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Bischel OE, Jung MK, Suda AJ, Seeger JB, Böhm PM. Epidemiology of Periprosthetic Fractures After Cementless Revision Total Hip Arthroplasty with Tapered, Fluted Stems at a Mid- to Long-Term Follow-Up. J Clin Med 2025; 14:1468. [PMID: 40094883 PMCID: PMC11900479 DOI: 10.3390/jcm14051468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 02/15/2025] [Accepted: 02/18/2025] [Indexed: 03/19/2025] Open
Abstract
Background: Although tapered and fluted stems are frequently used in revision total hip arthroplasty (RTHA), major complications following the implantation of these implants, like periprosthetic fractures, are less investigated. As epidemiological data do not exist yet, the incidence of PPF in a mid- to long-term follow-up is unknown and potential risk factors have not been detected. Methods: Propensity score matching (PSA) of two retrospectively investigated cohorts after femoral RTHA with either modular (n = 130) or monobloc prosthesis (n = 129) was executed. A total of 186 cases, including 93 of each device, were finally analyzed during a mean follow-up period of 9.1 (0.5-23.1) years. The time-dependent risk of PPF was calculated using a Kaplan-Meier analysis. Results: The cumulative risk for PPF of the whole cohort was 5.7% (95% CI: 1.7-9.8%) at 23.1 years, for the modular device, 13.0% (95% CI: 0-26.0%) after 13.7 years and the monobloc stem, 3.4% (95% CI: 0-7.1%) after 23.1 years, without a significant difference between the two designs (log-rank p = 0.1922). All eight fractures occurred in women and there was one collapse of the fracture after open reduction and internal fixation. The cumulative risk was 10.1% (95% CI: 3.1-17.1%) at 23.1 years compared to 0% after 21.4 years in men (log-rank p = 0.0117). Diabetes was significantly associated with the presence of PPF during follow-up (non-diabetic, 4.4% (95% CI: 0-8.2%) after 21.3 years vs. diabetic, 16.6% (96% CI: 0-34.5%) after 13.3 years; log-rank p = 0.0066). Longer reconstructions showed also a significantly higher fracture risk (equal or longer than median implant length vs. shorter; 10.5% (95% CI: 3.1-17.1%) after 21.4 years vs. 1.0% (95% CI: 0-3.1%) after 23.1 years; log-rank p = 0.0276) but did not correlate with a preoperative defect situation. Conclusions: The cumulative risk for PPF after femoral revision with tapered and fluted devices is a relevant failure reason in this mid- to long-term investigation. There was no difference between the monobloc stem or modular implant. Women and diabetics are at risk, and the choice of a longer implant than necessary is neither prophylactical for PPF nor useful in the case of the operative treatment of a PPF after femoral RTHA with these revision devices.
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Affiliation(s)
- Oliver E. Bischel
- BG Trauma Center at University of Heidelberg, Ludwig-Guttmann-Str. 13, 67 071 Ludwigshafen, Germany;
| | - Matthias K. Jung
- BG Trauma Center at University of Heidelberg, Ludwig-Guttmann-Str. 13, 67 071 Ludwigshafen, Germany;
| | - Arnold J. Suda
- Medical Faculty Mannheim, University of Heidelberg, Ludolf-Krehl-Str. 13-17, 68 167 Mannheim, Germany;
| | - Jörn B. Seeger
- Parc Clinic, Am Kaiserberg 2-4, 61 231 Bad Nauheim, Germany;
| | - Paul M. Böhm
- General Orthopedics, Pläntschweg 25, 81 247 Munich, Germany;
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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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Li Y, Cao L. Management of Severe Bone Defects in Femoral Revision following Total Hip Arthroplasty. Hip Pelvis 2024; 36:101-107. [PMID: 38825819 PMCID: PMC11162874 DOI: 10.5371/hp.2024.36.2.101] [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: 07/17/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 06/04/2024] Open
Abstract
Treatment of femoral bone defects continues to be a challenge in revision total hip arthroplasty (THA); therefore, meticulous preoperative evaluation of patients and surgical planning are required. This review provides a concise synopsis of the etiology, classification, treatment strategy, and prosthesis selection in relation to femoral bone loss in revision THA. A search of literature was conducted for identification of research articles related to classification of bone loss, management of femoral revision, and comparison of different types of stems. Findings of a thorough review of the included articles were as follows: (1) the Paprosky classification system is used most often when defining femoral bone loss, (2) a primary-length fully coated monoblock femoral component is recommended for treatment of types I or II bone defects, (3) use of an extensively porouscoated stem and a modular fluted tapered stem is recommended for management of types III or IV bone defects, and (4) use of an impaction grafting technique is another option for improvement of bone stock, and allograft prosthesis composite and proximal femoral replacement can be applied by experienced surgeons, in selected cases, as a final salvage solution. Stems with a tapered design are gradually replacing components with a cylindrical design as the first choice for femoral revision; however, further confirmation regarding the advantages and disadvantages of modular and nonmodular stems will be required through conduct of higher-level comparative studies.
