Results of revision total hip arthroplasty with Anatomic BR stem: 10-year minimum follow-up

Abstract

Twenty cementless total hip revision arthroplasties using Anatomic BR stems were performed in 20 patients. Fourteen patients, with a mean age of 62.6 years (range 41-74 years) at time of revision surgery, were followed retrospectively for a minimum of 10 years (range 11-15 years). Clinical function and radiographic evidence of implant stability were evaluated. Preoperative femoral deficiencies were evaluated radiographically and classified according to Paprosky type as follows: four Type-II, four Type-IIIA, four Type-IIIB, and two Type-IV femurs. Mean preoperative Harris hip score was 46.3 points (range 29-58 points) and improved to 68.8 points (range 45-90 points) at the most recent follow-up examination. Of the 14 patients followed, six had radiographic evidence of subsidence (axial shift of more than 2 mm after revision with long-stem components). Component fixation showed bone ingrowth in three (21%) patients, inconclusive evidence of ingrowth in six (43%) patients, suboptimal but stable fixation in three (21%) patients, and unstable fixation in two (14%) patients. Based on these we results, we conclude that even with circumferential proximal porous coating and improved proximal geometry, nonmodular femoral implant stability remains unpredictable following total hip arthroplasty revision.

Cementless primary or revision stem in revision hip arthroplasty for aseptic stem loosening with Paprosky type I/II femoral defect?

“…39,40 The reported incidence of intraoperative fracture or greater trochanter fracture varies. 9,10,12,14,15,17,25 However, using revision stem rather than primary stem tends to result in a higher rate of intraoperative fracture (0%-64% vs. 0.7%-20.2%) 9,12,14,25 or greater trochanter fracture (6%-19.5% vs. 3.3%) 10,15,17 Using additional fixation procedures for a greater trochanter or femur fracture may lead to longer operation time, which might increase the risk of shortterm complications, including surgical site infection. 41,42 In our study, the revision group tended to have a higher rate of surgical site infection than the primary group (18.0% vs. 3.6%, p = 0.086).…”

Cementless Primary or Revision Stem in the First-time Revision Hip Arthroplasty for Aseptic Stem Loosening? A Retrospective Comparative Study.

“…Moreover, increased magnitude of sagittal and coronal femoral bowing in the Asian population might further increase the risk of breach over the distal cortex 34,35 . The reported incidence of intraoperative fracture or greater trochanter fracture varied 7,8,10,12,13,15,23 . But there was a trend toward a higher rate of intraoperative fracture (0-64% vs 0.7-20.2%) 7,10,12,23 or greater trochanter fracture (6-19.5% vs 3.3%) 8,13,15 of using revision stem than the primary stem.…”

“…The reported incidence of intraoperative fracture or greater trochanter fracture varied 7,8,10,12,13,15,23 . But there was a trend toward a higher rate of intraoperative fracture (0-64% vs 0.7-20.2%) 7,10,12,23 or greater trochanter fracture (6-19.5% vs 3.3%) 8,13,15 of using revision stem than the primary stem. Additional xation procedures for the greater trochanter or femur fracture might lead to longer operation time, which might be associated with an increased risk of short-term complications, including surgical site infection 36,37 .…”

“…As a result, we hypothesized and validated that there might be a role for a cementless primary stem during the revision THA procedure. The potential advantages of using cementless primary stem included preservation of diaphyseal bone stock and less stress-shielding effect compared with the longer, extensively coated revision stem, in which the long-term incidence of stressshielding around a revision stem can be up to 30% 18,23,40 . A cohort study with long-term follow-up is necessary to further validate these bene ts.…”

“…The study design of most studies that presented the outcome using either cementless primary or revision stem were single-arm, case series 5,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . Although the mid-term implant survival of both primary (85.0% to 96.2%) 7,10,21 and long stem (86.0% to 97.0%) [13][14][15]17,18 were considered good to excellent, the incidence of common complications including surgical site infection (0% vs. 0-7%) 7,10,12,15,21,22 , periprosthetic joint infection (0.7%-5.2% vs. 0-14%) 7,9,16,19 , intraoperative fracture (0.7-20.2% vs. 0-64%) 7,10,12,23 , greater trochanter fracture (3.3% vs. 6.0-19.5%) 8,13,15 , periprosthetic fracture (1.4%-2.1% vs. 1-5%) 5,7,11,14 , stem subsidence (0% vs. 3-19.5%) 7,13,...…”