Revision hip arthroplasty using a cementless modular tapered stem

Pattyn, Christophe; Mulliez, Alexander; Verdonk, René; Audenaert, Emmanuel

doi:10.1007/s00264-011-1299-2

Cited by 37 publications

(27 citation statements)

References 27 publications

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“…By comparing all the post-operative radiographs, the extent of subsidence of the stem was evaluated using the technique of Callaghan et al 42 Significant subsidence was defined as being > 5 mm. 16,27 The femoral score of Barnett and Nordin 43 was calculated immediately post-operatively and at the five-year follow-up examination in order to analyse the formation of bone in the 14 The sum of the thicknesses of the medial and lateral cortices of the shaft at the level below the lesser trochanter, where the inner and outer rims of the cortex are parallel, was divided by the total diameter of the shaft at that level and the result multiplied by 100. 43 The difference between the Barnett and Nordin-Score five years after the operation and the immediate post-operative score was used to calculate the amount of proximal bone formation.…”

Section: Methodsmentioning

confidence: 99%

“…[19][20][21][22][23][24] The incidence of subsidence and peri-prosthetic fracture of modular curved stems (MRP-Schaft, Peter Brehm, Weisendorf, Germany; Profemur-RSchaft, Wright Medical, Arington, Tennessee; Revitan Curved, Zimmer GmbH) has been reported to be between 0.8% and 17.1%, and 0% and 11.7% respectively. 3,4,7,8,[25][26][27][28][29] Two surgical techniques have been described for the introduction of modular curved, distally fixed stems. Either the fixation bed for the prosthesis is prepared with a cylindrical reamer alone (Brehm-MRP-Schaft, Profemur-R-Schaft) and results in cone-in-cylinder fixation; or the medullary cavity is first reamed with a cylindrical tool and then cone-in-cone fixation is obtained with a conical rasp (Revitan Curved).…”

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confidence: 99%

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Mid term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement

Fink¹,

Urbansky²,

Schuster³

2014

The Bone & Joint Journal

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We report our experience of revision total hip replacement (THR) using the Revitan curved modular titanium fluted revision stem in patients with a full spectrum of proximal femoral defects. A total of 112 patients (116 revisions) with a mean age of 73.4 years (39 to 90) were included in the study. The mean follow-up was 7.5 years (5.3 to 9.1). A total of 12 patients (12 hips) died but their data were included in the survival analysis, and four patients (4 hips) were lost to follow-up. The clinical outcome, proximal bone regeneration and subsidence were assessed for 101 hips. The mean Harris Hip Score was 88.2 (45.8 to 100) after five years and there was an increase of the mean Barnett and Nordin-Score, a measure of the proximal bone regeneration, of 20.8 (-3.1 to 52.7). Five stems had to be revised (4.3%), three (2.9%) showed subsidence, five (4.3%) a dislocation and two of 85 aseptic revisions (2.3%) a periprosthetic infection. At the latest follow-up, the survival with revision of the stem as the endpoint was 95.7% (95% confidence interval 91.9% to 99.4%) and with aseptic loosening as the endpoint, was 100%. Peri-prosthetic fractures were not observed. We report excellent results with respect to subsidence, the risk of fracture, and loosening after femoral revision using a modular curved revision stem with distal cone-in-cone fixation. A successful outcome depends on careful pre-operative planning and the use of a transfemoral approach when the anatomy is distorted or a fracture is imminent, or residual cement or a partially-secured existing stem cannot be removed. The shortest appropriate stem should, in our opinion, be used and secured with > 3 cm fixation at the femoral isthmus, and distal interlocking screws should be used for additional stability when this goal cannot be realised.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Mid term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement

Fink¹,

Urbansky²,

Schuster³

2014

The Bone & Joint Journal

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“…The high failure rate of cemented acetabular components in revision THA due to failure of interdigitation of cement into the sclerotic host bone has led to the increased use of cementless fixation [1][2][3][4][5]. Small contained defects can usually be treated with porous hemispherical cups with supplemental bone grafting [6].…”