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Affiliation(s)
- Yicheng Li
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Li Cao
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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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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Affiliation(s)
- Etienne Massardier
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France.
| | - Paul-Henri Bauwens
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
| | - Jean-Baptiste Masson
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
| | - Frédéric Rongieras
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
| | - Antoine Bertani
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
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Bischel OE, Suda AJ, Böhm PM, Bormann T, Jäger S, Seeger JB. Breakage of Tapered Junctions of Modular Stems in Revision Total Hip Arthroplasty—High Incidence in a Consecutive Series of a Single Institution. Bioengineering (Basel) 2023; 10:bioengineering10030341. [PMID: 36978732 PMCID: PMC10044894 DOI: 10.3390/bioengineering10030341] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/15/2023] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Modularity in revision THA (RTHA) has become accepted during the last three decades. Nevertheless, specific risks of modularity of current revision devices such as breakage of taper junctions occur during follow-up. Data reporting failure rates are predominantly given by the manufacturers but independent data acquisition is missing so far. Questions/Purposes: 1. What time-related risk of breakage of taper junction between neck and body of an established modular revision device can be expected in a consecutive single institutional series and a mid-term follow-up? 2. Are there specific factors influencing breakage in this cohort? Materials and Methods: A retrospective analysis was performed of a consecutive series of 89 cases after femoral revision using a tapered modular revision stem. Mean follow-up period was 7.1 (range: 3.0–13.7) years. Breakage of stem as failure criteria of the implant was investigated with a Kaplan–Meier analysis. Results: Breakage of taper junctions occurred in four patients during follow-up showing a time-depending implant survival of 94.2 (95% CI: 88.6–100%) after 13.7 years. Implant survival of stems with lateralized necks of 87.4 (95% CI: 75.6–100%) after 13.7 years was significantly lower compared to the standard offset variant with 100% after 13.5 years (log rank test p = 0.0283). Chi square test also revealed a significantly higher risk of breakage of lateralized necks compared to standard offset pieces (p = 0.0141). Three of four patients were obese with a mean BMI of 37.9 kg/m2. Grade of obesity (grade 1 or higher) had significant influence on risk of breakage. Survival of the implant was significantly lower in obese patients with at least grade 1 obesity compared to patients with a BMI < 30 kg/m2 (82.9 (95% CI: 64.9–100%) after 11.6 years vs. 98.4 (95% CI: 95.3–100%) after 13.7 years; log-rank p = 0.0327). Conclusions: Cumulative risk for failure of taper junctions was high in this consecutive single institutional cohort and may further increase during follow-up. As independent data acquisition in registries is missing, failure rate may be higher than reported data of the manufacturers. The use of lateralized offset necks in obese patients of at least grade 1 obesity showed a significantly higher risk of breakage. The use of monobloc revision devices may be an option, but randomized control trials are currently missing to establish standardized treatment protocols considering individual risks for both monobloc and/or modular implants.
