Medium-Term Follow-Up Series Using a Modular Distal Fixation Prosthesis to Address Proximal Femoral Bone Deficiency in Revision Total Hip Arthroplasty. A 5- to 9-Year Follow-Up Study

Abstract

We reviewed a series of 39 patients (40 cases) receiving the Link MP stem in revision hip arthroplasty. Average follow-up was 68 months (range 60-115 months). Proximal femoral defects were classified using the Endo-Klinik and Paprosky classifications. Indications included: osteolysis 13 cases; septic loosening 8 cases; periprosthetic fractures 18 cases; metastatic bone disease 1 case. We found 92.5% overall survival rate, average Harris Hip Score past two years of 67 and average Oxford Hip Score past five years of 43. We found no implant failure or loosening. Complications included: 4 deep infections (2 revised to excision arthroplasty), 5 dislocations (1 revision of the proximal modular segment for impingement). We concluded that revision was successful in cases of peri-prosthetic fractures, septic and aseptic loosening. We advocate use of cerclage wires to prevent peri-operative fractures and use of proximal modular segments with CCD angle of 126 to avoid dislocation.

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

“…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.…”

Salvage of failed hip osteosynthesis for fractures with modular hip prosthesis

“…The use of modular femoral stems is presented by many authors in demanding cases of hip reconstruction such as congenital dysplastic hip and revision arthroplasty [16,17]. The use of a calcar-replacement and/or a modular implant should be considered for challenging cases of hip reconstruction even after failed peritrochanteric treatment [18].…”

Cementless, modular, distally fixed stem in hip revision arthroplasty: a single-center study of 132 consecutive hips

“…Implant failure (modular junction) was no problem in our series, which is in accordance with other studies. Tamvakopoulos et al [ 13 ] reported comparable findings with an overall survival of 92.5% of the MP system at an average follow-up of 5.6 years in 40 cases. Kwong et al [ 8 ] evaluated 143 patients at an average of 3.3 years with 97% component survival using the same stem.…”