Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Van Houwelingen AP, Duncan CP, Masri BA, Greidanus NV, Garbuz DS. High survival of modular tapered stems for proximal femoral bone defects at 5 to 10 years followup. Clin Orthop Relat Res 2013;471:454-62. [PMID: 22948527 PMCID: PMC3549179 DOI: 10.1007/s11999-012-2552-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]

For:	Van Houwelingen AP, Duncan CP, Masri BA, Greidanus NV, Garbuz DS. High survival of modular tapered stems for proximal femoral bone defects at 5 to 10 years followup. Clin Orthop Relat Res 2013;471:454-62. [PMID: 22948527 PMCID: PMC3549179 DOI: 10.1007/s11999-012-2552-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]

Number

Cited by Other Article(s)

Zitsch BP, Byrd JJ, Buckner B, Konigsberg BS, Hartman CW. Tapered, Fluted, Titanium Stems in Revision Total Hip Arthroplasty. Orthopedics 2025;48:79-86. [PMID: 40052900 DOI: 10.3928/01477447-20250217-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2025]

Abstract

BACKGROUND

Establishing stable femoral component fixation in revision total hip arthroplasty (rTHA) remains challenging. Early monobloc tapered, fluted, titanium (TFT) designs were complicated by high rates of subsidence, while modular designs were complicated by taper corrosion and junctional fractures. Newer generation monobloc stems have been designed to minimize subsidence. Therefore, the aim of this study was to present the clinical and radio-graphic results of the most recent modular and monobloc TFT designs.

MATERIALS AND METHODS

Patients undergoing rTHA in which TFT femoral stems were used, whether modular or monobloc, were included in this retrospective review. Included stems had the same design characteristics and were from the same manufacturer. The only difference was neck modularity. Radiographic analysis for stem subsidence was performed. Clinical outcomes including Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and re-revisions were collected. We examined survivorship for the endpoints of subsidence or re-revision for any reason.

RESULTS

Ninety-four (66 monobloc, 28 modular) hips met inclusion criteria, with a median follow-up of 25.9 months. Mean stem subsidence was 1.9±0.2 mm in the modular group and 2.1±0.3 mm in the monobloc group (P=.56), with 90 of 94 (95%) stems subsiding less than 5 mm. Twelve hips (13%) required re-revision with no difference in survival between the groups. HHS and WOMAC scores significantly improved from preoperative to last recorded follow-up in both groups (P≤.01).

CONCLUSION

Advances in implant design including spline geometry and more aggressive tapers in monobloc TFT femoral components offer encouraging clinical outcomes with an overall low risk of clinically significant subsidence. [Orthopedics. 2025;48(2):79-86.].

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Shah I, Khan Z, Khan ZA, Ekram A, Butt U, Shah JA. Clinical and functional outcomes of a modular fluted titanium stem in complex hip surgery with femoral bone loss. J Clin Orthop Trauma 2024;59:102843. [PMID: 39691939 PMCID: PMC11647212 DOI: 10.1016/j.jcot.2024.102843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 11/17/2024] [Accepted: 11/23/2024] [Indexed: 12/19/2024] Open

Abstract

Background

The tapered fluted titanium stem is a viable option for complex hip reconstruction. We therefore, evaluate the results of complex hip arthroplasty for femoral bone loss (Paprosky type IIIA to type IV femoral defect), using a modular fluted titanium stem.

Methods

Data for this retrospective study was collected from the medical records of the 2 participating orthopaedic units from December 2018 to December 2021. Twenty-seven patients who underwent reconstruction of femoral bone loss with a modular fluted titanium stem were included in this study. General, demographic and clinical data including patient's age, comorbidities, ambulatory status before and after surgery, blood transfusion, surgical complications, rehabilitation after surgery, length of stay in hospital (in days), readmission after surgery, implant details and mortality rate were recorded. Clinical evaluation was performed using the oxford hip score and 12-item short-form health survey (SF-12). Complications and survivorship were evaluated using Kaplan-Meier survival rate with 95 % confidence interval.

Results

The mean age for the cohort was 60.14 ± 11.58 years, with mean follow-up of 3.2 years for the study. The median pre-operative OHS was 10 (8), which improved to 39 (12) and 41 (4) at 1 and 2-year postoperative follow-up, respectively (P < 0. 001). The quality of life measures (SF-12 scores) in both mental and physical components showed progressive improvement at 2 years follow-up with P- value < 0.001. A total of five patients (18.5 %) had postoperative complications, including deep venous thrombosis in one patient, dislocations in two patients and one patient each with superficial and deep infection. The implant survival rate was 100 % at mean follow-up of 3.2 years.

Conclusions

Proximal femur reconstruction with a modular fluted titanium stem restores mobility, improves the quality of life and reduces pain significantly. It can be considered as a good option as a salvage procedure.

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Chandi SK, Neitzke CC, O'Donnell JA, Gausden EB, Sculco PK, Bostrom MPG, Chalmers BP. Contemporary Outcomes of Proximal Femoral Replacement as a Salvage Treatment in Nononcologic Severe Bone Loss. J Arthroplasty 2024:S0883-5403(24)00914-8. [PMID: 39903456 DOI: 10.1016/j.arth.2024.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 08/26/2024] [Accepted: 08/29/2024] [Indexed: 02/06/2025] Open

Abstract

BACKGROUND

Severe proximal femoral bone loss remains a challenging problem in revision total hip arthroplasty (rTHA). Proximal femoral replacements (PFRs) are salvage options for severe bone loss in complex rTHA. The purpose of this study was to describe the survivorship and clinical outcomes of PFR for nononcologic indications.

METHODS

We performed a retrospective review of 49 patients who underwent 50 PFRs from January 2014 to May 2021 at a single institution. Indications for PFR included periprosthetic femur fracture (n = 20), reimplantation after periprosthetic joint infection (n = 18), aseptic loosening with severe proximal femoral bone loss (n = 10), heterotopic ossification (n = 1), and instability (n = 1). The mean age was 70 years. The mean body mass index was 28 and 25 (50%) patients were women. The mean follow-up was three years. Kaplan-Meier analysis was used to assess survivorship free from reoperation, rerevision, and dislocation.

RESULTS

The 2-year survivorship free from all-cause reoperation was 78%, and the 2-year survivorship free from rerevision was 87%. Overall, there were 11 (22%) reoperations, with indications including periprosthetic joint infection (n = 6), aseptic loosening (n = 2), hematoma evacuation (n = 1), instability (n = 1), and delayed wound healing (n = 1). There were eight (16%) patients who dislocated after PFR. The mean Hip Injury and Osteoarthritis Outcome Score for Joint Replacement increased from 48 preoperatively to 77 at two years postoperatively (P < 0.001).