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Affiliation(s)
- Oliver E. Bischel
- Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
- Correspondence:
| | - Arnold J. Suda
- AUVA-Unfallkrankenhaus Salzburg, Dr.-Franz-Rehrl-Platz 5, 5010 Salzburg, Austria
| | - Paul M. Böhm
- General Orthopedics, Neumeyerstr. 46, 90411 Nuremberg, Germany
| | - Therese Bormann
- Department of Orthopedics and Traumatology, University of Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Sebastian Jäger
- Department of Orthopedics and Traumatology, University of Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany
| | - Jörn B. Seeger
- Kurparkklinik, Kurstr. 41-45, 61231 Bad Nauheim, Germany
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Çelen ZE, Gazi O. Distal fixation modular stem hemiarthroplasty versus proximal femoral nailing for unstable intertrochanteric fractures: a retrospective cohort study. Acta Orthop Belg 2022; 88:599-608. [PMID: 36791715 DOI: 10.52628/88.3.9875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The treatment of unstable intertrochanteric fractures (UITF) is a controversial issue in the current literature. The aim of this study was to compare the curative effects of distal fixation modular stem (DFMS) hemiarthroplasty with proximal femoral nailing (PFN) on UITFs in the elderly. From February 2017 to November 2019, 98 elderly (≥65 years) patients with UITF were included in this single-center retrospective cohort study. Mean follow-up duration was 24.1±11.9 months. Patients were divided into the DFMS group (52 patients) and the PFN group (46 patients). In the DFMS group, trochanteric fixation was performed using a trochanteric cable plate system. Primary outcome measures included Harris hip score (HHS), mobility score, implant related complications and mortality. Secondary outcome measures included hospitalization duration, surgical time and transfusion rate. Mean age of the patients was 78.7±7.2 years (65-96 years). DFMS group had longer surgical time, higher transfusion rates and longer hospital stays (p<0.05). Mean HHS was 80.7±10.5 and 81.9±12.2 in the DFMS group and PFN group, respectively. There was no statistically significant difference between the two groups in terms of HHS, mobility score and mortality. Implant failure rates were significantly higher in the PFN group (p=0.015). Implant failure, one year mortality and overall mortality rates were 0%, 15.4% and 17.3% in DFMS group and 10.9%, 15.2% and 19.5% in PFN group, respectively. Both surgical methods can be effectively used in the treatment of UITFs with similar satisfactory functional results and similar mortality rates. In addition, the DFMS group exhibited significantly lower implant failure rates and PFN group provided significantly lower surgical time duration, transfusion rate and hospital stay duration.
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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]
Abstract
Contemporary uncemented femoral revision hip systems have become commonly used over the past decade and have enabled the reconstruction of leg length, offset and anteversion as independent variables through the use of modular junctions. Modular junction failures between the proximal body and distal stem have been described with revision systems, although this is rare. We sought to identify the survivorship of one revision system in a salvage arthroplasty scenario where no host bone support of the modular junction was present. From a series of 136 patients, 15 patients (16 hips) were identified without host bone support of the modular junction with a mean radiological follow up of over 6 years (76 months +/- 35 months). There have been no cases of prosthetic fracture over the follow-up duration, with two revisions performed for reasons of aseptic loosening and infection. The mean BMI of the study group was 30.2 with 78% of the cohort classified as overweight or obese. It is well recognised that, host bone support of the modular junction is preferable, however the satisfactory outcomes over the midterm in these complex patients suggests that modular revision systems remain an option.
