Risk factors for subsidence of modular fluted tapered stem implanted by using transfemoral Wagner approach during revision hip arthroplasty

Bobovec, Dino; Bohaček, Ivan; Juras, Josip; Delimar, Domagoj

doi:10.1007/s00264-020-04582-1

Cited by 4 publications

(2 citation statements)

References 24 publications

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“…4 Subsidence has been attributed to surgeon learning curve, extensive femoral bone loss, undersizing the femoral stem, and unrecognized insertion fractures leading to a loss of press-fit. 12,37 Risk factors for subsidence with FTTS include heavier patients and reduced stem-cortical contact 38,39 ; however, we did not directly assess subsidence etiology in our patients. Nonetheless, the improved fixation in our cohort may be due to advancements in design, which provide increased diaphyseal rotational and axial stability.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiographic Outcomes of a Monoblock Fluted Titanium Tapered Stem Following Complex and Revision Total Hip Arthroplasty

Oakley,

Passano,

Lutes

et al. 2023

The Journal of Hip Surgery

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Achieving femoral stem stability in complex primary and revision total hip arthroplasty (rTHA) cases is a challenging goal that monoblock fluted titanium tapered stems (FTTS) were designed to address. However, as more modern FTTS are developed, there are still questions regarding outcomes for these stems. The purpose of this study is to determine the radiographic and clinical outcomes of a modern monoblock FTTS. A multicenter retrospective observational study examined the hip databases of three institutions to obtain all monoblock FTTS with up to 5 years of radiographic follow-up. Stem subsidence and osteointegration were assessed on the most recent radiograph. All-cause re-revisions and survival of the stem at latest follow-up were recorded. Descriptive statistics were calculated for demographics and outcomes. Ninety-six monoblock FTTS were examined. Median clinical follow-up was 28.5 months (range: 18.0–57.8 months). Median subsidence was 1.4 mm (range: 0–15.0 mm). Sixteen (16.7%) and 3 (3.1%) stems had subsidence greater than 5 and 10 mm, respectively. Overall, thirteen hips (13.5%) required reoperations, of which 5 stems were revised (5.2%). Four stems were revised for periprosthetic joint infection (PJI), and one stem was explanted for exposure during acetabular revision. Kaplan–Meier analysis yielded an all-cause stem survivorship of 95.8% at 2 years and 88.5% at 4 years. Stem survivorship excluding septic causes for revision was 99.0% at both 2 and 4 years. Monoblock FTTS in complex primary and rTHA demonstrate encouraging clinical and radiographic results at up to 5 years of follow-up.

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Section: Discussionmentioning

confidence: 99%

Clinical and Radiographic Outcomes of a Monoblock Fluted Titanium Tapered Stem Following Complex and Revision Total Hip Arthroplasty

Oakley,

Passano,

Lutes

et al. 2023

The Journal of Hip Surgery

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“…Stem subsidence was assessed by measuring the distance between predetermined landmarks on the prosthesis and the femur such as measuring the distance from the shoulder of the implanted prosthesis to the proximal tip of the greater trochanter of the femur, or the distance from the shoulder of the prosthesis to cerclage cables on the femur, as discussed by Callaghan et al 18 A change of > 5 mm from the immediate postoperative radiograph to the latest radiograph was considered significant subsidence as described by numerous studies. [19][20][21][22] Furthermore, stem osseointegration was assessed by radiologically analyzing fixation by bony ongrowth, defined as the formation and attachment of new bone onto the femoral prosthesis. 23 This was done according to criteria established by Rodriguez et al, 24 adapted from Engh et al, 25 who defined radiological fixation by bony ongrowth as minimal or no radio-opaque line formation around the stem and no subsidence beyond the initial six weeks of weightbearing.…”

Section: Methodsmentioning

confidence: 99%

Monoblock tapered stems in management of UCS B2 and B3 periprosthetic fractures in revision total hip arthroplasty

Thomas,

Shichman,

Ohanisian

et al. 2023

Bone Jt Open

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AimsUnited Classification System (UCS) B2 and B3 periprosthetic fractures in total hip arthroplasties (THAs) have been commonly managed with modular tapered stems. No study has evaluated the use of monoblock fluted tapered titanium stems for this indication. This study aimed to evaluate the effects of a monoblock stems on implant survivorship, postoperative outcomes, radiological outcomes, and osseointegration following treatment of THA UCS B2 and B3 periprosthetic fractures.MethodsA retrospective review was conducted of all patients who underwent revision THA (rTHA) for periprosthetic UCS B2 and B3 periprosthetic fracture who received a single design monoblock fluted tapered titanium stem at two large, tertiary care, academic hospitals. A total of 72 patients met inclusion and exclusion criteria (68 UCS B2, and four UCS B3 fractures). Primary outcomes of interest were radiological stem subsidence (> 5 mm), radiological osseointegration, and fracture union. Sub-analysis was also done for 46 patients with minimum one-year follow-up.ResultsFor the total cohort, stem osseointegration, fracture union, and stem subsidence were 98.6%, 98.6%, and 6.9%, respectively, at latest follow-up (mean follow-up 27.0 months (SD 22.4)). For patients with minimum one-year of follow-up, stem osseointegration, fracture union, and stem subsidence were 97.8%, 97.8%, and 6.5%, respectively.ConclusionMonoblock fluted stems can be an acceptable modality for the management of UCS B2 periprosthetic fractures in rTHAs due to high rates of stem osseointegration and survival, and the low rates of stem subsidence, and revision. Further research on the use of this stem for UCS B3 periprosthetic fractures is warranted to determine if the same conclusion can be made for this fracture pattern.Cite this article: Bone Jt Open 2023;4(8):551–558.

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Early clinical and radiological outcomes of a new tapered fluted titanium monobloc revision stem in hip arthroplasty

Moriarty

Vles

Haddad

et al. 2021

Arch Orthop Trauma Surg

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Risk factors for subsidence of modular fluted tapered stem implanted by using transfemoral Wagner approach during revision hip arthroplasty

Cited by 4 publications

References 24 publications

Clinical and Radiographic Outcomes of a Monoblock Fluted Titanium Tapered Stem Following Complex and Revision Total Hip Arthroplasty

Clinical and Radiographic Outcomes of a Monoblock Fluted Titanium Tapered Stem Following Complex and Revision Total Hip Arthroplasty

Monoblock tapered stems in management of UCS B2 and B3 periprosthetic fractures in revision total hip arthroplasty

Early clinical and radiological outcomes of a new tapered fluted titanium monobloc revision stem in hip arthroplasty

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