lei

Xie

et al. 2013

Sci Rep

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There is an increasing trend towards cementless modular femoral prostheses for revision hip replacement surgery, especially in patients with severe proximal femoral bone defects. However, for minor femoral bone defects, the benefit of cementless modular is not clear. We designed a retrospective cross-sectional study to compare outcomes of the two femoral implant designs. There were no significant differences in terms of visual analog pain scores, Harris hip scores, femoral bone restoration, stem subsidence, leg length correction, or overall complication rate. Three femoral reoperations (11%) occurred in the cemented group, and two (9%) in the cementless modular group. One femoral stem re-revised (4%) in the cemented group due to recurrent deep infection. Five-year survival for femoral reoperation was 88.2% for patients with the cemented implant and 91.3% for cementless group. Both groups had good clinical and radiological outcomes for femoral revision in patients with minor femoral bone defects during medium-term follow-up.

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Distal femoral stem-bone anchorage of a cementless revision total hip arthroplasty

Cited by 12 publications

References 19 publications

Uncemented or cemented stems in first-time revision total hip replacement? An observational study of 867 patients including assessment of femoral bone defect size

Uncemented or cemented stems in first-time revision total hip replacement? An observational study of 867 patients including assessment of femoral bone defect size

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

Medium-term Outcomes of Cemented Prostheses and Cementless Modular Prostheses in Revision Total Hip Arthroplasty

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