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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]
Abstract
BACKGROUND Revision total hip arthroplasty (THA) remains a significant challenge when there is severe femoral bone loss. The purpose of this study was to evaluate the clinical and radiographic outcomes of revision THA in patients with femoral bone loss treated with Zweymüller SLR-Plus stem. METHODS A retrospective review of 82 patients who underwent revision THA using tapered rectangular femoral stem between 1997 and 2007 was undertaken. Of the 82 patients, 9 patients were lost to follow-up and were excluded from the study. The most common reason for revision was aseptic loosening (92%), periprosthetic femur fracture (5%), and infection (3%). Bone loss was categorised preoperatively according to the Paprosky classification. The mean clinical follow-up was 14 years (range 10-19 years). Their mean age at the time of index surgery was 54.7 ± 15.3 (range 30-82) years. RESULTS The mean Harris Hip Score was significantly improved at final follow-up (68.1 ±10.3) compared with that before the revision surgery (30.4 ± 7.7) (p < 0.0001). Of the 75 stems, 69 (92%) stems were radiographically stable at the last evaluation. Among the 69 stems, 64 hips (85%) had radiographic evidence of bone ingrowth and 5 (5%) had stable fibrous fixation of the stem. Among the 7 hips that were re-revised, 5 hips were re-revised for aseptic loosening, whereas 2 were re-revised for an infection. Kaplan-Meier survivorship analysis, with removal of the stem for any cause as the endpoint, revealed that the 15-year rate of survival of the components was 90% (95% CI, 0.83-0.97). CONCLUSION Revision THA in patients with proximal femoral bone loss using Zweymüller SLR-Plus stem led to a high rate of osseointegration of the stem and good clinical results at long-term follow-up.
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Affiliation(s)
- Jian Wang
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wen-Li Dai
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ze-Ming Lin
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhan-Jun Shi
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Feng S, Zhang Y, Bao YH, Yang Z, Zha GC, Chen XY. Comparison of modular and nonmodular tapered fluted titanium stems in femoral revision hip arthroplasty: a minimum 6-year follow-up study. Sci Rep 2020; 10:13692. [PMID: 32792539 PMCID: PMC7426918 DOI: 10.1038/s41598-020-70626-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 08/02/2020] [Indexed: 12/02/2022] Open
Abstract
Both modular and nonmodular tapered fluted titanium stems are commonly used in revision total hip arthroplasty (THA). However, which type of femoral stem is superior remains controversial. The purpose of this study was to assess the clinical and radiographic outcomes of modular and nonmodular tapered fluted titanium. The clinical data of patients undergoing primary revision THA from January 2009 to January 2013 in two institutions were retrospectively analyzed. According to the type of prosthesis used on the femoral side, the patients were divided into the modular group (108 hips; Link MP modular stem in 73 hips and AK-MR modular stem in 35 hips) and nonmodular group (110 hips; Wagner SL stem in 78 hips and AK-SL stem in 32 hips). The operative time, hospital stay, blood loss, blood transfusion volume, hip function, hip pain, limb length discrepancy, imaging data, and complications were compared between the two groups.A total of 218 patients were followed up for 78–124 months, with an average of 101.5 months. The incidence of intraoperative fracture in the modular group (16.7%) was significantly higher than that in the nonmodular group (4.5%; (P < 0.05). At the last follow-up, the limb length difference in the modular group (2.3 ± 2.7 mm) was significantly lower than that in the nonmodular group (5.6 ± 3.5 mm; P < 0.05), and the postoperative prosthesis subsidence in the modular group (averaged 0.92 mm; 0–10.2 mm) was significantly less than that in the nonmodular group (averaged 2.20 mm; 0–14.7 mm; P < 0.05). Both modular and nonmodular tapered fluted titanium stems can achieve satisfactory mid-term clinical and imaging results in patients who underwent femoral revision. The modular stems have good control of lower limb length and low incidence of prosthesis subsidence.
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Affiliation(s)
- Shuo Feng
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221002, Jiangsu, China
| | - Yu Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221002, Jiangsu, China
| | - Yu-Hang Bao
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, Japan
| | - Zhi Yang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221002, Jiangsu, China
| | - Guo-Chun Zha
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221002, Jiangsu, China.
| | - Xiang-Yang Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221002, Jiangsu, China.