CONCLUSIONS

In this series of PFRs performed in complex rTHA, there was low 2-year survivorship free from all-cause reoperation (78%) and rerevision (87%). Furthermore, the dislocation rate was high at 16%. However, only one patient (2%) was revised for femoral component aseptic loosening. This study highlights the complexity of these patients and the utilization of PFR as a salvage option.

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Chung BC, Kumaran P, Heckmann ND, Oakes DA. Fracture of the Proximal Body of a Modern Cementless Modular Fluted Tapered Stem. Arthroplast Today 2024;29:101472. [PMID: 39185401 PMCID: PMC11344007 DOI: 10.1016/j.artd.2024.101472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 08/27/2024] Open

Alqahtani Y, Somerville LE, Vasarhelyi EM, Howard JL, Lanting BA, Naudie DDR, MacDonald SJ, McCalden RW. Minimum 2-Year Outcomes of a Modern Monoblock Titanium Fluted Tapered Revision Stem for Complex Primary and Revision Total Hip Arthroplasty. J Arthroplasty 2024;39:S208-S212. [PMID: 38521249 DOI: 10.1016/j.arth.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024] Open

Abstract

BACKGROUND

Modular titanium fluted tapered (TFT) stems have demonstrated excellent clinical success for femoral revision total hip arthroplasty (THA) surgery. This study reports the short-term outcomes of a novel modern monoblock TFT stem used for revision and complex primary THA with a minimum of 2 years of follow-up.

METHODS

We identified 126 patients who received a single monoblock TFT stem: 26 patients for complex THA (failed fracture fixation) and 100 patients for revision THA. The reasons for revision THA included 40 for previous periprosthetic joint infection, 42 for aseptic loosening, 9 for trunnionosis, and 9 for periprosthetic fractures. The Paprosky grading for femoral bone loss at the time of surgery and the measured subsidence of femoral stems at 3-month follow-up were determined. We evaluated the number and indications for reoperations.

RESULTS

The mean time from surgery was 3.9 years (range, 2.0 to 6.9). A paired t-test analysis showed significant improvement from preoperative versus postoperative clinical outcome scores (P < .001) for Harris Hip Score (38.76 ± 15.24 versus 83.42 ± 15.38), Western Ontario and McMaster Universities Arthritis Index (45.6 ± 19.0 versus 69.9 ± 21.3), Veterans RAND 12 Item Health Survey Physical component (31.7 ± 8.1 versus 37.8 ± 11.3), and Veterans RAND 12 Item Health Survey Mental component (48.2 ± 12.2 versus 51.6 ± 12.5). The Paprosky grading for femoral bone loss was Grade 1 (3.9%), Grade 2 (35.7%), Grade 3A (47.6%), Grade 3B (11.1%), and Grade 4 (1.6%) cases. There were 18 reoperations (14.7%), with 13 for periprosthetic joint infection (7 treated with implant retention and 6 treated with a 2-stage revision), 4 for instability, and 1 for acetabular aseptic loosening. There were no aseptic failures of the stem.

CONCLUSIONS

This novel modern monoblock TFT stem provided reliable femoral fixation and has increasingly supplanted the use of modular TFT stems for complex primary and revision surgery in our institution.

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Siljander BR, Chandi SK, Coxe FR, Nguyen JT, Sculco PK, Chalmers BP, Bostrom MP, Gausden EB. A Consecutive Series of Vancouver B2 Periprosthetic Femur Fractures Treated With Contemporary Monoblock Versus Modular Revision Stems: Clinical and Radiographic Outcomes. J Arthroplasty 2024;39:S213-S219. [PMID: 38537840 DOI: 10.1016/j.arth.2024.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 04/30/2024] Open

Abstract

BACKGROUND

Tapered fluted titanium (TFT) stems are the implant design of choice for managing Vancouver B2 periprosthetic femur fractures (PFFs), producing reliable results over the past few decades. The aim of this study was to compare the radiographic and clinical outcomes of Vancouver B2 PFFs treated with contemporary monoblock versus modular TFTs.

METHODS

A consecutive series of 113 patients (72 women, 64%, mean age 70 years [range, 26 to 96]) who had a B2 PFF were treated with either a monoblock (n = 42) or modular (n = 71) TFT stem between 2008 and 2021. The mean body mass index was 30 ± 7. The mean follow-up was 2.9 years. A radiographic review was performed to assess leg length and offset restoration, endosteal cortical contact length, and stem subsidence. Kaplan-Meier analyses were used to determine survivorship without revision, reoperation, or dislocation.

RESULTS

There was no difference in the restoration of leg length (0.3 ± 8.0 mm) or offset (2.8 ± 8.2 mm) between the monoblock and modular cohorts (P > .05). Mean endosteal cortical contact length (47.2 ± 26.6 versus 46.7 ± 2 6.4 mm, P = .89) and stem subsidence (2.7 ± 3.5 versus 2.4 ± 3.2 mm, P = .66) did not differ. No difference in patient-reported outcome measures (Hip Disability and Osteoarthritis Outcome Score-Joint Replacement; Veterans RAND 12 Item Health Survey Physical and Mental; visual analog score; and Lower Extremity Activity Scale) between the groups was observed. Survivorship at 2 years free from reoperation, revision, and dislocation was 90.4, 90.3, and 97.6%, respectively, for the monoblock cohort; and 84.0, 86.9, and 90.0%, respectively, for the modular cohort.

CONCLUSIONS

No significant differences in radiographic or clinical outcomes were observed between patients treated with monoblock or modular TFTs in this large series of B2 PFFs.

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Carender CN, Larson DR, Trousdale RT, Lewallen DG, Berry DJ, Abdel MP. Aseptic Revision Total Hip Arthroplasty Using Modular Fluted Tapered Stems: Long-Term Follow-up of 515 Cases. J Bone Joint Surg Am 2024;106:1470-1478. [PMID: 38935701 DOI: 10.2106/jbjs.23.00921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]

De Meo D, Martini P, Perciballi B, Guarascio G, Vacca M, Cera G, Gumina S, Villani C. Clinical outcomes and survival rates of a uncemented modular revision stem system in hip arthroplasty: a 10-year single-institution study on a frail population. Arch Orthop Trauma Surg 2024;144:3833-3840. [PMID: 39126455 PMCID: PMC11417061 DOI: 10.1007/s00402-024-05483-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024]

Abstract

INTRODUCTION

The increasing prevalence of primary hip arthroplasty has led to a parallel rise in revision cases. Femoral revision often entails compromised bone integrity, requiring consideration of various solutions for optimal reconstructive options. Despite technological advancements, there is limited evidence on the clinical outcomes of the latest modular revision stems. This study aimed to evaluate the clinical outcomes and survival rates of next generation uncemented modular revision stem in patients undergoing hip revision surgery.

