Three to seven year follow-up of a tapered modular femoral prosthesis in revision total hip arthroplasty

Wang, Long; Dai, Zixun; Wen, Ting; Li, Ming‐Qing; Hu, Yihe

doi:10.1007/s00402-012-1644-y

Cited by 22 publications

(18 citation statements)

References 35 publications

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“…32 The incidence of new infection was 2.3% (2 of 85) and lay within the range reported for other revision systems of between 0% and 5.5%. 8,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] The incidence of recurrent infection following a two-stage, cementless septic revision was 6.4% (2 of 31) and was also within the published range of between 5% and 18% for cementless, two-stage revisions. [44][45][46][47][48][49][50][51] Fracture of the stem is a rare complication of modular revision stems and has been described for other systems.…”

Section: Discussionmentioning

confidence: 84%

“…[13][14][15][16][17][18] For modular kinked stems the incidence for these problems has ranged from 0% to 15%, and 0% to 17% respectively (Link MP, Waldemar Link GmbH, Norderstedt, Germany). [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.…”

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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: Discussionmentioning

confidence: 84%

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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“…Early to midterm results of modular tapered stems used for femoral revision are now being published [5,6,[11][12][13][14][15][16][17][18]. One study documented success in achieving implant stability and osteointegration, as well as restoring leg length and offset across all Paprosky classifications [15].…”

Section: Discussionmentioning

confidence: 99%

“…One study documented success in achieving implant stability and osteointegration, as well as restoring leg length and offset across all Paprosky classifications [15]. Multiple reports from one institution have demonstrated the success of modular tapered stems for cases of proximal femoral bone loss.…”

Section: Discussionmentioning

confidence: 99%

Modular Femoral Tapered Revision Stems in Total Hip Arthroplasty

Frye¹,

Berend²,

Morris³

et al. 2013

Reconstructive Review

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Background: Modular component options can assist the surgeon in addressing complex femoral reconstructions in total hip arthroplasty by allowing for customization of version control and proximal to distal sizing. We review the early clinical results of a single modular femoral revision system that offers 3 proximal body types, 5 distal stem geometries, and a wide range of offset, sizing and auxiliary options.Methods: A query of our practice's arthroplasty registry revealed 60 patients (61 hips) who signed an IRB-approved general research consent allowing retrospective review, and underwent total hip arthroplasty performed with the modular femoral revision system between December 2009 and April 2012. There were 35 men (58%) and 25 women (42%). Mean age was 65.1 years (range, 35-94) and BMI was 31.3 kg.m2 (range, 14-53). Procedures were complex primary in 1 hip, conversion in 6 (10%), revision in 32 (53%), and two-staged exchange for infection in 22 (33%). Two-thirds of procedures included complete acetabular revision (n=40), while 31% (19) involved liner change only and 2 were isolated femoral revisions.Results: At an average follow-up of 1.5 years (maximum: 3.7 years) there have been no revisions or failures of the femoral component. Average Harris hip scores (0 to 100 possible) improved from 44.2 preoperatively to 66.0 at most recent evaluation, while the pain component (0 to 44 possible) improved from 15.8 to 31.2. Complications requiring surgical intervention included intraoperative periprosthetic femur fracture in one patient returned to the operating suite same day for open reduction internal fixation, which further required incision and debridement for super-

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“…However, concerns about junctional fractures of the modular stem have been raised and reported by a few authors [20,21]. Several studies of RTHA with modular, uted, tapered stems obtained good results at short-to mid-term followup [22][23][24]. However, few reports of the long-term results of the LINK MP modular prosthesis are available, and survivorship of the junction of the modular stem is worth further investigation.…”

Section: Introductionmentioning

confidence: 99%

Mid- to long-term outcomes of cementless modular, fluted, tapered stem for massive femoral bone loss in revision total hip arthroplasty

Zheng

Zhang

et al. 2020

Preprint

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Abstract Background: Revision total hip arthroplasty is frequently accompanied by bone loss. The purpose of this study is to evaluate mid- to long-term results of revision total hip arthroplasty for massive femoral bone loss using cementless modular, fluted, tapered stems.Methods: During the period of 2007 to 2015 at a single hospital, 34 hips (33 patients) underwent primary revision surgery with cementless modular, fluted, tapered stems due to massive bone loss, and patients with prosthetic joint infection (PJI) or tumours were excluded. The hips were revised with the LINK MP (Waldemar Link, Hamburg, Germany) prosthesis. Bone loss was categorized by the Paprosky classification for prosthesis loosening and Vancouver classification for peri-prosthetic fracture. All revision bearing surfaces were ceramic-on-ceramic (CoC). Clinical outcomes, radiographic outcomes and survivorship were evaluated.Results: The mean follow-up was 9.1±2.5 years (range, 5-13 years). The Harris hip score was 43.6±11.5 preoperatively and maintained at 86.5±6.6 at the time of latest follow-up (p<0. 05). The X-ray showed bone ingrowth fixation in 30 hips (88%), fibrous stable fixation in 3 hips (9%) and instability in 1 hip (3%). The average stem subsidence was 3.9±2.2 mm (range, 1 to 10 mm). The survivorship of prostheses with re-revision for any reason was 95% (95% CI, 12.0 to 13.0) at the 10-year follow-up. Three (9%) re-revisions were needed, including 1 for aseptic loosening, 1 for dislocation and 1 for infection.Conclusions: The mid- to long-term results of revision total hip arthroplasty with the cementless modular, fluted, tapered stem (LINK MP stem) are encouraging for massive femoral bone loss.

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Three to seven year follow-up of a tapered modular femoral prosthesis in revision total hip arthroplasty

Abstract: Modular femoral components can improve hip function, provide distal fixation, equalize leg length, and result in fewer complications when used to revise failed femoral components.

Cited by 22 publications

References 35 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

Modular Femoral Tapered Revision Stems in Total Hip Arthroplasty

Mid- to long-term outcomes of cementless modular, fluted, tapered stem for massive femoral bone loss in revision total hip arthroplasty

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