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Saunders PRJ, Shaw DA, Sidharthan SK, Siney PD, Young SK, Board TN. Survivorship and Radiological Analysis of a Monoblock, Hydroxyapatite-Coated Titanium Stem in Revision Hip Arthroplasty. J Arthroplasty 2020; 35:1678-1685. [PMID: 32169384 DOI: 10.1016/j.arth.2020.01.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/17/2020] [Accepted: 01/30/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We evaluated the survivorship, incidence of complications, radiological subsidence, proximal stress shielding, and patient-reported outcomes of a conservative, monoblock, hydroxyapatite-coated femoral stem. METHODS This retrospective cohort study reports on 254 revision hip arthroplasties between January 2006 and June 2016. The mean age of patients was 71 years. The mean length of follow-up was 62 months (range 12-152). RESULTS There were 13 stem re-revisions: infection (4), periprosthetic fracture (4), aseptic stem loosening (3), stem fracture (1), and extended trochanteric osteotomy nonunion (1). Kaplan-Meier aseptic stem survivorship was 97.33% (confidence interval 94-100) at 6 years. There were 29 intraoperative fractures. There were 6 cases of subsidence greater than 10 mm; however, none required revision. Ninety-six percent of cases showed no proximal stress shielding. Thigh pain was reported in 3% of cases. CONCLUSION This study confirms that this stem provides good survivorship at 6 years, acceptable complication rates, adequate proximal bone loading, low incidences of thigh pain, and reliable clinical performance in revision hip arthroplasty. KEY MESSAGE A monoblock, fully hydroxyapatite-coated titanium stem is reliable in revision arthroplasty with mild-moderate femur deficiencies.
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Affiliation(s)
- Paul R J Saunders
- Department of Orthopaedics, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom
| | - Debbie A Shaw
- Wrightington Lower Limb Unit, Wrightington Centre for Hip Surgery, Wrightington Hospital, Wigan, United Kingdom
| | - Sijin K Sidharthan
- Wrightington Lower Limb Unit, Wrightington Centre for Hip Surgery, Wrightington Hospital, Wigan, United Kingdom
| | - Paul D Siney
- Wrightington Lower Limb Unit, Wrightington Centre for Hip Surgery, Wrightington Hospital, Wigan, United Kingdom
| | - Stephen K Young
- Department of Orthopaedics, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom
| | - Tim N Board
- Wrightington Lower Limb Unit, Wrightington Centre for Hip Surgery, Wrightington Hospital, Wigan, United Kingdom
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11
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Dyreborg K, Petersen MM, Balle SS, Kjersgaard AG, Solgaard S. Observational study of a new modular femoral revision system. World J Orthop 2020; 11:167-176. [PMID: 32280606 PMCID: PMC7138861 DOI: 10.5312/wjo.v11.i3.167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/25/2020] [Accepted: 03/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The uncemented ArcosTM Modular Femoral Revision System (ARCOS) is a new comprehensive, press-fit revision design. The modular design offers a wide range of possible combinations to accommodate different variations of anatomy and bone stock. The ARCOS is made by a proximal body and a distal stem. As probably the only ones worldwide we predominantly use a combination of body and stem which supports proximal fixation and load, since this mimics the concept of the primary total hip arthroplasty with proximal weight-bearing, leading to bone stock preservation and no stress shielding or thigh pain.
AIM To evaluate the early results after femoral revision in a consecutive series of patients undergoing surgery over 3 years.
METHODS We included 116 patients in the study. They were operated in the period August 2011 to December 2014 and we got a clinical mean observation time of 4 (0.5-6) years. Clinical and radiographical follow-up included present function of the hip assessed by Harris Hip Score, Oxford Hip Score, and EQ5D (measure of health outcome). Of the 116 patients, 17 died in the interim and were consequently included only in the implant survivorship analysis; 46 patients attended the follow-up control.
