Revision Total Hip Arthroplasty Using the Modular Proximal Stem Modified for Asians: Medium-Term Clinical Results and Perioperative Complications

Published:January 03, 2022DOI:



      This study aimed to examine the medium-term clinical and radiological outcomes of revision THA using the S-ROM-A stem, a modification of the S-ROM stem intended for Asians.


      Femoral reconstruction using the S-ROM-A stem was performed in 126 hips that underwent revision THA. All patients were followed for perioperative complications. In addition, clinical and radiographic outcomes at a mean of 8 (range 5-14) years postoperatively were evaluated in 96 hips of 86 patients (76%).


      The most common perioperative complication was a femoral fracture, occurring in 16 hips (13%), including 11 intraoperative and 5 postoperative fractures. Dislocation occurred in five hips (4.0%), infection in three hips (2.4%), and trunnionosis in two hips (1.6%), including late complications. The total second stem revision was performed in two hips while stem only second revision preserving the bone ingrown sleeve was performed in four hips. With a second revision for aseptic loosening as the endpoint, the 13-year stem survival rate was 100%. Hip function as assessed by the Japanese Orthopedic Association score improved from a mean of 48 points preoperatively to 87 points 8 years postoperatively (P < .05). Radiological evaluation at the final follow-up showed that 95 hips (99%) achieved bone ingrowth fixation and one hip (1%) achieved fibrous stable status.


