Extensively Porous-Coated Stems for Femoral Revision

123

Background Currently, the two most commonly used options for the revision of femoral components in North America are: cylindrical, nonmodular, cobalt-chromium stems and tapered, fluted, modular, titanium (TFMT) stems. Previous reports have cited high failure rates with cylindrical cobalt chrome stems in large femoral defects but the longer term survival of the fluted stems is unknown. Questions/PurposesWe examined the 5-to 10-year survival of TFMT stems implanted for severe femoral defects. Methods We reviewed all 65 patients with severe proximal bone defects revised with the TMFT stem between January 2000 and 2006. Ten were lost to followup and seven were dead, leaving 48 patients for followup at 5 to 10 years (mean, 84 months; range, 60-120 months). All patients completed five quality-of-life (QOL) questionnaires. Radiographs were evaluated for loosening, subsidence, and preservation of proximal host bone stock.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High Survival of Modular Tapered Stems for Proximal Femoral Bone Defects at 5 to 10 Years Followup

Houwelingen

Duncan

Masri

et al. 2013

123

“…Although long-term survivorship has been well established (95%-96% survivorship at a mean of 10-14 years [13,23]), concerns have been raised regarding postoperative thigh pain (8%-30% [16,19]), a high incidence of intraoperative fractures (9%-30% [18,23]), and stress shielding of the proximal femur (reportedly 8% [19]) with the use of this stem design. Several femoral component designs, with varying degrees of modularity and different fixation concepts, have been developed in an attempt to address these concerns.…”

Section: Introductionmentioning

confidence: 99%

“…Cylindrical, nonmodular, cobalt chromium (CNCC) stems have been commonly used for cementless femoral component revision in North America for some years [13,16,19,23]. Although long-term survivorship has been well established (95%-96% survivorship at a mean of 10-14 years [13,23]), concerns have been raised regarding postoperative thigh pain (8%-30% [16,19]), a high incidence of intraoperative fractures (9%-30% [18,23]), and stress shielding of the proximal femur (reportedly 8% [19]) with the use of this stem design.…”

Section: Introductionmentioning

confidence: 99%

Femoral Revision Hip Arthroplasty: A Comparison of Two Stem Designs

Richards

Duncan

Masri

et al. 2010

106

For various reasons the tapered, fluted, modular titanium (TFMT) stem has become our component of choice over cylindrical, nonmodular cobalt chrome (CNCC) components for THA revision. We therefore asked whether the TFMT femoral components better achieved three important goals of revision arthroplasty than CNCC stems: (1) improving quality of life; (2) avoiding complications; and (3) preserving or restoring femoral bone stock. We compared patients undergoing femoral component revision hip arthroplasty with either a CNCC (N = 105) component or a TFMT (N = 95) component to determine if the increased use of TFMT components is justified. We retrospectively reviewed all patients under-

“…Revision THA in the setting of femoral bone loss is a difficult clinical problem with a variety of available treatment options including cemented stems [3,6,16], monoblock tapered stems [11,14,19], cylindrical stems [1,2], modular tapered stems, proximal femoral-replacing prostheses, and the use of impaction grafting [15]. In general, cylindrical, nonmodular, fully porous, cobaltchromium stems have been used as the workhorse of femoral revision surgery in North America with several studies demonstrating excellent results, particularly in Paprosky [23] Type I to IIIA femurs [8,17,19,20,22].…”

Section: Introductionmentioning

confidence: 99%

Modular Tapered Implants for Severe Femoral Bone Loss in THA: Reliable Osseointegration but Frequent Complications

Brown

Tetreault

Cipriano

et al. 2015

Background Modular tapered stems have been suggested as the optimal implants for patients with severe femoral bone loss (Paprosky Type IIIB and IV) undergoing revision total hip arthroplasty (THA); however, there are few data describing survivorship and hip scores associated with this treatment. Questions/purposes At minimum 2 years, we sought to determine the (1) survivorship of these implants; (2) radiographic evidence of osseointegration; and (3) the Harris hip scores of patients revised with a modular tapered stem for severe femoral bone loss including the complications associated with their use. Methods Between 1999 and 2010, we performed 1124 femoral revisions; of those, 135 (12%) were performed using a modular tapered stem. General indications for use of this device included bone loss, poor quality bone, leg length discrepancy, difficulty adjusting version, proximal femoral remodeling, and ectatic medullary canals in the setting of revision THA. This report reviewed 70 of those that were performed in Type IIIB and IV femurs. Of those 70 patients, 11 had died and one was lost before 2-year followup; the remaining 58 (83%, 33 with a Type IIIB femur and 25 with a Type IV femur) were followed for a minimum of 24 months (average, 67 months; range, 24-151 months). Survivorship free from revision, radiographic analysis for signs of subsidence or stem loosening, and Harris hip scores were tallied. Results One patient underwent stem revision for early subsidence followed by failure of ingrowth for a survivorship free from repeat revision of 98% (57 of 58 patients). Five other stems (for a total of six [10%]) subsided early but nonetheless achieved radiographic signs of ingrowth and were not revised again. All other stems demonstrated osseointegration without subsidence and remained radiographically well fixed. In patients with surviving implants, the mean Harris hip score improved from 34 (range, 11-49) preoperatively to 74 (range, 14-