RESULTS In total 6 (5%) hips were re-revised due to infection (n = 3), fracture (n = 2) or subsidence (n = 1). No patient was re-revised due to aseptic loosening. The 1-, 2- and 5-year probability of implant survival (95%CI) were 97% (93%-100%), 97% (93%-100%) and 96% (92%-99%), respectively. In this cohort 95 patients received a combination of a proximal broach and a distal curved and slotted stem (BS), aiming for proximal fixation and load bearing; 21 patients received a different combination. When comparing these two groups the BS-group had a 5-year implant survival probability (95%CI) of 97% (93%-100%) compared with the group of other combinations with a 5-year implant survival probability (95%CI) of 90% (78%-100%) (P = 0.3). Our regression analysis showed that periprosthetic fracture as an indication for the ARCOS operation was the only significant negative outcome predictor. The mean Harris Hip Score result (100 points being best) was 83 (range 5-98). The mean Oxford Hip Score result (48 points being best) was 40 (range 19-48).
CONCLUSION The early results of the ARCOS are promising compared with similar studies. We encourage the use of the BS combination whenever the bone stock proximally is adequate.
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Affiliation(s)
- Karen Dyreborg
- Department of Orthopaedic Surgery, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark
| | | | - Sidse Schwartz Balle
- Department of Diagnostic Radiology, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark
| | | | - Søren Solgaard
- Department of Orthopaedic Surgery, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark
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12
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Kildow BJ, Della-Valle CJ, Springer BD. Single vs 2-Stage Revision for the Treatment of Periprosthetic Joint Infection. J Arthroplasty 2020; 35:S24-S30. [PMID: 32046827 DOI: 10.1016/j.arth.2019.10.051] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/27/2019] [Accepted: 10/27/2019] [Indexed: 02/01/2023] Open
Abstract
Periprosthetic joint infection (PJI) is one of the most devastating complications following total joint arthroplasty, accounting for a projected 10,000 revision surgeries per year by 2030. Chronic PJI is complicated by the presence of bacterial biofilm, requiring removal of components, thorough debridement, and administration of antibiotics for effective eradication. Chronic PJI is currently managed with single-stage or 2-stage revision surgery. To date, there are no randomized, prospective studies available evaluating eradication rates and functional outcomes between the 2 techniques. In this review, both treatment options are described with the most current literature to guide effective surgical decision-making that is cost-effective while decreasing patient morbidity.
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Affiliation(s)
- Beau J Kildow
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina
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13
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Tyson Y, Rolfson O, Kärrholm J, Hailer NP, Mohaddes M. Uncemented or cemented revision stems? Analysis of 2,296 first-time hip revision arthroplasties performed due to aseptic loosening, reported to the Swedish Hip Arthroplasty Register. Acta Orthop 2019; 90:421-426. [PMID: 31154890 PMCID: PMC6746274 DOI: 10.1080/17453674.2019.1624336] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and purpose - Uncemented stems are increasingly used in revision hip arthroplasty, but only a few studies have analyzed the outcomes of uncemented and cemented revision stems in large cohorts of patients. We compared the results of uncemented and cemented revision stems. Patients and methods - 1,668 uncemented and 1,328 cemented revision stems used in first-time revisions due to aseptic loosening between 1999 and 2016 were identified in the Swedish Hip Arthroplasty Register. Kaplan-Meier analysis was used to investigate unadjusted implant survival with re-revision for any reason as the primary outcome. Hazard ratios (HR) for the risk of re-revision were calculated using a Cox regression model adjusted for sex, age, head size, concomitant cup revision, surgical approach at primary and at index revision surgery, and indication for primary total hip arthroplasty. Results - Unadjusted 10-year survival was 85% (95% CI 83-87) for uncemented and 88% (CI 86-90) for cemented revision stems. The adjusted HR for re-revision of uncemented revision stems during the first year after surgery was 1.3 (CI 1.0-1.6), from the second year the HR was 1.1 (CI 0.8-1.4). Uncemented stems were most often re-revised early due to infection and dislocation, whereas cemented stems were mostly re-revised later due to aseptic loosening. Interpretation - Both uncemented and cemented revision stems had satisfactory long-term survival but they differed in their modes of failure. Our conclusions are limited by the fact that femoral bone defect size could not be investigated within the setting of the current study.
