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Long-Term Outcomes of Revision Total Hip Arthroplasty Using a Tapered and Fluted Modular Stem: A Mean Follow-Up of 16 Years

      Abstract

      Background

      Tapered modular stems are increasingly used in revision total hip arthroplasty (THA) with deficient femoral bone stock. This study aimed to report the long-term outcomes of revision THA using a tapered and fluted modular stem.

      Methods

      Between December 1998 and February 2006, 113 revision THAs (110 patients) were performed with a tapered and fluted modular stem at a single institution. Hip radiographs were used to identify stem subsidence, stability, and femoral radiolucency. Final outcomes were assessed in 72 hips (70 patients), with a minimum follow-up of 10 years.

      Results

      The mean follow-up duration was 16 years (range, 10-23). At the final evaluation, the Harris Hip Score improved from a mean of 41 points (range, 10-72) preoperatively to 83 points (range, 56-100) (P < .001). Six femoral re-revisions were performed for the following reasons: 1 aseptic loosening, 2 stem fractures, and 3 infections. One stem fracture occurred at the modular junction after 14 years, and the other at a more distal location after 15 years. Stem subsidence was >5 mm in 6 hips (9.1%), but secondary stability was achieved in all stems. Osseointegration was observed in 63 (95.5%) hips. Stem survivorship was 91.1% with an end point of any re-revision and 94.6% for aseptic re-revision.

      Conclusion

      A tapered and fluted modular stem demonstrated excellent implant survivorship with reliable bony fixation at a mean follow-up of 16 years. This type of stem can be a durable option for revision THA in patients who have femoral defects.