      Revision THA using the S-ROM-A stem resulted in good medium-term outcomes. Although modifications of the stem length and shape may be effective in preventing fractures in Asians with relatively small body sizes, attention should be paid to the occurrence of trunnionosis, which may be associated with the decreased taper size.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-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 to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Imbuldeniya A.M.
        • Walter W.K.
        • Zicat B.A.
        • Walter W.L.
        The S-ROM hydroxyapatite proximally-coated modular femoral stem in revision hip replacement.
        J Bone Joint Surg Am. 2014; 96: 730-736
        • Cameron H.U.
        The long-term success of modular proximal fixation stems in revision total hip arthroplasty.
        J Arthroplasty. 2002; 17: 138-141
        • William L.
        • Walter W.K.
        • Zicat B.
        Clinical and radiographic assessment of a modular cementless ingrowth femoral stem system for revision hip arthroplasty.
        J Arthroplasty. 2006; 21: 172-178
        • Christie M.J.
        • DeBoer D.K.
        • Tingstad E.M.
        • Capps M.
        • Brinson M.F.
        • Trick L.W.
        Clinical experience with a modular noncemented femoral component in revision total hip arthroplasty: 4 to 7 year results.
        J Arthroplasty. 2000; 15: 840
        • Chandler H.P.
        • Ayres D.K.
        • Tan R.C.
        • Anderson L.C.
        • Varma A.K.
        Revision total hip replacement using the S-ROM femoral component.
        Clin Orthop Relat Res. 1995; 319: 130
        • McCarthy J.C.
        • Mattingly D.
        • Turner R.H.
        • Bierbaum B.
        • Chandler H.P.
        • Cameron H.U.
        Revision of the deficient femur with a modular femoral component.
        Orthop Trans. 1993; 17: 966
        • Iorio R.
        • Healy W.L.
        • Presutti A.H.
        A prospective outcomes analysis of femoral component fixation in revision total hip arthroplasty.
        J Arthroplasty. 2008; 23: 662-669
        • Bolognesi M.P.
        • Pietrobon R.
        • Clifford P.E.
        • Vali T.P.
        Comparison of a hydroxyapatite-coated sleeve with a modular revision hip stem: a prospective, randomized study.
        J Bone Joint Surg Am. 2004; 86: 2720-2725
        • Kido K.
        • Fujioka M.
        • Takahashi K.
        • Ueshima K.
        • Goto T.
        • Kubo T.
        Short-term results of the S-ROM-A femoral prosthesis operative strategies for Asian patients with osteoarthritis.
        J Arthroplasty. 2009; 24: 1193-1199
        • Sato A.
        • Okuda N.
        • Tsukada S.
        • Kimura A.
        • Kase M.
        • Matsubara M.
        Midterm outcomes and frequency of osteolysis of total hip arthroplasty using cementless modular stem for Asian patients.
        J Arthroplasty. 2020; 35: 811-817
        • Tamegai H.
        • Otani T.
        • Fujii H.
        • Kawaguchi Y.
        • Hayama T.
        • Marumo K.
        A modified S-ROM stem in primary total hip arthroplasty for developmental dysplasia of the hip.
        J Arthroplasty. 2013; 28: 1741-1745
        • Paprosky W.G.
        • Greidanus N.V.
        • Antoniou J.
        Minimum10-year-results of extensively porous-coated stems in revision hip arthroplasty.
        Clin Orthop Relat Res. 1999; 369: 230-242
        • Ogawa R.
        • Imura S.
        Evaluation chart of hip joint functions.
        Nippon Seikeigeka Gakkai Zasshi. 1995; 69: 860
        • Kaplan E.L.
        • Meier P.
        Nonparametric estimation from incomplete observations.
        J Am Stat Assoc. 1958; 53: 457-481
        • Engh C.A.
        • Bobyn J.D.
        • Glassman A.H.
        Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results.
        J Bone Joint Surg Am. 1987; 69: 45-55
        • Engh C.A.
        • Massin P.
        • Suthers K.E.
        Roentgenographic assessment of the biologic fixation of porous-surface femoral components.
        Clin Orthop Relat Res. 1990; 257: 107-128
        • Biant L.C.
        • Bruce W.J.
        • Assini J.B.
        • Walker P.M.
        • Walsh W.R.
        The anatomically difficult primary total hip replacement: medium-to long-term results using a cementless modular stem.
        J Bone Joint Surg Br. 2008; 90: 430-435
        • Gruen T.A.
        • McNeice G.M.
        • Amstutz H.C.
        ‘Modes of failure’ of cemented stem-type femoral components: a radiographic analysis of loosening.
        Clin Orthop Relat Res. 1979; 141: 17-27
        • Kobayashi K.
        • Kidera K.
        • Itose M.
        • Motokawa T.
        • Chiba K.
        • Osaki M.
        Higher incidence of aseptic loosening caused by a lower canal filling ratio with a modified modular stem in total hip arthroplasty.
        J Orthop Surg. 2020; 15: 568
        • Christie M.J.
        • DeBoer D.K.
        • Trick L.W.
        • Brothers J.C.
        • Jones R.E.
        • Vise G.T.
        • et al.
        Primary total hip arthroplasty with use of the modular S-ROM prosthesis. Four to seven-year clinical and radiographic results.
        J Bone Joint Surg Am. 1999; 81: 1707-1716
        • Brooker A.F.
        • Bowerman J.W.
        • Robinson R.A.
        • Riley Jr., L.H.
        Ectopic ossification following total hip replacement. Incidence and a method of classification.
        J Bone Joint Surg Am. 1973; 55-A: 1629-1632
        • Langton D.J.
        • Jameson S.S.
        • Joyce T.J.
        • Hallab N.J.
        • Natu S.
        • Nargol A.V.
        Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: a consequence of excess wear.
        J Bone Joint Surg Br. 2010; 92: 38-46
        • Davies A.P.
        • Willert H.G.
        • Campbell P.A.
        • Learmonth I.D.
        • Case C.P.
        An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements.
        J Bone Joint Surg Am. 2005; 87: 18-27
        • Esposito C.I.
        • Wright T.M.
        • Goodman S.B.
        • Berry D.J.
        What is the trouble with trunnions?.
        Clin Orthop Relat Res. 2014; 472: 3652-3658
        • Kop A.M.
        • Keogh C.
        • Swarts E.
        Proximal component modularity in THA-at what cost? An implant retrieval study.
        Clin Orthop Relat Res. 2012; 470: 1885
        • Berstock J.R.
        • Whitehouse M.R.
        • Duncan C.P.
        Trunnion corrosion: what surgeons need to know in 2018.
        Bone Joint J. 2018; 100–B: 44-49
        • Matsen Ko L.
        • Chen A.F.
        • Deirmengian G.K.
        • Hozack W.J.
        • Sharkey P.F.
        Catastrophic femoral head-stem trunnion dissociation secondary to corrosion.
        J Bone Joint Surg Am. 2016; 98-A: 1400-1404
        • Langton D.J.
        • Sidaginamale R.
        • Lord J.K.
        • Nargol A.V.
        • Joyce T.J.
        Taper junction fail ure in large-diameter metal-on-metal bearings.
        Bone Joint Res. 2012; 1: 56-63
        • Hussenbocus S.
        • Kosuge D.
        • Solomon L.B.
        • Howie D.W.
        • Oskouei R.H.
        Head-neck taper corrosion in hip arthroplasty.
        Biomed Res Int. 2015; 2015: 758123
        • Bolland B.J.
        • Culliford D.J.
        • Langton D.J.
        • Millington J.P.
        • Arden N.K.
        • Latham J.M.
        High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis.
        J Bone Joint Surg Br. 2011; 93-B: 608-615
        • Lavernia C.J.
        • Iacobelli D.A.
        • Villa J.M.
        • Jones K.
        • Gonzalez J.L.
        • Jones W.K.
        Trunnion-head stresses in THA: are big heads trouble?.
        J Arthroplasty. 2015; 30: 1085-1088
        • Goldberg J.R.
        • Gilbert J.L.
        • Jacobs J.J.
        • Bauer T.W.
        • Paprosky W.
        • Leurgans S.
        A multicentre retrieval study of the taper interfaces of modular hip prostheses.
        Clin Orthop Relat Res. 2002; 401: 149-161
        • Hothi H.S.
        • Matthies A.K.
        • Berber R.
        • Whittaker R.K.
        • Skinner J.A.
        • Hart A.J.
        The reliability of a scoring system for corrosion and fretting, and its relationship to material loss of tapered, modular junctions of retrieved hip implant.
        J Arthroplasty. 2014; 29: 1313-1317
        • Higgs G.B.
        • Hanzlik J.A.
        • MacDonald D.W.
        • Gilbert J.L.
        • Rimnac C.M.
        • Kurtz S.M.
        Is increased modularity associated with increased fretting and corrosion damage in metal-on-metal total hip arthroplasty devices?: a retrieval study.
        J Arthroplasty. 2013; 28: 2-6