MATERIALS AND METHODS

This retrospective single-center study assessed the survival and failure causes of a specific uncemented modular stem in 48 patients undergoing hip revision surgery between 2012 and 2022. Data included preoperative parameters, surgical details, and postoperative outcomes measured through clinical and radiographic assessments. Forty-eight patients (25 males, 23 females; mean age 72 years) were included, with a mean Charlson Comorbidity Index of 5. Preoperative diagnoses varied, with periprosthetic joint infection (PJI) being the most common (45.8%), followed by periprosthetic fractures (27.1%). Partial revisions occurred in 60.4%, total revisions in 39.6%. According to Paprosky classification of femoral bone loss, type II and III were the most represented, respectively 35.4% and 50%.

RESULTS

At a mean follow-up of 4.6 years, stem survival was 92.5%. Complications (20%) included dislocation, PJI, fracture, and loosening; the overall reoperation rate was 12.5%. The SF-12 physical score was 43.6, while the mental score was 51.1. The HOOS score was 71.8, and the HHS score was 71.4. Radiographic analysis identified nonprogressive osteolysis in 15.1% of patients.

CONCLUSIONS

This study on this uncemented modular revision stem demonstrated favorable outcomes in an elder fragile population with moderate to severe femoral bone loss. The implant's modularity provides versatility in addressing various defects, without any implant breakage observed during the study period. Literature comparison highlighted similar outcomes despite sample size differences. The promising results warrant continued investigation into the long-term survivorship of this modular stem system.

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Affiliation(s)

Daniele De Meo Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 3, Rome, 00161, Italy. Department of General Surgery, Plastic Surgery and Orthopaedics, Policlinico Umberto I University Hospital, Rome, Italy.
Paolo Martini Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 3, Rome, 00161, Italy Department of General Surgery, Plastic Surgery and Orthopaedics, Policlinico Umberto I University Hospital, Rome, Italy
Beatrice Perciballi Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 3, Rome, 00161, Italy Department of General Surgery, Plastic Surgery and Orthopaedics, Policlinico Umberto I University Hospital, Rome, Italy
Giovanni Guarascio Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 3, Rome, 00161, Italy Department of General Surgery, Plastic Surgery and Orthopaedics, Policlinico Umberto I University Hospital, Rome, Italy
Matteo Vacca Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 3, Rome, 00161, Italy
Gianluca Cera Emergency Department, Policlinico Umberto I University Hospital, Rome, Italy
Stefano Gumina Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 3, Rome, 00161, Italy Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
Ciro Villani Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 3, Rome, 00161, Italy Department of General Surgery, Plastic Surgery and Orthopaedics, Policlinico Umberto I University Hospital, Rome, Italy

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Ekweariri N, White R, Brown N, Schmitt D. A rare case of taper junction corrosion in semi-constrained total knee arthroplasty. Knee 2024;48:46-51. [PMID: 38507890 DOI: 10.1016/j.knee.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 12/19/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024]

Baldwin TJ, Deckard ER, Buller LT, Meneghini RM. Incidence and Predictors of Subsidence Using Modular, Tapered, Fluted Titanium Femoral Stems in Aseptic Revision Total Hip Arthroplasty. J Arthroplasty 2024;39:1304-1311. [PMID: 37924992 DOI: 10.1016/j.arth.2023.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023] Open

Abstract

BACKGROUND

Tapered, fluted titanium (TFT) femoral stems have become the gold standard in revision total hip arthroplasty (rTHA). However, there is a paucity of data on TFT stem subsidence rates following aseptic rTHA. Subsidence can lead to instability, mechanical failure, leg-length discrepancy, and may require revision surgery. This study evaluated the incidences and predictors of TFT subsidence in aseptic rTHA.

METHODS

A total of 102 TFT femoral stems of 4 designs were retrospectively reviewed. Stem subsidence was measured on digital radiographs taken immediately after surgery and at standard clinical follow-up. Patient characteristics, risk factors for subsidence, revision etiologies, and implant characteristics were recorded. Patient-reported outcome measures were also evaluated for a subset of cases.

RESULTS

Overall, 12% of stems subsided >1 cm, and subsidence was minimal (<3 mm) in ≥64% of cases. From immediate postoperative to 1-month radiographic follow-up, 79% of stems subsided a mean of 2.9 mm (range, 0.1 to 12 mm). Beyond 1 month, subsidence was minimal for ≥77% of cases. In multivariate analyses, women and less femoral implant canal fill were associated with greater subsidence (P ≤ .034). The TFT stem design was not associated with early subsidence (P = .816). There were no modular junction fractures. There were 2 fractures and 2 subsidence-related revisions for aseptic loosening that occurred postoperatively.

CONCLUSIONS

The amount of subsidence in TFT stems was low and was detectable in the early (less than 1 year) postoperative period. Maximizing TFT stem fill within the femoral canal appears to reduce the risk of subsidence without increasing femoral fracture rates and should be the goal with implantation of these devices.

LEVEL OF EVIDENCE

IV-Case Series, No Control Group.

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Hickie KL, Neufeld ME, Howard LC, Greidanus NV, Masri BA, Garbuz DS. Long-term outcomes of revision total hip arthroplasty with the Zimmer Modular Revision hip system. Bone Joint J 2024;106-B:112-117. [PMID: 38688497 DOI: 10.1302/0301-620x.106b5.bjj-2023-0733.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]

Abstract

Aims

There are limited long-term studies reporting on outcomes of the Zimmer Modular Revision (ZMR) stem, and concerns remain regarding failure. Our primary aim was to determine long-term survival free from all-cause revision and stem-related failure for this modular revision stem in revision total hip arthroplasty (THA). Secondary aims included evaluating radiological and functional outcomes.

Methods

We retrospectively identified all patients in our institutional database who underwent revision THA using the ZMR system from January 2000 to December 2007. We included 106 patients (108 hips) with a mean follow-up of 14.5 years (2.3 to 22.3). Mean patient age was 69.2 years (37.0 to 89.4), and 51.9% were female (n = 55). Indications for index revision included aseptic loosening (73.1%), infection (16.7%), fracture (9.3%), and stem fracture (0.9%). Kaplan-Meier analysis was used to determine the all-cause and stem-related failure revision-free survival. At most recent follow-up, Oxford Hip Scores (OHS) were collected, and radiological stem stability was determined using the Engh classification.

