Outcome After Femoral Revision Using the Restoration Cone/conical Femoral Revision Stem

Abstract

Despite improvements in implant technology and surgical technique, failure of total hip arthroplasty (THA) remains a persistent problem. This article reports clinical outcomes at a mean follow-up of 42 months using the Restoration cone/conical modular femoral revision stem (Stryker, Newbury, United Kingdom). A prospective cohort study was performed of 46 consecutive patients who underwent revision THA between January 2004 and June 2007. Patients were reviewed pre- and postoperatively at regular intervals for clinical and radiological assessment. Forty-six patients (17 men, 29 women) with a mean age of 72 years (range, 44-93 years) were observed for a mean of 42 months (range, 28-66 months). Indications for surgery included aseptic loosening/osteolysis (38/46 [83%]), periprosthetic fracture (4/46 [9%]), and infection (4/46 [8%]). Median time from index procedure was 16 years (range, 1-26 years). No patient was lost to follow-up. Two patients (4%) with well-fixed asymptomatic stems died during follow-up. Three patients (7%) sustained an early postoperative dislocation. One patient sustained a periprosthetic fracture after a fall. This was treated by osteosynthesis, and stem revision was not required. Mean Oxford Hip Score improved from 42 points (range, 24-57 points) to 28 points (range, 18-51 points) at 3-month follow-up (P=.003). Median stem subsidence was 1.0 mm (standard error of the mean, ±1.7 mm; range, 0-7mm) at last follow-up. No patient developed loosening or osteolysis around the stem. The Restoration femoral revision system has favorable clinical and radiological outcomes at a mean follow-up of 42 months.

The Survivorship of Revision Total Hip Replacement With Severe Proximal Bone Deficiency Using a Modular Taper Fluted Prosthesis

“…In this study, we examined our experience with a single design, tapered, uted, modular, titanium, uncemented revision system. A number of published series highlights the success of the system presented in this study with midterm follow-up [24][25][26][27].…”

“…Revision hip surgery is challenging, especially when there is signi cant proximal femoral bone loss [2]. Surgical options in these arthroplasty salvage cases may include proximal femoral allograft-prosthesis composite reconstruction, proximal femoral replacement, and uncemented distal stem xation [24].…”

Revisiones de cadera en defectos óseos femorales Paprosky II y IIIA. Utilización de prótesis no cementada, modular, de fijación proximal y anclaje distal. [Revision total hip arthroplasty in Paprosky II and IIIA femoral bone defects. Use of modular uncemented stems with proximal fixation.]

“…7 La fijación biológica metafisaria favorecerá la transmisión de cargas, minimizando el salteo de fuerzas y, en aquellas revisiones donde el capital óseo femoral proximal se encuentra dañado, que esto ocurra será indispensable, pero inicialmente se deberá lograr una adecuada estabilidad mecánica diafisaria que saltee el defecto metafisario. 9,10 El modelo empleado en esta serie se ha asociado con bajos índices de fracasos. McCarthy y cols.…”

“…8 Los tallos modulares surgieron, entonces, como un intento de solucionar, mediante su versatilidad, la adaptación a estos defectos y, al mismo tiempo, permitir restaurar la longitud, el offset femoral y la inestabilidad, lo cual se debe tener en cuenta durante la planificación preoperatoria. 7,9,10 Mediante el empleo de este tipo de prótesis, Cameron y cols. 11 reportaron buenos y excelentes resultados en el 81% de las 104 revisiones analizadas, con un índice de fallo del 4%.…”

Outcomes of dual modular cementless femoral stems in revision hip arthroplasty

“…Mean follow up was 85 months. Holt et al 49 published their results using the Restoration modular femoral stem (Stryker) in revision hip replacement. This was a prospective cohort study (Level IV evidence) of 46 patients showing a survival rate of 94%.…”