Section: Introductionmentioning

confidence: 99%

Systematic review on outcomes of acetabular revisions with highly-porous metals

Banerjee

Issa

Kapadia

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to systematically review the literature and report the clinical and radiographic outcomes of highly-porous acetabular cups in revision settings. Method A literature search of four electronic databases of EMBASE, CINAHL-plus, PubMed, and SCOPUS yielded 25 studies reporting the outcomes of 2,083 revision procedures with highly-porous acetabular components. There was lack of high quality evidence (level I and level II studies) and only two studies with level III evidence, while the remainder were all level IV studies. In addition, a majority of the studies had small sample sizes and had short to mid-term follow-up. The mean age of the patients was 65 years (range, 58-72 years) and the mean follow-up was 3.6 years (range, two to six years). Outcomes evaluated were aseptic survivorship, Harris hip scores, migration rates, incidence of peri-acetabular radiolucencies and radiographic restoration of the hip centre. Results The mean aseptic survivorship was 97.2 % (range, 80-100 %). The Harris hip scores improved from a mean preoperative score of 42 points, (range, 29-75 points), to a mean postoperative score of 79 points (range, 69-94 points). The mean incidence of cup migration and prevalence of periacetabular radiolucencies was 2.4 % (range, 0-8.8 %) and 4.6 % (range, 0-19 %), respectively, at final follow-up. The vertical hip centre-of-rotation was restored significantly from a mean of 39.2 mm (range, 27.6-50 mm) pre-operatively, to a mean of 24.1 mm (range, 7.4-47 mm), postoperatively. Conclusion The short-term clinical and radiographic results of highly-porous metals in revision hip arthroplasty are excellent with a low rate of loosening in the presence of both major and minor bone loss.

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“…Similarly, Traina et al reported no modular neck fractures in 88 THRs with a mean follow-up of nine years [21]. Pattyn et al also reported no modular neck fractures for 68 revision THRs performed using a revision femoral stem from the same manufacturer with identical modular necks [22]. These results suggest that modular neck fracture is not a prominent failure mode for the subject femoral stem or modular neck design.…”

Section: Modular Neck Fracturesmentioning

confidence: 54%

Long-term survivorship and complication rate comparison of a cementless modular stem and cementless fixed neck stems for primary total hip replacement

Fitch¹,

Ancarani

Bordini

2015

International Orthopaedics (SICOT)

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Purpose Modular necks used in total hip replacement (THR) have become an increasingly discussed topic with the recent recall of multiple modular systems, but it is anticipated that outcomes for these devices are highly design-specific. The objectives of this study were to determine if the survivorship and complication rates of a specific modular femoral stem (PROFEMUR® Z, MicroPort Orthopedics Inc., Arlington, TN, USA) were significantly lower than those of all cementless fixed neck stems in an arthroplasty registry. Methods The database of an arthroplasty registry was searched for all patients implanted with a specific modular stem and all those implanted with cementless fixed neck stems. Kaplan-Meier survivorship and complication rates were compared between the two groups. Results The 12-year survivorship of the modular stem (95.8 %) was not significantly less than that of all cementless fixed neck stems (96.1 %). There was also no difference in revision rates for dislocation, periprosthetic fractures, aseptic loosening or septic loosening between the two groups. Conclusions The use of the specific modular stem did not adversely affect long-term component survivorship or complication rates when compared to all cementless fixed neck THRs in an arthroplasty registry.

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Revision hip arthroplasty using a cementless modular tapered stem

Abstract: Purpose Here we report the short-term clinical and radiological results of the Profemur®-R cementless modular revision stem. Methods Between

Cited by 37 publications

References 27 publications

Mid term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement

Mid term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement

Systematic review on outcomes of acetabular revisions with highly-porous metals

Long-term survivorship and complication rate comparison of a cementless modular stem and cementless fixed neck stems for primary total hip replacement

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