Results

A total of 17 hips (15.7%) underwent re-revision of any component. Indications for re-revision were stem failure (35.3%; n = 6), infection (29.4%; n = 5), instability (29.4%; n = 5), and acetabular aseptic loosening (5.9%; n = 1). The five- and 15-year all-cause survival was 89.7% (95% confidence interval (CI) 86.7 to 92.7) and 83.3% (95% CI 79.6 to 87.0), respectively. There were six re-revisions (5.6%) for stem failure; five for stem fracture and one for aseptic loosening. The five- and 15-year survival free from stem-related failure was 97.2% (95% CI 95.6 to 98.8) and 94.0% (95% CI 91.6 to 96.4), respectively. At final follow-up, the mean OHS was 36.9 (8.0 to 48.0) and 95.7% (n = 66) of surviving modular revision stems were well-fixed in available radiographs.

Conclusion

Femoral revision with the ZMR offers satisfactory long-term all-cause revision-free survival, good survival free of stem-related failure, and favourable clinical outcomes. Stem fracture was the most common reason for stem-related failure and occurred both early and late. This highlights the importance of both early and long-term surveillance for stem-related failure.

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Carender CN, Perry KI, Sierra RJ, Trousdale RT, Berry DJ, Abdel MP. Modular fluted tapered stems in two-stage reimplantation of previously infected total hip arthroplasties. Bone Joint J 2024;106-B:125-132. [PMID: 38688510 DOI: 10.1302/0301-620x.106b5.bjj-2023-0788.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]

Abstract

Aims

Uncemented implants are now commonly used at reimplantation of a two-stage revision total hip arthoplasty (THA) following periprosthetic joint infection (PJI). However, there is a paucity of data on the performance of the most commonly used uncemented femoral implants - modular fluted tapered (MFT) femoral components - in this setting. This study evaluated implant survival, radiological results, and clinical outcomes in a large cohort of reimplantation THAs using MFT components.

Methods

We identified 236 reimplantation THAs from a single tertiary care academic institution from September 2000 to September 2020. Two designs of MFT femoral components were used as part of an established two-stage exchange protocol for the treatment of PJI. Mean age at reimplantation was 65 years (SD 11), mean BMI was 32 kg/m2 (SD 7), and 46% (n = 109) were female. Mean follow-up was seven years (SD 4). A competing risk model accounting for death was used.

Results

The 15-year cumulative incidence of any revision was 24%. There were 48 revisions, with the most common reasons being dislocation (n = 25) and infection (n = 16). The 15-year cumulative incidence of any reoperation was 28%. Only 13 revisions involved the fluted tapered component (FTC), for a 15-year cumulative incidence of any FTC revision of 8%. Only two FTCs were revised for aseptic loosening, resulting in a 15-year cumulative incidence of FTC revision for aseptic loosening of 1%. Stem subsidence ≥ 5 mm occurred in 2% of unrevised cases. All stems were radiologically stable at most recent follow-up. Mean Harris Hip Score was 69 (SD 20) at most recent follow-up.

Conclusion

This series demonstrated that MFT components were durable and reliable in the setting of two-stage reimplantation THA for infection. While the incidence of aseptic loosening was very low, the incidence of any revision was 24% at 15 years, primarily due to dislocation and recurrent PJI.

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Shelton J, Gordon A. The Minimum 5-Year Follow up of a Highly Versatile Distally Anchored Femoral Revision System With Hydroxyapatite Coating. Arthroplast Today 2024;26:101185. [PMID: 39006859 PMCID: PMC11239970 DOI: 10.1016/j.artd.2023.101185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/11/2023] [Accepted: 07/06/2023] [Indexed: 07/16/2024] Open

Lucena T, Cavaignac E, Courtot L, Marot V, Chiron P, Reina N. Implant breakage and revision factors for modular fluted tapered stems in revision total hip arthroplasty. Hip Int 2024;34:207-214. [PMID: 37306180 DOI: 10.1177/11207000231180065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]

Abstract

PURPOSE

Modular stems in revision total hip arthroplasties allow diaphyseal fixation and optimal restoration of the architecture of the proximal femur. Several studies report metaphyseal implant breakage having a negative impact on survivorship. The aim of the study was to evaluate the outcome of an uncemented modular fluted tapered stem (MFT) in revision surgery.

METHODS

In a retrospective study, 316 patients who had revision surgery using the same design of MFT implant (Modular Revision Stem [MRS], Lima Corporate, Italy) between 2012 and 2017 were identified. Patients were male in 51% of cases and mean age was 74 years. Indications were 110 periprosthetic fractures, 98 periprosthetic joint infection, 97 aseptic loosening, 10 instability and 1 other cause. Survivorship, complications, clinical and radiographic outcomes, were assessed. Mean follow-up was 5 years.

RESULTS

There was no implant breakage. At 5-year follow-up, the survivorship, free from revision for aseptic loosening and free of revision for any reason were 96% and 87%, respectively. At last follow-up (8 years), these figures were 92% and 71%, respectively. 31 implants were revised. The risk of revision for any cause was higher for extreme length metaphyseal implants, hazard ratio was 3.7 (95% CI, 1.82-7.52). A mean stem subsidence of 9 mm was noted in 37 cases; 4 were revised for aseptic loosening. The Harris Hip Score at final follow-up was 82.

CONCLUSIONS

At 5-year follow-up, the MFT implant showed a good survivorship and outcomes with no specific complications. Unlike literature reports, no specific complications occurred with this design. Stem junction positioning and therefore metaphyseal length may be key to optimise long-term survivorship. However, a longer follow-up is needed as implant breakage is more often seen after long implantation times.

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Randelli F, Fioruzzi A, Barion G, Volpe G, Viganò M. Last generation fluted modular titanium stem in revision hip arthroplasty: a narrative review of mid- and long-term outcomes. ANNALS OF JOINT 2024;9:5. [PMID: 38529293 PMCID: PMC10929368 DOI: 10.21037/aoj-23-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/18/2023] [Indexed: 03/27/2024]

Abstract

Background and Objective

Tapered fluted titanium stems (TFTS), were introduced to overcome proximal femur bone defects. They obtain stable fixation even in catastrophic proximal bone loss. Modular ones have the advantage to adjust length, rotation, off-set independently from the distal module. Short-term publications have been showing favorable outcomes burdened by an unacceptably high rate of stem failure. Still, there is a paucity of mid- and long-term reports. This narrative review aims at analyzing recent literature on modular TFTS with at least 5 years of minimum follow-up to gain a better understanding of implant survival, performance, and complications.

Methods

A search of the PubMed database was performed with selected key terms. Results were screened after the application of strict inclusion and exclusion criteria. Extracted data were subsequently evaluated to obtain an up-to-date overview of the results and complications of TFTS.

