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

Abstract

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.

Last generation fluted modular titanium stem in revision hip arthroplasty: a narrative review of mid- and long-term outcomes

“…Among the various parameters considered, the only association that could be established was with Dorr type C femurs and the use of structural grafts, both related to bone loss severity ( 30 ). In this review, 7 out of 15 studies reported a subsidence ( 19 , 20 , 22 , 26 - 28 , 31 ), with an average of 4.2 mm (SD, ±4.05 mm). Stem subsidence greater than 5 mm was reported only in 34/648 of cases, 5% of the total.…”

“…Interestingly, the highest number of dislocations has been reported by Wirtz (n=20, 12%), who reported being in line with the published literature at that time ( 25 ). Considering only studies produced in the last 5 years ( 19 , 20 , 22 , 26 , 27 ), the overall dislocation rate drops to 2.6% (SD, ±2.7%). This difference can be hypothetically attributed to surgical techniques and tribology improvements, like the introduction of 36 mm heads and dual mobility couplings.…”

“…Some authors attribute this difference to an individual tendency toward a more aggressive search for the “fit and fill” ( 21 ). Clearly, osteoporosis and amount of bone loss have been recognized as risk factors for this complication ( 22 ). Other predisposing conditions include excessive anterior femoral bowing and the use of stem with a diameter superior to 18 mm or longer than 200 mm ( 23 ).…”

Implant breakage and revision factors for modular fluted tapered stems in revision total hip arthroplasty

“…Few studies with limited samples have analysed a single type of implant in a heterogeneous patient and surgical population for MFT stems. 4,6,[19][20][21][22][23][24][25][26] Survival of different MFTs varies minimally according to the type of implant used. On the other hand, while survival is often satisfactory, implant fractures may have negatively impacted the reputation of these modular implants.…”

EBRA Migration Analysis of a Modular, Distally Fixed Stem in Hip Revision Arthroplasty: A Clinical and Radiological Study

“…Subsidence of the stem has shown to be a negative predictive sign for successful osseointegration and was also considered to be one of the most common risk factors for re-revision, whereby the importance and extent of subsidence varies by implant design [ 16 , 20 , 21 ]. Furthermore, the reason for revision can also be associated with an increased risk of subsidence.…”