Long Stem Cemented Revision Arthroplasty for Aseptic Loosening in Elderly Patients Produces Good Results, despite Significant Bone Loss

Harrison, Timothy; Jones, Harold; Darrah, Clare; Warriner, Gary; Tucker, J.K.

doi:10.5301/hip.2013.10615

Cited by 4 publications

(5 citation statements)

References 23 publications

(31 reference statements)

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“…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.…”

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confidence: 99%

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

Amanatullah

Howard

Siman

et al. 2015

The Bone & Joint Journal

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Revision total hip arthroplasty (THA) is challenging when there is severe loss of bone in the proximal femur. The purpose of this study was to evaluate the clinical and radiographic outcomes of revision THA in patients with severe proximal femoral bone loss treated with a fluted, tapered, modular femoral component. Between January 1998 and December 2004, 92 revision THAs were performed in 92 patients using a single fluted, tapered, modular femoral stem design. Pre-operative diagnoses included aseptic loosening, infection and peri-prosthetic fracture. Bone loss was categorised pre-operatively as Paprosky types III-IV, or Vancouver B3 in patients with a peri-prosthetic fracture. The mean clinical follow-up was 6.4 years (2 to 12). A total of 47 patients had peri-operative complications, 27 of whom required further surgery. However, most of these further operations involved retention of a well-fixed femoral stem, and 88/92 femoral components (97%) remained in situ. Of the four components requiring revision, three were revised for infection and were well fixed at the time of revision; only one (1%) was revised for aseptic loosening. The most common complications were post-operative instability (17 hips, 19%) and intra-operative femoral fracture during insertion of the stem (11 hips, 12%). Diaphyseal stress shielding was noted in 20 hips (22%). There were no fractures of the femoral component. At the final follow-up 78% of patients had minimal or no pain. Revision THA in patients with extensive proximal femoral bone loss using the Link MP fluted, tapered, modular stem led to a high rate of osseointegration of the stem at mid-term follow-up. Cite this article: Bone Joint J 2015; 97-B:312-17.

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confidence: 99%

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

Amanatullah

Howard

Siman

et al. 2015

The Bone & Joint Journal

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“…Revision THA with massive bone defects indicates a complex challenge to perform and reconstruct the bone stock. Numerous different designs of prostheses, including cemented stems 9 , uncemented long stems 10 , cylindrical stems 11 , and monoblock tapered stems 12 , have been applied to treat this problem during RTHA. For Paprosky types I and II bone defects, these strategies have been associated with acceptable long‐term results; however, for severe bone loss, such as Paprosky type IIIA, IIIB, and IV, and Vancouver types B2 and B3, modular, fluted, tapered stems were considered to have the potential advantage of achieving long‐term fixation 17 .…”

Section: Discussionmentioning

confidence: 99%

“…A variety of strategies have been applied to treat femoral bone loss in RTHA. Long cemented stems for aseptic loosening in elderly patients permit early weight bearing and show promising clinical and radiographic outcomes 9 . Long tapered hydroxyapatite‐coated stems can provide stable fixation, bone integration, and reduce stress shielding.…”

Section: Introductionmentioning

confidence: 99%

Mid‐ to Long‐Term Outcomes of Cementless Modular, Fluted, Tapered Stem for Massive Femoral Bone Loss in Revision Total Hip Arthroplasty