Key Content and Findings

Modular TFTS showed a consistent increase in patient reported outcomes that persists at 10 years and above. Femoral fractures were the most common intraoperative complication. Despite modularity, dislocation still occurs at a variable rate (1.2-12%). With revision for any cause as an endpoint, overall survival approaches 83% after 10 years of follow-up. If femoral revision only is evaluated, excellent survival rates (>95%) have been published. Stem subsidence over 5 mm was reported in less than 5% of patients, only 1 requiring femoral revision. The mean incidence of stem mechanical failure was 3.39%, although most breakages occurred in stems eventually retired from the market.

Conclusions

Satisfactory survival rates were observed, with an acceptable rate of complications. Stem mechanical failure, excluding those stems eventually retired from the market, remains a marginal event. Therefore, the use of modular TFTS in revision surgery is safe and effective even in the long term.

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Ali E, Howard LC, Neufeld ME, Masri BA. Treatment of femoral bone loss in revision total hip arthroplasty: a clinical practice review. ANNALS OF JOINT 2024;9:4. [PMID: 38529292 PMCID: PMC10929365 DOI: 10.21037/aoj-23-31] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/19/2023] [Indexed: 03/27/2024]

Abstract

Patient and implant selection is essential to optimize outcome. Femoral bone loss classifications such as the American Academy of Orthopaedic Surgeons, Gross, and Paprosky classifications permit surgeons to systematically manage bone stock deficiencies and guide implant selection. Here we provide a comprehensive report on the pitfalls and management of this reconstructive challenge. Preoperative planning remains vital to the treatment of femoral bone loss in revision hip arthroplasty and the authors believe it is essential and should include the entire femur. This commonly includes imaging for bone loss such as Judet views or computed tomography scan and must include the entire femur though additional radiographs such as Judet views apply more for acetabular bone loss as opposed to femoral bone loss. All patients should have pre-operative work up to exclude infection. If any of these results area elevated, an aspirate and sampling is required to guide microbiological management. Classically with regards femoral revision surgery, uncemented fixation has proven to give the best outcomes but surgeons must remain flexible and use cemented fixation when necessary. Adequate proximal bone stock permits the use of implants used in primary joint surgery. Implants with proximal modularity can be used in cases where bone stock allows for superb proximal bone support. The vast majority of femoral revisions have inadequate proximal bone stock, thus distally fixed stems should be used and have been shown to provide both axial and rotational stability provided there is an intact isthmus. Taper fluted stems can provide good outcomes even in cases of major bone loss. However, with severe bony loss, impaction grating or the use of a megaprotsthesis is sometimes necessary and is down to surgeon choice and preference. This article has been written as a guide for management and summarises the best evidence available.

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Massardier E, Bauwens PH, Masson JB, Rongieras F, Bertani A. Survival and complications at a minimum 5years' follow-up of the modular Mark-2 Extreme™ cementless femoral stem: Does the reduced modularity resolve the mechanical issues of the Mark-I stem? Orthop Traumatol Surg Res 2023;109:103613. [PMID: 37004733 DOI: 10.1016/j.otsr.2023.103613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 04/03/2023]

Abstract

INTRODUCTION

The Extreme™ modular stem was developed for implant revision with metaphyseal-diaphyseal defect. Due to the high breakage rate, a new "reduced modularity" design has been introduced, but without reported results. We therefore conducted a retrospective assessment of (1) overall stem survival, (2) functional results, (3) osseointegration, and (4) the rate of complications, and notably of mechanical failure.

HYPOTHESIS

Reduced modularity reduces the risk of revision surgery for mechanical failure.

MATERIAL AND METHODS

Forty-five prostheses were implanted between January 2007 and December 2010 in 42 patients with severe bone defect (Paprosky≥III) or periprosthetic shaft fracture. Mean age was 69.6years (range: 44-91years). Minimum follow-up was 5years, for a mean 115.4months (range: 60-156months). The main study endpoint was femoral stem survival, counting all-cause explantation as event. Functional assessment comprised subjective rating of satisfaction, Postel Merle d'Aubigné (PMA) and Harris Hip scores, and Forgotten Joint Score (FJS). Whether the revision assembly was carried out in situ, in the patient's hip, or outside, on the operating table, was not known in 2 cases; in the other 43, assembly was in situ in 15 cases (35%) and on the operating table in 28 (65%).

RESULTS

Five-year stem survival was 75.7% (95% CI: 61.9-89.5%), taking all causes of change together. Seventeen patients (45.9%) had complications, 13 (35.1%) requiring revision surgery, including 10 (27.0%) for stem replacement. Five patients (13.5%) had steam breakage at the junction between the metaphysis and the diaphyseal stem, 4 of which occurred within 2 years of implantation or of fixation of a periprosthetic fracture. Mean preoperative Harris score was 48.4 [IQR (25-75% interquartile range): 37-58] and PMA score 11.1 (IQR: 10-12), compared to respectively 74 (IQR: 67-89) and 13.6 (IQR: 12.5-16) at follow-up. Mean FJS at follow-up was 71.5 (IQR: 61-94.5). In the 15 in situ assemblies, there were 3 breakages (20%), compared to 2 (7.1%) in the 28 table assemblies (p=0.21).

DISCUSSION

The stem breakage rate was high despite the reduced modularity, which concentrated all stress on a single junction but without reducing the risk of mechanical failure. Surgical technique was faulty in some cases, with in situ assembly of the metaphysis after implanting the diaphyseal stem, which does not respect the manufacturer's recommendations.

LEVEL OF EVIDENCE

IV; retrospective study.

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Thomas J, Shichman I, Ohanisian L, Stoops TK, Lawrence KW, Ashkenazi I, Watson DT, Schwarzkopf R. Monoblock tapered stems in management of UCS B2 and B3 periprosthetic fractures in revision total hip arthroplasty. Bone Jt Open 2023;4:551-558. [PMID: 37524356 PMCID: PMC10390262 DOI: 10.1302/2633-1462.48.bjo-2022-0160.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open

Morgan S, Bourget-Murray J, Garceau S, Grammatopoulos G. Revision total hip arthroplasty for periprosthetic fracture: epidemiology, outcomes, and factors associated with success. ANNALS OF JOINT 2023;8:30. [PMID: 38529253 PMCID: PMC10929400 DOI: 10.21037/aoj-23-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/19/2023] [Indexed: 03/27/2024]

Harmer JR, Hadley ML, Trousdale RT. Modular Proximal Body Exchange for Re-revision Total Hip Arthroplasty: Rarely Utilized and Moderately Successful. J Arthroplasty 2023:S0883-5403(23)00366-2. [PMID: 37084920 DOI: 10.1016/j.arth.2023.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023] Open

