Abstract
Background
We describe the intraoperative parameters that affect stem subsidence rates in tapered
modular femoral stems for revision total hip arthroplasty (THA). We also determine
the effect of the stem bicortical contact on subsidence rates and whether there is
a minimum threshold bicortical contact that must be achieved to avoid the complication
of subsidence.
Methods
This is a retrospective cohort study consisting of 109 hips in 105 patients (53 males
and 52 females) at a minimum of 2 years of follow-up. All revisions were carried out
for Paprosky type 3A and 3B femoral deficits. Clinical outcomes included the indication
for revision, aseptic re-revision surgery, specifications of the stem inserted, and
specifications of the femoral head and acetabular components implanted. Radiographic
outcome measures included subsidence (mm) and bicortical contact (mm).
Results
Using multivariate regression analysis, 3 parameters were associated with an increased
rate of stem subsidence. A reduced bicortical contact distance (P < .001) and a stem length of ≤155 mm (P < .001) were both associated with higher subsidence rates. We also demonstrated a
novel threshold of 20-mm bicortical contact which must be achieved to significantly
reduce subsidence rates in these modular femoral stems for revision THA.
Conclusion
Subsidence rates of modular tapered femoral stems for revision THA can be significantly
reduced by increasing the initial bicortical contact of the stem within the diaphysis
and the overall length of the femoral stem >155 mm. We describe a minimum threshold
bicortical contact distance of 20 mm that should ideally be exceeded to significantly
reduce the risk of stem subsidence within the femoral canal.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic and PersonalCorporate R&D ProfessionalsOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of ArthroplastyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Reconstruction of major segmental loss of the proximal femur in revision total hip arthroplasty.Clin Orthop Relat Res. 1994; 298: 67-74
- Custom-made segmental femoral replacement prosthesis in revision total hip arthroplasty.Orthop Clin North Am. 1993; 24: 727-733
- [The value of the Wagner SL revision prosthesis for bridging large femoral defects].Orthopade. 2001; 30: 294-303
- Revision total hip arthroplasty. Long-term results without cement.Orthop Clin North Am. 1993; 24: 635-644
- A comparison of modular tapered versus modular cylindrical stems for complex femoral revisions.J Arthroplasty. 2013; 28: 71-73
- The use of tapered stems for femoral revision surgery.Clin Orthop Relat Res. 2004; : 148-159
- The use of femoral struts and impacted cancellous bone allograft in patients with severe femoral bone loss who undergo revision total hip replacement: a three- to nine-year follow-up.J Bone Joint Surg Br. 2012; 94: 167-172
- Minimal 11-year follow-up of extensively porous-coated stems in femoral revision total hip arthroplasty.J Arthroplasty. 2002; 17: 134-137
- Five- to 10-year results using a noncemented modular revision stem without bone grafting.J Arthroplasty. 2008; 23: 964-970
- A distal fluted, proximal modular femoral prosthesis in revision hip arthroplasty.J Arthroplasty. 2010; 25: 932-938
- Three-to 7-year results with the uncemented SL femoral revision prosthesis.Arch Orthop Trauma Surg. 1997; 116: 187-197
- Revision total hip arthroplasty using a modular tapered stem with distal fixation: good short-term results in 125 revisions.J Arthroplasty. 2010; 25: 348-354
- Leg-length discrepancy after total hip replacement.Hip Int. 1997; 7: 121
- Bypass fixation.Orthop Clin North Am. 1998; 29: 319-329
- Effect of distal stem geometry on interface motion in uncemented revision total hip prostheses.Am J Orthop (Belle Mead NJ). 2007; 36: 545-549
- Revision total hip arthroplasty: the limits of fully coated stems.Clin Orthop Relat Res. 2003; : 203-209
- Risk factors for subsidence of a modular tapered femoral stem used for revision total hip arthroplasty.J Arthroplasty. 2015; 30: 1030-1034
- Revision total hip arthroplasty using a fluted and tapered modular distal fixation stem with and without extended trochanteric osteotomy.J Arthroplasty. 2007; 22: 993-999
- Results of revision total hip arthroplasty with modular, titanium-tapered femoral stems in severe proximal metaphyseal and diaphyseal bone loss.J Arthroplasty. 2013; 28: 690-694
- A modular distal fixation option for proximal bone loss in revision total hip arthroplasty: a 2- to 6-year follow-up study.J Arthroplasty. 2003; 18: 94-97
- Full weight bearing after non-cemented total hip replacement is compatible with satisfactory results.Int Orthop. 2003; 27: 94-97
- Implant migration after early weightbearing in cementless hip replacement.Clin Orthop Relat Res. 2005; : 132-137
- Modular fluted tapered stems in aseptic revision total hip arthroplasty.J Bone Joint Surg Am. 2017; 99: 873-881https://doi.org/10.2106/JBJS.16.00423
Article Info
Publication History
Published online: April 01, 2020
Accepted:
March 26,
2020
Received in revised form:
March 18,
2020
Received:
February 9,
2020
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2020.03.047.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