      Keywords

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      References

        • Kurtz S.M.
        • Ong K.L.
        • Lau E.
        • Bozic K.J.
        Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021.
        J Bone Joint Surg Am. 2014; 96: 624-630
        • Rajaee S.S.
        • Campbell J.C.
        • Mirocha J.
        • Paiement G.D.
        Increasing burden of total hip arthroplasty revisions in patients between 45 and 64 years of age.
        J Bone Joint Surg Am. 2018; 100: 449-458
        • Jibodh S.R.
        • Schwarzkopf R.
        • Anthony S.G.
        • Malchau H.
        • Dempsey K.E.
        • Estok 2nd, D.M.
        Revision hip arthroplasty with a modular cementless stem: mid-term follow up.
        J Arthroplasty. 2013; 28: 1167-1172
        • Van Houwelingen A.P.
        • Duncan C.P.
        • Masri B.A.
        • Greidanus N.V.
        • Garbuz D.S.
        High survival of modular tapered stems for proximal femoral bone defects at 5 to 10 years followup.
        Clin Orthop Relat Res. 2013; 471: 454-462
        • Konan S.
        • Garbuz D.S.
        • Masri B.A.
        • Duncan C.P.
        Modular tapered titanium stems in revision arthroplasty of the hip: the risk and causes of stem fracture.
        Bone Joint J. 2016; 98-b: 50-53
        • Weeden S.H.
        • Paprosky W.G.
        Minimal 11-year follow-up of extensively porous-coated stems in femoral revision total hip arthroplasty.
        J Arthroplasty. 2002; 17: 134-137
        • Sheth N.P.
        • Nelson C.L.
        • Paprosky W.G.
        Femoral bone loss in revision total hip arthroplasty: evaluation and management.
        J Am Acad Orthop Surg. 2013; 21: 601-612
        • Park Y.S.
        • Moon Y.W.
        • Lim S.J.
        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
        • Hellman M.D.
        • Kearns S.M.
        • Bohl D.D.
        • Haughom B.D.
        • Levine B.R.
        Revision total hip arthroplasty with a monoblock splined tapered grit-blasted titanium stem.
        J Arthroplasty. 2017; 32: 3698-3703
        • Sandiford N.A.
        • Garbuz D.S.
        • Masri B.A.
        • Duncan C.P.
        Nonmodular tapered fluted titanium stems osseointegrate reliably at short term in revision THAs.
        Clin Orthop Relat Res. 2017; 475: 186-192
        • Meek R.M.
        • Garbuz D.S.
        • Masri B.A.
        • Greidanus N.V.
        • Duncan C.P.
        Intraoperative fracture of the femur in revision total hip arthroplasty with a diaphyseal fitting stem.
        J Bone Joint Surg Am. 2004; 86: 480-485
        • DeRogatis M.J.
        • Wintermeyer E.
        • Sperring T.R.
        • Issack P.S.
        Modular fluted titanium stems in revision hip arthroplasty.
        J Bone Joint Surg Am. 2019; 101: 745-754
        • Park C.W.
        • Lim S.J.
        • Park Y.S.
        Modular stems: advantages and current role in primary total hip arthroplasty.
        Hip Pelvis. 2018; 30: 147-155
        • Amanatullah D.F.
        • Howard J.L.
        • Siman H.
        • Trousdale R.T.
        • Mabry T.M.
        • Berry D.J.
        Revision total hip arthroplasty in patients with extensive proximal femoral bone loss using a fluted tapered modular femoral component.
        Bone Joint J. 2015; 97-b: 312-317
        • Otero J.E.
        • Martin J.R.
        • Rowe T.M.
        • Odum S.M.
        • Mason J.B.
        Radiographic and clinical outcomes of modular tapered fluted stems for femoral revision for Paprosky III and IV femoral defects or Vancouver B2 and B3 femoral fractures.
        J Arthroplasty. 2020; 35: 1069-1073
        • Brown N.M.
        • Tetreault M.
        • Cipriano C.A.
        • Della Valle C.J.
        • Paprosky W.
        • Sporer S.
        Modular tapered implants for severe femoral bone loss in THA: reliable osseointegration but frequent complications.
        Clin Orthop Relat Res. 2015; 473: 555-560
        • Sporer S.M.
        • Paprosky W.G.
        Revision total hip arthroplasty: the limits of fully coated stems.
        Clin Orthop Relat Res. 2003; 417: 203-209
        • Huddleston 3rd, J.I.
        • Tetreault M.W.
        • Yu M.
        • Bedair H.
        • Hansen V.J.
        • Choi H.R.
        • et al.
        Is there a benefit to modularity in ‘simpler’ femoral revisions?.
        Clin Orthop Relat Res. 2016; 474: 415-420
        • Rueckl K.
        • Sculco P.K.
        • Berliner J.
        • Cross M.B.
        • Koch C.
        • Boettner F.
        Fracture risk of tapered modular revision stems: a failure analysis.
        Arthroplast Today. 2018; 4: 300-305
        • Zheng K.
        • Li N.
        • Zhang W.
        • Zhu Y.
        • Zhou J.
        • Xu Y.
        • et al.
        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
        • Kang J.S.
        • Na Y.
        • Ko B.S.
        • Jeon Y.S.
