Minimum 5-Year Follow-Up of a Cementless, Modular, Tapered Stem in Hip Revision Arthroplasty

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: Discussionsupporting

confidence: 80%

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

“…Comparisons to other studies are difficult, because most do not report leg length discrepancy. Weiss et al [30] reported that only two of 63 patients (3%) had [ 3 cm discrepancy and 30 of 63 patients (48%) had no discrepancy with the use of the Link MP prosthesis; however, the patient population in this study substantially differed from ours such that the bone loss was less severe in the majority of patients. Although design features of the implant (such as the degree of the taper, curvature of stem, and surface coating) may affect the frequency of this complication, we did not have large enough numbers to identify definitively which stem design characteristics were most advantageous.…”

Section: Discussioncontrasting

confidence: 54%

“…Furthermore, this complication rate is comparable to that found by Van Houwelingen et al [28] who reported a 17% rate of intraoperative fracture (eight of 48 patients) and 10% dislocation rate (five of 48 patients) in addition to having five of 27 (19%) of the standard ZMR stems fracture. The most common reason for reoperation was instability, which in a recent large series [31] of revisions was seen in 10% with earlier papers showing even higher rates of dislocation in the revision population [4,30]. Given the high risk, great care must be taken with trialing and we recommend the use of large-diameter femoral heads routinely [10].…”

Section: Discussionmentioning

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-

“…Currently, the dislocation rate after revision THA is between 6.6% and 21.2% [1,3,5,12,15,23]. Alberton et al [1] evaluated 1548 revision THAs and reported risk factors of small femoral head size, trochanteric nonunion, and elevated rim liners.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Dislocation After Revision Total Hip Arthroplasty

Wetters

Murray

Moric

et al. 2013

187

112

Background Despite dislocation being the most frequent complication after revision THA, risk factors for its occurrence are not completely understood. Questions/purposesWe therefore (1) determined the overall risk of dislocation after revision THA in a large series of revision THAs using contemporary revision techniques, (2) identified patient-related risk factors predicting dislocation, and (3) identified surgical variables predicting dislocation. Methods We performed 1211 revision THAs between June 2004 and October 2010 in 576 women and 415 men who had a mean age of 64.7 years (range, 25-95 years) at time of surgery. Forty-six (4%) were lost to followup and 13 died (1%), leaving 1152 hips followed for a minimum of 90 days (mean, 2 years; range, 90 days to 7.1 years). Multivariate logistic regression was performed to identify risk factors for dislocation. The model was also tested on patients followed for a minimum 1 year to assess any difference in longer followup. Results One hundred thirteen patients dislocated over the followup period (9.8%). Factors that were different between patients who dislocated and those who remained stable included a history of at least one previous dislocation (odds ratio [OR] = 2.673), abductor deficiency (OR = 2.672), and Paprosky acetabulum class (OR = 1.522).