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Affiliation(s)
- Yosef Tyson
- Section of Orthopedic Surgery, Department of Surgical Sciences, Uppsala University Hospital, Uppsala; ,The Swedish Hip Arthroplasty Register, Gothenburg; ,Correspondence:
| | - Ola Rolfson
- The Swedish Hip Arthroplasty Register, Gothenburg; ,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register, Gothenburg; ,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Nils P Hailer
- Section of Orthopedic Surgery, Department of Surgical Sciences, Uppsala University Hospital, Uppsala; ,The Swedish Hip Arthroplasty Register, Gothenburg;
| | - Maziar Mohaddes
- The Swedish Hip Arthroplasty Register, Gothenburg; ,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Mölndal, Sweden
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14
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Heinecke M, Layher F, Matziolis G. Anchoring of a Kinked Uncemented Femoral Stem after Preparation with a Straight or a Kinked Reamer. Orthop Surg 2019; 11:705-711. [PMID: 31332970 PMCID: PMC6712377 DOI: 10.1111/os.12490] [Citation(s) in RCA: 2] [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: 05/06/2018] [Revised: 08/27/2018] [Accepted: 10/03/2018] [Indexed: 01/17/2023] Open
Abstract
Objective To investigate a stem‐adjusted preparation of the femur with a kinked reamer and to determine whether this approach results in higher primary stability of a kinked stem than straight reaming of the intramedullary canal. Methods Ten cementless stems with a kinked design were implanted in synthetic femurs after preparation of the femoral canal with 2 different reamer designs (straight reaming [SR] group vs kinked reaming [KR] group). The specimens were analyzed using CT to determine the anchoring length and examined with a mechanical testing system to establish their axial stiffness, torsional stiffness, and migration distance after 10 000 gait cycles. Results The stem migration distances did not differ significantly between the groups (SR group 0.51 ± 0.16 mm vs KR group 0.36 ± 0.03 mm, P = 0.095). Only for the SR group, a correlation was found between the completely conical anchorage length and absolute stem migration (P < 0.05, R = 0.89). Regarding the torsional stiffness, no differences were observed between the study groups (SR group 6.48 ± 0.17 Nm/° vs KR group 6.52 ± 0.25 Nm/°, P = 0.398). In the KR group, significantly higher axial stiffness values were measured than in the SR group (SR group 1.68 ± 0.14 kN/mm vs KR group 2.09 ± 0.13 kN/mm, P = 0.008). Conclusions The implantation of a kinked stem after kinked conical intramedullary preparation of the proximal femur showed equivalent results regarding anchoring length, stem migration, and torsional stiffness to those for straight conical reaming. The specimens with kinked reaming showed significantly higher axial stiffness values.
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Affiliation(s)
- Markus Heinecke
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Eisenberg, Germany
| | - Frank Layher
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Eisenberg, Germany
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15
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Kenney C, Dick S, Lea J, Liu J, Ebraheim NA. A systematic review of the causes of failure of Revision Total Hip Arthroplasty. J Orthop 2019; 16:393-395. [PMID: 31110401 DOI: 10.1016/j.jor.2019.04.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/15/2019] [Indexed: 12/26/2022] Open
Abstract
This study reviewed literature published in the last 10 years to investigate the reasons for revision failure. A total of 9952 revisions were identified and it was determined that the number one cause of failure was aseptic loosening (23.19%), followed by instability (22.43%) and infection (22.13%). Further analysis of applicable revisions investigated BMI and age at the failure rates. The rate of rerevision in obese patients was markedly higher (p < 0.01) compared to non-obese patients and individuals receiving a revision THA under the age of 55 are at a higher risk of rerevision (p < 0.01).