        Clinical outcomes and survival rate of cementless modular distal fixation femoral stem for revision hip arthroplasty: a minimum 6-year follow-up.
        J Orthop Surg (Hong Kong). 2018; 26 (2309499018812241)
        • Jayasinghe G.
        • Buckle C.
        • Maling L.C.
        • To C.
        • Anibueze C.
        • Vinayakam P.
        • et al.
        Medium term radiographic and clinical outcomes using a modular tapered hip revision implant.
        Arthroplast Today. 2021; 8: 181-187
        • Perticarini L.
        • Rossi S.M.P.
        • Fioruzzi A.
        • Jannelli E.
        • Mosconi M.
        • Benazzo F.
        Modular tapered conical revision stem in hip revision surgery: mid- term results.
        BMC Musculoskelet Disord. 2021; 22: 29
        • Duncan C.P.
        • Masri B.A.
        Fractures of the femur after hip replacement.
        Instr Course Lect. 1995; 44: 293-304
        • 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 Br. 1987; 69: 45-55
        • 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
        • Park C.W.
        • Lim S.J.
        • Ye D.H.
        • Park Y.S.
        Outcomes of cerclage cabling for intraoperative calcar cracks in cementless total hip arthroplasty using broach-only, tapered wedge stems.
        J Arthroplasty. 2020; 35: 3002-3009
        • Engh C.A.
        • Glassman A.H.
        • Griffin W.L.
        • Mayer J.G.
        Results of cementless revision for failed cemented total hip arthroplasty.
        Clin Orthop Relat Res. 1988; 235: 91-110
        • Cabanela M.E.
        • Trousdale R.T.
        • Berry D.J.
        Impacted cancellous graft plus cement in hip revision.
        Clin Orthop Relat Res. 2003; 417: 175-182
        • Lawrence J.M.
        • Engh C.A.
        • Macalino G.E.
        • Lauro G.R.
        Outcome of revision hip arthroplasty done without cement.
        J Bone Joint Surg Am. 1994; 76: 965-973
        • Böhm P.
        • Bischel O.
        The use of tapered stems for femoral revision surgery.
        Clin Orthop Relat Res. 2004; 420: 148-159
        • Egan K.J.
        • Di Cesare P.E.
        Intraoperative complications of revision hip arthroplasty using a fully porous-coated straight cobalt-chrome femoral stem.
        J Arthroplasty. 1995; 10: S45-S51
        • Lakstein D.
        • Eliaz N.
        • Levi O.
        • Backstein D.
        • Kosashvili Y.
        • Safir O.
        • et al.
        Fracture of cementless femoral stems at the mid-stem junction in modular revision hip arthroplasty systems.
        J Bone Joint Surg Am. 2011; 93: 57-65
        • Azzam K.A.
        • Austin M.S.
        • Sharkey P.F.
        Early failure of a nonmodular titanium femoral stem after primary hip arthroplasty.
        J Arthroplasty. 2010; 25: 333.e1-333.e5
        • Harvie P.
        • Haroon M.
        • Henderson N.
        • El-Guindi M.
        Fracture of the hydroxyapatite-ceramic-coated JRI-Furlong femoral component: body mass index and implications for selection of the implant.
        J Bone Joint Surg Br. 2007; 89: 742-745
        • Tangsataporn S.
        • Safir O.A.
        • Vincent A.D.
        • Abdelbary H.
        • Gross A.E.
        • Kuzyk P.R.
        Risk factors for subsidence of a modular tapered femoral stem used for revision total hip arthroplasty.
        J Arthroplasty. 2015; 30: 1030-1034
        • Langlais F.L.
        • Ropars M.
        • Gaucher F.
        • Musset T.
        • Chaix O.
        Dual mobility cemented cups have low dislocation rates in THA revisions.
        Clin Orthop Relat Res. 2008; 466: 389-395
        • Charissoux J.L.
        • Asloum Y.
        • Marcheix P.S.
        Surgical management of recurrent dislocation after total hip arthroplasty.
        Orthop Traumatol Surg Res. 2014; 100: S25-S34
        • Regis D.
        • Sandri A.
        • Bartolozzi P.
        Stem modularity alone is not effective in reducing dislocation rate in hip revision surgery.
        J Orthop Traumatol. 2009; 10: 167-171
        • Chung Y.Y.
        • Lee S.M.
        • Baek S.N.
        • Park T.G.
        Direct Anterior Approach for Total Hip Arthroplasty in the Elderly with Femoral Neck fractures: Comparison with Conventional Posterolateral Approach.
        Clin Orthop Surg. 2022; 14: 35-40
        • Brown N.M.
        • McDonald 3rd, J.F.
        • Sershon R.A.
        • Hopper Jr., R.H.
        The Effect of Intraoperative Radiographs on Component Position and Leg Length during Routine Posterior Approach Total Hip Arthroplasty.
        Hip Pelvis. 2021; 33: 128-139
        • Park C.W.
        • Lim S.J.
        • Kim I.S.
        • Jang M.C.
        • Moon Y.W.
        • Park Y.S.
        Outcomes of revision total hip arthroplasty using the modular dual mobility acetabular system to treat recurrent dislocation.
        Int Orthop. 2022; 46: 789-795