Long-Term Outcomes of Revision Total Hip Arthroplasty Using a Tapered and Fluted Modular Stem: A Mean Follow-Up of 16 Years. J Arthroplasty 2022;37:2420-2426. [PMID: 35753649 DOI: 10.1016/j.arth.2022.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 02/02/2023] Open

Bahamonde L, Zecchetto P. Resection and reconstruction of the proximal femur with revision stems: a cost-effective alternative. ANNALS OF JOINT 2022;8:1. [PMID: 38529246 PMCID: PMC10929315 DOI: 10.21037/aoj-20-104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 07/27/2022] [Indexed: 03/27/2024]

Abstract

Background

Modular oncologic megaprosthesis is the standard method for reconstruction after resection of tumors of the proximal femur. These implants have been utilized for either primary tumors or metastatic disease of bone and multiple myeloma. Fixation is based on either cemented or cementless stems, and a collar supporting the body of the prosthesis. For those patients with advanced disease and/or limited life span, a judicious approach should balance the functional expectations, prognosis, and the issue of cost of the surgical procedure and the implant that is selected.

Methods

Based on the principles of distal fixation of tapered stems, the authors have utilized implants originally designed for hip revision surgery to reconstruct the proximal femur in 19 patients, after resection because of metastases, multiple myeloma and some aggressive primary tumors. The essentials of the technique consist of distal fixation in the remaining isthmus of the femur by means of tapered stems, impacted in such a way to achieve solid primary fixation, balanced with accurate leg length restoration. Proximally, the implant remains devoid of bone coverage.

Results

In this retrospective study, proper distal fixation, leaving the proximal part of the implant uncovered with bone, has resulted in good functional results in mid-term follow-up of patients. Primary fixation has led to secondary bone ongrowth and remodeling, providing secondary fixation. Complications such as instability, loosening and infection are comparable with those associated to the traditional management with mega prosthesis.

Conclusions

The utilization of tapered stems for distal fixation after proximal femoral resections has shown reliable results after mid-term follow-up. The method might be considered as a cost-effective alternative for selected patients.

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Willems JH, Smulders K, Innocenti M, Bosker BH, van Hellemondt GG. Stay Short or Go Long in Revision Total Hip Arthroplasty With Paprosky Type II Femoral Defects: A Comparative Study With the Use of an Uncemented Distal Fixating Modular Stem and a Primary Monobloc Conical Stem With 5-Year Follow-Up. J Arthroplasty 2022;37:2239-2246. [PMID: 35537612 DOI: 10.1016/j.arth.2022.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/21/2022] [Accepted: 05/03/2022] [Indexed: 02/02/2023] Open

Pomeroy E, Flynn SO, Grigoras M, Murphy TP, Stavrakis AI, Rowan FE. Subsidence of monoblock and modular titanium fluted tapered stems in revision hip arthroplasty: A retrospective multicentre comparison study. J Clin Orthop Trauma 2022;34:102021. [PMID: 36147379 PMCID: PMC9486022 DOI: 10.1016/j.jcot.2022.102021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 11/22/2022] Open

EBRA Migration Analysis of a Modular, Distally Fixed Stem in Hip Revision Arthroplasty: A Clinical and Radiological Study. J Clin Med 2022;11:jcm11195857. [PMID: 36233724 PMCID: PMC9572611 DOI: 10.3390/jcm11195857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/20/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022] Open

Soleilhavoup M, Villatte G, Cambier S, Descamps S, Boisgard S, Erivan R. Does metaphyseal modularity in femoral revision stems have a role in treating bone defects less severe than IIIB? Clinical and radiological results of a series of 163 modular femoral stems. Orthop Traumatol Surg Res 2022;108:103353. [PMID: 35716986 DOI: 10.1016/j.otsr.2022.103353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 02/03/2023]

Abstract

INTRODUCTION

Revision for loosening of femoral stems requires an extensive analysis of bone defects to determine the most appropriate course of action. The drawbacks of using modular stems are that they can break or corrode at their junction. They have rarely been evaluated based on the extent of bone loss and particularly in patients with less severe bone loss. This led us to carry out a retrospective study to analyze modular femoral stems as a function of the initial bone defect (stage IIIB versus less severe in the Paprosky classification): 1) implant survivorship, 2) osteointegration and subsidence of the stem, and 3) breakage of implant.

HYPOTHESIS

Modular femoral stems can be used for all types of bone defects (not only IIIB) as the complication rate is identical.

PATIENTS AND METHODS

Between January 1, 1996, and December 31, 2016, 163 patients were included who had received a modular femoral revision stem. The minimum follow-up was 4 years; the mean was 6.7 years±3.3 [4-21]. One patient was lost to follow-up, 88 had died before the analysis date and 74 were still alive; however, 10 of them had the stem removed less than 4 years after implantation. Thus 64 patients were available for the clinical evaluation. There were 44% (72 patients) with Paprosky stage IIIB femoral bone loss and 56% (91 patients) with stage I, II or IIIA bone loss. The stem's bone integration was evaluated using the Engh and Massin score. All complications were documented.

RESULTS

The survivorship of the femoral stem was 93.75% (95% CI: 83.33-96.70) at 5 years with removal for any reason as the end point. There was no significant difference (p=0.0877) in survivorship relative to the severity of the initial bone loss: 89.84% (95% CI: 78.73-95.31) for stage IIIB; 95.23% (95% CI: 82.24-98.79) for stage IIIA; 97.06% (95% CI: 80.90-99.58) for stage II. Bone integration was considered as being achieved in 76% of stems based on available radiographs (119 of 156 patients) with the severity of bone loss having no effect. We found 18 instances of stem subsidence out of 156 stems with available data (11.5%). The mean subsidence was 14.7 mm ± 12.3 [5-40]. Among the 18 stems with postoperative subsidence, 13 had been implanted for stage IIIB defects, while 5 were for less severe defects (p=0.751). Two stem fractures occurred in patients with stage IIIB bone loss, thus 2/66 for stage IIIB and 0/86 in the less severe bone loss cases (p=0.188).

CONCLUSION

Modularity provides similar results no matter the severity of initial bone loss, without the risk of additional complications.

LEVEL OF EVIDENCE

IV, Retrospective study.