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Affiliation(s)
- Connor Kenney
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, 43614, United States
| | - Steven Dick
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, 43614, United States
| | - Justin Lea
- University of Toledo Medical Center, Toledo, OH, 43614, United States
| | - Jiayong Liu
- University of Toledo Medical Center, Toledo, OH, 43614, United States
| | - Nabil A Ebraheim
- University of Toledo Medical Center, Toledo, OH, 43614, United States
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16
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Pelt CE, Stagg ML, Van Dine C, Anderson MB, Peters CL, Gililland JM. Early outcomes after revision total hip arthroplasty with a modern modular femoral revision stem in 65 consecutive cases. Arthroplast Today 2018; 5:106-112. [PMID: 31020033 PMCID: PMC6470366 DOI: 10.1016/j.artd.2018.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 01/22/2023] Open
Abstract
Background We evaluated the early outcomes, including all-cause revisions, aseptic revisions, and reoperations after revision total hip arthroplasty (THA) using a single modern modular femoral stem design. Methods A retrospective cohort study on a consecutive series of 62 patients (65 hips) who underwent revision THA with a modern modular femoral stem system, between January 2011 and October 2015, at a single academic medical center was performed. A cumulative incidence competing risk model was used to evaluate the cumulative incidence of failure with death as the competing risk. Results The cumulative incidence rate of all-cause revision THA was 14.5% (95% confidence interval [CI], 6%–24%) at 2 years when accounting for the competing risk of death. The rate of aseptic revisions was 6.8% (95% CI, 0.1%–13%), and the rate of all-cause reoperations was 21.6% (95% CI, 11%–31%). Ten THA cases (15%) underwent re-revision THA for any reason: five for infection and five for aseptic failures. The mean time to re-revision was 1 year (range, 0.04–5.34). Patients with a preoperative Mallory classification of 3 or more were at greater risk for reoperation (sub-hazard rate, 3.84; 95% CI, 1.54–9.53; P = .004). Conclusions Although the high incidence of reoperation illustrates the complexity of the revision THA population, particularly related to infection and joint instability, the relatively low rate of aseptic failures, minimal radiographic subsidence, and the lack of modular junctional failures suggest that the use of this modular revision THA system may provide adequate fixation and could be considered as a viable treatment option in the setting of revision THA.
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Affiliation(s)
| | | | | | | | | | - Jeremy M. Gililland
- Corresponding author. 590 Wakara Way, Salt Lake City, Utah 84108, USA. Tel.: +1 801-587-5410.
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17
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Riesgo AM, Hochfelder JP, Adler EM, Slover JD, Specht LM, Iorio R. Survivorship and Complications of Revision Total Hip Arthroplasty with a Mid-Modular Femoral Stem. J Arthroplasty 2015. [PMID: 26220105 DOI: 10.1016/j.arth.2015.06.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
We retrospectively reviewed 161 revision THAs with diaphyseal fitting, mid-modular femoral components performed by ten surgeons at two academic medical centers. The average follow-up was 6.1 years. At final follow-up, 4 patients required re-revision for failure of the femoral component; 3 (2%) for aseptic loosening and 1 for mechanical failure of stem in setting of periprosthetic fracture. There were a total of 24 (14.9%) revisions for any reason, with the most common reason being septic failure (10 of 24). To our knowledge, this is the largest reported series of mid-term survivorship and complications of revision THA with mid-modular femoral components. Our results show that these stems have a low rate of aseptic loosening, subsidence, and mechanical failure.
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Affiliation(s)
- Aldo M Riesgo
- Department of Orthopaedic Surgery, NYU Langone Medical Center-Hospital for Joint Diseases, New York, New York
| | - Jason P Hochfelder
- Department of Orthopaedic Surgery, NYU Langone Medical Center-Hospital for Joint Diseases, New York, New York
| | - Edward M Adler
- Department of Orthopaedic Surgery, NYU Langone Medical Center-Hospital for Joint Diseases, New York, New York
| | - James D Slover
- Department of Orthopaedic Surgery, NYU Langone Medical Center-Hospital for Joint Diseases, New York, New York
| | - Lawrence M Specht
- Boston University School of Medicine, Lahey Clinic Hospital & Medical Center, Burlington, Massachusetts
| | - Richard Iorio
- Department of Orthopaedic Surgery, NYU Langone Medical Center-Hospital for Joint Diseases, New York, New York
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