Zheng

Zhang

et al. 2021

Orthopaedic Surgery

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Objective To evaluate mid‐ to long‐term results of revision total hip arthroplasty for massive femoral bone loss using a cementless modular, fluted, tapered stem. Methods This is a retrospective study performed at a single hospital. During the period of January 2007 to January 2015, 33 patients (34 hips) underwent primary revision surgery with cementless modular, fluted, tapered stems due to femoral bone loss. Sixteen men and 17 women were included in the study, with an average age of 63.9 ± 11.7 years (range, 27 to 88 years). Operative data including operative duration, length of incision, drainage volume and duration, blood loss and transfusion, cases of bone graft and extended trochanteric osteotomy were recorded. Clinical evaluation was performed using Harris hip score (HHS), visual analogue scale (VAS), and patients' satisfaction. Radiographic data including femoral stem fixation, subsidence, integrin of allograft bone, and leg length discrepancy were assessed. Complications and survivorship were evaluated using Kaplan–Meier survival rate. Results The mean follow‐up was 9.1 ± 2.5 years (range, 5–13 years). The Harris hip score was 43.6 ± 11.5 preoperatively and maintained at 86.5 ± 6.6 at the time of latest follow‐up (P < 0. 05). The X‐ray showed bone ingrowth fixation in 30 hips (88%), fibrous stable fixation in three hips (9%), and instability in one hip (3%). The average stem subsidence was 3.9 ± 2.2 mm (range, 1 to 10 mm). The mean difference in leg length in our study was 3.3 ± 2.7 mm (range, 0 to 10 mm), and the leg length discrepancy in 28 (82%) patients was within 5 mm. No case of junction fracture was observed. Seven (21%) intraoperative fractures occurred in our study. Three (9%) cases with infection were observed after revision. Six (18%) patients had lower limb vein thrombosis. The survivorship of prostheses with re‐revision for any reason was 95% (95% CI, 12.0 to 13.0) at the 10‐year follow‐up. Three (9%) re‐revisions were needed, including one for aseptic loosening, one for dislocation, and one for infection. Conclusion The mid‐ to long‐term results of revision total hip arthroplasty with the cementless modular, fluted, tapered stems are encouraging for massive femoral bone loss.

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“…Revision THA with massive bone defects indicates a complex challenge to perform and reconstruct the bone stock. Numerous different designs of prostheses, including cemented stems [9], uncemented long stems [10], cylindrical stems [11], and monoblock tapered stems [12], have been applied to treat this problem during RTHA. For Paprosky types I, II, and IIIA bone defects, these strategies have been associated with acceptable long-term results; however, for severe bone loss, such as Paprosky type IIIB, IV and Vancouver types B2 and B3, modular uted tapered stems were considered to have the potential advantage of achieving long-term xation [16].…”

Section: Discussionmentioning

confidence: 99%

“…A variety of strategies have been applied to treat massive femoral bone loss in RTHA, including cemented stems [9], uncemented long stems [10], cylindrical stems [11], monoblock tapered stems [12] and bone grafting [13]. Nevertheless, the effect of these reconstruction techniques is limited and unsatisfactory in long-term results [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Mid- to long-term outcomes of cementless modular, fluted, tapered stem for massive femoral bone loss in revision total hip arthroplasty

Zheng

Zhang

et al. 2020

Preprint

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Abstract Background: Revision total hip arthroplasty is frequently accompanied by bone loss. The purpose of this study is to evaluate mid- to long-term results of revision total hip arthroplasty for massive femoral bone loss using cementless modular, fluted, tapered stems.Methods: During the period of 2007 to 2015 at a single hospital, 34 hips (33 patients) underwent primary revision surgery with cementless modular, fluted, tapered stems due to massive bone loss, and patients with prosthetic joint infection (PJI) or tumours were excluded. The hips were revised with the LINK MP (Waldemar Link, Hamburg, Germany) prosthesis. Bone loss was categorized by the Paprosky classification for prosthesis loosening and Vancouver classification for peri-prosthetic fracture. All revision bearing surfaces were ceramic-on-ceramic (CoC). Clinical outcomes, radiographic outcomes and survivorship were evaluated.Results: The mean follow-up was 9.1±2.5 years (range, 5-13 years). The Harris hip score was 43.6±11.5 preoperatively and maintained at 86.5±6.6 at the time of latest follow-up (p<0. 05). The X-ray showed bone ingrowth fixation in 30 hips (88%), fibrous stable fixation in 3 hips (9%) and instability in 1 hip (3%). The average stem subsidence was 3.9±2.2 mm (range, 1 to 10 mm). The survivorship of prostheses with re-revision for any reason was 95% (95% CI, 12.0 to 13.0) at the 10-year follow-up. Three (9%) re-revisions were needed, including 1 for aseptic loosening, 1 for dislocation and 1 for infection.Conclusions: The mid- to long-term results of revision total hip arthroplasty with the cementless modular, fluted, tapered stem (LINK MP stem) are encouraging for massive femoral bone loss.

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Long Stem Cemented Revision Arthroplasty for Aseptic Loosening in Elderly Patients Produces Good Results, despite Significant Bone Loss

Cited by 4 publications

References 23 publications

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

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

Mid‐ to Long‐Term Outcomes of Cementless Modular, Fluted, Tapered Stem for Massive Femoral Bone Loss in Revision Total Hip Arthroplasty

Mid- to long-term outcomes of cementless modular, fluted, tapered stem for massive femoral bone loss in revision total hip arthroplasty

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