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Koutalos AA, Varitimidis S, Malizos KN, Karachalios T. Clinical, functional and radiographic outcomes after revision total hip arthroplasty with tapered fluted modular or non-modular stems: a systematic review. Hip Int 2022;32:475-487. [PMID: 33829900 DOI: 10.1177/11207000211004383] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]

Govilkar S, Gandhi MJ, Bhachu DS, Whittaker JP, Evans CR, Spencer-Jones R. The survivorship of revision total hip replacement with severe proximal bone deficiency using a modular taper fluted prosthesis. Acta Orthop Belg 2022;88:303-309. [DOI: 10.52628/88.2.9674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]

Calek AK, Schöfl T, Zdravkovic V, Zurmühle P, Ladurner A. Aseptic Revision of Total Hip Arthroplasty With a Single Modular Femoral Stem and a Modified Extended Trochanteric Osteotomy-Treatment Assessment With the Forgotten Joint Score-12. Arthroplast Today 2022;15:159-166. [PMID: 35601994 PMCID: PMC9121271 DOI: 10.1016/j.artd.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/20/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open

Santiago L I, Gerardo A, Fernando V, Leonel PA, Ignacio P, Pablo M, Fernando A L, Hernán DS, Bartolomé L A. Midterm results and complications rates in vancouver type B2 and B3 periprosthetic femoral fractures treated with modular fluted tapered stems. J Orthop 2021;28:1-4. [PMID: 34707333 DOI: 10.1016/j.jor.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/26/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022] Open

El Ashmawy AA, Hosny HAH, El-Bakoury A, Yarlagadda R, Keenan J. Mid- to long-term results of the Cone-Conical modular system in revision hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021;46:531-539. [PMID: 34635943 DOI: 10.1007/s00264-021-05237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]

Yacovelli S, Hozack W. Modular or Monolithic Tapered Fluted Prostheses for Periprosthetic Fractures: Which One Could Work for You? Orthop Clin North Am 2021;52:305-315. [PMID: 34538343 DOI: 10.1016/j.ocl.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]

Skibicki HE, Post ZD, Kay AB, Czymek MM, Ong AC, Orozco FR, Ponzio DY. A Role for Modern Primary Cementless Femoral Stems in Revision Hip Arthroplasty. J Arthroplasty 2021;36:3269-3274. [PMID: 34053749 DOI: 10.1016/j.arth.2021.04.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 02/02/2023] Open

Abstract

BACKGROUND

In revision total hip arthroplasty (THA) cases with preserved femoral metaphyseal bone, tapered proximally porous-coated "primary" femoral stems may be an option. The objective of this study was to compare outcomes of patients with Paprosky I or II femoral bone loss undergoing revision THA with either a primary metaphyseal-engaging cementless stem or a revision diaphyseal-engaging stem.

METHODS

This was a retrospective analysis of 70 patients with Paprosky I or II femoral bone loss who underwent femoral revision. 35 patients who were revised using a primary cementless femoral stem were compared with 35 patients who underwent femoral revision using a revision diaphyseal-engaging stem. The groups were similar regarding age, gender, body mass index, and American Society of Anesthesiologists. Clinical and radiographic outcomes and complications were compared over an average follow-up of 2.9 years (SD 1.4).

RESULTS

Revision THA was most commonly performed for periprosthetic joint infection (N = 27, 38.6%). The groups were similar with regards to Paprosky femoral classification (P = .56), length of stay (P = .68), discharge disposition (P = .461), operative time (P = .20), and complications (P = .164). There were no significant differences between primary and revision femoral stem subsidence (0.12 vs. 0.75 mm, P = .18), leg length discrepancy (2.3 vs. 4.05 mm, P = .37), and Hip Disability and Osteoarthritis Outcome Score Jr (73.1 [SD 21.1] vs. 62.8 [SD 21.7], P = .088). No patient underwent additional revision surgery involving the femoral component.

CONCLUSION

Use of modern primary cementless femoral stems is a viable option for revision hip arthroplasty in the setting of preserved proximal femoral metaphyseal bone. Outcomes are not inferior to those of revision stems and offer potential benefits.

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Butler Ransohoff C, Wanner R, Solinger T, Gautier E, Eijer H, Wahl P. The different failure modes of the connecting elements of the modular hip arthroplasty revision stem Revitan. J Mech Behav Biomed Mater 2021;123:104778. [PMID: 34416537 DOI: 10.1016/j.jmbbm.2021.104778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/23/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]

Herold F, Nötzli H, Eijer H. Short proximal components in modular revision stems carry a higher risk for stem fractures. Hip Int 2021;31:398-403. [PMID: 31640427 DOI: 10.1177/1120700019884049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]

Fink B. Technical Note for Transfemoral Implantation of Tapered Revision Stems. The Advantage to Stay Short. Arthroplast Today 2021;9:16-20. [PMID: 33997203 PMCID: PMC8099717 DOI: 10.1016/j.artd.2021.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 11/29/2022] Open

Sukopp M, Taylor D, Forst R, Seehaus F. Femoral Stem Fracture in Hip Revision Arthroplasty: A Systematic Literature Review of the Real-World Evidence. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021;160:160-171. [PMID: 33851402 PMCID: PMC8967430 DOI: 10.1055/a-1348-2873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]

Abstract

Background Total hip arthroplasty (THA) presents as an excellent treatment for the osteoarthritic hip, demonstrating good survival rates. However, aseptic loosening and infection are the main causes of operative revision. The methods used in revision surgery are non-modular or modular THA implants. In addition to the abovementioned revision reasons for THA, this treatment could be associated with the possibility of femoral stem fracture, especially in the modular system. The topic of material failure has been focused on in the public media. The question arises as to how such media reports correlate with the published literature. The observed mentioned number of cases concerning a femoral stem fracture vary between one single case and up to 18.5% within a clinical study, thus presenting an inhomogeneous data situation with a large span. The specific aim of this systematic review is to establish facts and clarify the number of unforeseen events of a femoral stem fracture based on peer review articles and registry data. This clarification is important to us, as these media reports have led to uncertainty among patients.

Methods A systematic review was performed in accordance with the PRISMA statement. Peer review articles in English and German, presenting original articles, meta-analyses, or case reports, were searched from the turn of the millennium up to December 2019. Only articles that reported a femoral stem component fracture, with content of clinical data as well as register data, were included. Relevant papers published after the defined research time frame were taken into account within the discussion.

Results In total, 218 fractures of a femoral stem (141 primary and 77 revision THA) component could be identified within the selected literature. Most cases of a femoral stem fracture occurred in the modular THA implants compared to the non-modular stems. Regarding revision THA, in summary, 77 implants, presenting 23 non-modular and 54 modular implants, failed by means of femoral stem fracture. A review of 11 National Joint Registries shows a revision rate between 0.04 and 0.05% in only 2 registers according to the specific subject of a femoral stem fracture. For the remaining 9 registers, however, detailed information is lacking and only nonspecific information such as a generic “implant failure” or “other reason” (which can cover a multitude of causes) is supplied.

