Does metaphyseal modularity in femoral revision stems have a role in treating bone defects less severe than IIIB? Clinical and radiological results of a series of 163 modular femoral stems

Soleilhavoup, Marion; Villatte, Guillaume; Cambier, Sébastien; Descamps, Stéphane; Boisgard, Stéphane; Érivan, Roger

doi:10.1016/j.otsr.2022.103353

Cited by 3 publications

(4 citation statements)

References 28 publications

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“…The modular connection of modular hip stems is subject to high stresses and has been frequently discussed in the literature as a potential source of mechanical failure. 4,9,11,13 However, recent analyses have shown satisfactory low failure rates of modular hip stems. 17,18 The aim of this analysis was to determine the clinical presentation and frequency of mechanical failure of the Prevision hip stem recorded in the manafacturer’s vigilance database after more than 18 years of clinical experience, and in particular after a design change of the taper in 2008.…”

Section: Discussionmentioning

confidence: 99%

“…9 However, authors who generally recommend the use of modular hip stems also continue to point out the potential risk of fretting, wear, corrosion, and ultimately fracture of the modular taper connection. 4,[11][12][13] To date, little is known about the mechanical failure rates of current modular revision hip stems. A recent review of the literature concluded that the majority of stem fractures following revision THA (54 of 77 published failure cases) were associated with modular revision hip stems.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analysis of modular taper fractures of the revision hip stem Prevision and comparison of the original and current taper design

Dreyer,

Bader,

Flörkemeier

et al. 2024

Bone Joint J

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AimsThe risk of mechanical failure of modular revision hip stems is frequently mentioned in the literature, but little is currently known about the actual clinical failure rates of this type of prosthesis. The current retrospective long-term analysis examines the distal and modular failure patterns of the Prevision hip stem from 18 years of clinical use. A design improvement of the modular taper was introduced in 2008, and the data could also be used to compare the original and the current design of the modular connection.MethodsWe performed an analysis of the Prevision modular hip stem using the manufacturer’s vigilance database and investigated different mechanical failure patterns of the hip stem from January 2004 to December 2022.ResultsTwo mechanical failure patterns were identified: fractures in the area of the distal fluted profile (distal stem fracture) and failure of the modular taper (modular fracture). A failure rate of 0.07% was observed for distal stem fracture, and modular fracture rates of 1.74% for the original and 0.013% for the current taper design.ConclusionA low risk of mechanical failure for both fracture types was observed compared to other known complications in revision hip arthroplasty. In addition, the data show that a design change did significantly reduce the risk of a modular fracture.Cite this article: Bone Joint J 2024;106-B(2):151–157.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analysis of modular taper fractures of the revision hip stem Prevision and comparison of the original and current taper design

Dreyer,

Bader,

Flörkemeier

et al. 2024

Bone Joint J

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“…With the rate of total hip arthroplasty (THA) mounting rapidly, the rate of revision THA also has been on the rise annually, the number of procedures being projected to increase from 40,800 in 2005 to 96,700 in 2030 [1]. A challenge posed by the femoral revision is various degrees of bone defects, particularly Paprosky II-IV [2], which result in insufficient support for the prosthesis, thus, leading to subsidence, loosening, and other serious complications [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Conservative femoral revision using short cementless stems with a tapered rectangular shape for selected Paprosky II–IV bone defects: an average seven-year follow-up

Li,

Zhang,

et al. 2024

Arthroplasty

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Background The use of long stems for severe femoral bone defects is suggested by many scholars, but it is associated with further bone loss, intraoperative fracture, increased surgical trauma, and complications. With better bone retention, simple and quick surgical procedures, and minimal complications, the short cementless stems with a tapered rectangular shape may be an alternative for femoral revision. This study aimed to evaluate the results of this type of stem in treating selected Paprosky II–IV bone defects. Methods This retrospective study included 73 patients (76 hips involved) who underwent conservative femoral revision using the short cementless stems with a tapered rectangular shape between January 2012 and December 2020. The preoperative femoral bone defects were identified as follows: 54 cases of type II, 11 cases of type IIIA, 7 cases of type IIIB, and 4 cases of type IV. Indications for revision included aseptic loosening (76.3%) and prosthetic joint infection (23.7%). Six cementless stems with a tapered rectangular shape from three companies were used in all patients. Among them, SLR-Plus, SL-Plus MIA, and Corail stems were employed in most patients (40.8%, 23.7%, and 17.1%, respectively). The average length of these stems measured 171.7 mm (SD 27 mm; 122–215 mm). Radiographic results, Harris hip scores (HHS), complications, and survivorship were analyzed. The follow-up lasted for 7 years on average (range 3–11 years). Results The subsidence was observed in three hips (3.9%), and all stems achieved stable bone ingrowth. Proximal femoral bone restoration in the residual osteolytic area was found in 67 hips (88.2%), constant defects in nine hips (11.8%), and increasing defects in 0 cases. There was no evidence of stem fractures and stem loosening in this series. The mean HHS significantly improved from 32 (range 15–50) preoperatively to 82 (range 68–94) at the last follow-up (t = − 36.297, P < 0.001). Five hips developed prosthesis-related complications, including three infection and two dislocation cases. The mean 5- and 10-year revision-free survivorships for any revision or removal of an implant and reoperation for any reason were 94.6% and 93.3%, respectively. Both mean 5- and 10-year revision-free survivorships for aseptic femoral loosening were 100%. Conclusion Conservative femoral revision using short cementless stems with a tapered rectangular shape can provide favorable radiographic outcomes, joint function, and mid-term survivorship with minimal complications. Of note, a sclerotic proximal femoral bone shell with continued and intact structure and enough support strength is the indication for using these stems. Graphical Abstract

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Revision of total hip arthroplasty by long locking stem with fully hydroxyapatite-coated modular metaphysis (Reef™): A continuous series of 78 cases at a minimum 2-year follow-up

de Leissegues,

Viste,

Fessy

2024

Orthopaedics & Traumatology: Surgery & Research

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Does metaphyseal modularity in femoral revision stems have a role in treating bone defects less severe than IIIB? Clinical and radiological results of a series of 163 modular femoral stems

Cited by 3 publications

References 28 publications

Analysis of modular taper fractures of the revision hip stem Prevision and comparison of the original and current taper design

Analysis of modular taper fractures of the revision hip stem Prevision and comparison of the original and current taper design

Conservative femoral revision using short cementless stems with a tapered rectangular shape for selected Paprosky II–IV bone defects: an average seven-year follow-up

Revision of total hip arthroplasty by long locking stem with fully hydroxyapatite-coated modular metaphysis (Reef™): A continuous series of 78 cases at a minimum 2-year follow-up

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