Conclusion A femoral stem fracture presents a devastating complication for the patient, the surgeon as well as for the manufacturer of the implant. Modular THA implants play an increasingly valuable role concerning restoration of individual anatomy in modern THA revision surgery, especially within complex cases. Regarding revision procedures, data suggests a lower risk of femoral stem fracture for modular implants compared to primary procedures, while the risk of fracture for non-modular implants seems to increase during revision. Ultimately, it cannot be proven whether this is actually applicable, since the absolute number of implanted prosthesis systems is not known. Various implant-, patient-, and surgeon-related factors may lead to these reported femoral stem fractures. However, this systematic review suggests that this is, in general, a rare complication.

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Hasegawa M, Tone S, Naito Y, Wakabayashi H, Sudo A. Minimum ten-year results in revision total hip arthroplasty using titanium fully porous long stem. INTERNATIONAL ORTHOPAEDICS 2021;45:1727-1733. [PMID: 33825004 DOI: 10.1007/s00264-021-05030-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/29/2021] [Indexed: 01/17/2023]

Zheng K, Li N, Zhang W, Zhu Y, Zhou J, Xu Y, Geng D. Mid- to Long-Term Outcomes of Cementless Modular, Fluted, Tapered Stem for Massive Femoral Bone Loss in Revision Total Hip Arthroplasty. Orthop Surg 2021;13:989-1000. [PMID: 33821565 PMCID: PMC8126951 DOI: 10.1111/os.12936] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/12/2020] [Accepted: 12/27/2020] [Indexed: 12/14/2022] Open

Abstract

OBJECTIVE

To evaluate mid- to long-term results of revision total hip arthroplasty for massive femoral bone loss using a cementless modular, fluted, tapered stem.

METHODS

This is a retrospective study performed at a single hospital. During the period of January 2007 to January 2015, 33 patients (34 hips) underwent primary revision surgery with cementless modular, fluted, tapered stems due to femoral bone loss. Sixteen men and 17 women were included in the study, with an average age of 63.9 ± 11.7 years (range, 27 to 88 years). Operative data including operative duration, length of incision, drainage volume and duration, blood loss and transfusion, cases of bone graft and extended trochanteric osteotomy were recorded. Clinical evaluation was performed using Harris hip score (HHS), visual analogue scale (VAS), and patients' satisfaction. Radiographic data including femoral stem fixation, subsidence, integrin of allograft bone, and leg length discrepancy were assessed. Complications and survivorship were evaluated using Kaplan-Meier survival rate.

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 three hips (9%), and instability in one hip (3%). The average stem subsidence was 3.9 ± 2.2 mm (range, 1 to 10 mm). The mean difference in leg length in our study was 3.3 ± 2.7 mm (range, 0 to 10 mm), and the leg length discrepancy in 28 (82%) patients was within 5 mm. No case of junction fracture was observed. Seven (21%) intraoperative fractures occurred in our study. Three (9%) cases with infection were observed after revision. Six (18%) patients had lower limb vein thrombosis. 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 one for aseptic loosening, one for dislocation, and one for infection.

CONCLUSION

The mid- to long-term results of revision total hip arthroplasty with the cementless modular, fluted, tapered stems are encouraging for massive femoral bone loss.

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Jayasinghe G, Buckle C, Maling LC, To C, Anibueze C, Vinayakam P, Slack R. Medium Term Radiographic and Clinical Outcomes Using a Modular Tapered Hip Revision Implant. Arthroplast Today 2021;8:181-187. [PMID: 33898674 PMCID: PMC8056170 DOI: 10.1016/j.artd.2021.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 12/30/2022] Open

Wahl P, Solinger T, Schläppi M, Gautier E. Removal of an osteointegrated broken uncemented femoral stem after hip arthroplasty-technical note. J Orthop Surg Res 2021;16:221. [PMID: 33771182 PMCID: PMC7995790 DOI: 10.1186/s13018-021-02365-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open

Lopreite F, Perez Alamino L, Simesen de Bielke H, Garabano G, Del Sel H. Distal fixation stems for revision of total hip replacement. J Orthop 2021;24:151-156. [PMID: 33716420 PMCID: PMC7932857 DOI: 10.1016/j.jor.2021.02.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/28/2020] [Accepted: 02/13/2021] [Indexed: 12/28/2022] Open

Chatelet JC, Ait-Si-Selmi T, Machenaud A, Ramos-Pascual S, Fessy MH. Mid-Term Clinical and Radiographic Outcomes of a Long Cementless Monobloc Stem for Revision Total Hip Arthroplasty. J Arthroplasty 2021;36:261-267. [PMID: 32819781 DOI: 10.1016/j.arth.2020.07.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 02/02/2023] Open

Revision Hip Arthroplasty Using a Porous-coated or Taper ZMR Implant: Minimum 10-year Follow-up of Implant Survivorship. J Am Acad Orthop Surg 2021;29:e41-e50. [PMID: 32796364 DOI: 10.5435/jaaos-d-19-00512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 05/03/2020] [Indexed: 02/01/2023] Open

Picado CHF, Savarese A, Cardamoni VDS, Sugo AT, Garcia FL. Clinical, radiographic, and survivorship analysis of a modular fluted tapered stem in revision hip arthroplasty. J Orthop Surg (Hong Kong) 2020;28:2309499019891638. [PMID: 31833457 DOI: 10.1177/2309499019891638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open

Ellenrieder M, Souffrant R, Schulze C, Mittelmeier W, Bader R. Micromotion and subsidence of a cementless conical fluted stem depending on femoral defect size - A human cadaveric study. Clin Biomech (Bristol, Avon) 2020;80:105202. [PMID: 33129564 DOI: 10.1016/j.clinbiomech.2020.105202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/09/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023]

Modular Fluted Tapered Stems in Aseptic Oncologic Revision Total Hip Arthroplasty: A Game Changer? J Arthroplasty 2020;35:3692-3696. [PMID: 32653350 DOI: 10.1016/j.arth.2020.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/02/2020] [Accepted: 06/15/2020] [Indexed: 02/02/2023] Open

Munegato D, Caminita AD, Sotiri R, Rossi A, Bigoni M, Zatti G. Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes. Hip Int 2020;30:101-107. [PMID: 33267693 DOI: 10.1177/1120700020971313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]

Kheir MM, Drayer NJ, Chen AF. An Update on Cementless Femoral Fixation in Total Hip Arthroplasty. J Bone Joint Surg Am 2020;102:1646-1661. [PMID: 32740265 DOI: 10.2106/jbjs.19.01397] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]

Wang J, Dai WL, Lin ZM, Shi ZJ. Revision total hip arthroplasty in patients with femoral bone loss using tapered rectangular femoral stem: a minimum 10 years' follow-up. Hip Int 2020;30:622-628. [PMID: 32686507 DOI: 10.1177/1120700019859809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]