Medium-Term Follow-Up of a Modular Tapered Noncemented Titanium Stem in Revision Total Hip Arthroplasty A Single-Surgeon Experience
ABSTRACT We report a single-surgeon experience with a noncemented modular revision shaft (Modular Prosthesis; LINK, Hamburg, Germany) with clinical and radiographic results of 63 patients after 10 years. The Harris Hip Score improved from 51 to 84 points. Intraoperative complications included 11 fractures. Four patients had postoperative femoral fractures. Further shaft revisions were necessary: 1 subsidence, 1 late fracture, 1 late deep infection. Sixty-eight percent of cases showed revision defects as graded 3° by Mallory; 95 % did not show signs of loosening or subsidence; 38 patients showed adequate bone remodeling in the shaft and proximal femur; 21 patients showed excellent recovery of preoperative osteolytic areas, and 5 patients did not show signs of remodeling. The Modular Prosthesis stem shows adequate fixation and tendency toward satisfactory bone remodeling after 10 years.
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ABSTRACT: We report our experience of revision total hip replacement (THR) using the Revitan curved modular titanium fluted revision stem in patients with a full spectrum of proximal femoral defects. A total of 112 patients (116 revisions) with a mean age of 73.4 years (39 to 90) were included in the study. The mean follow-up was 7.5 years (5.3 to 9.1). A total of 12 patients (12 hips) died but their data were included in the survival analysis, and four patients (4 hips) were lost to follow-up. The clinical outcome, proximal bone regeneration and subsidence were assessed for 101 hips. The mean Harris Hip Score was 88.2 (45.8 to 100) after five years and there was an increase of the mean Barnett and Nordin-Score, a measure of the proximal bone regeneration, of 20.8 (-3.1 to 52.7). Five stems had to be revised (4.3%), three (2.9%) showed subsidence, five (4.3%) a dislocation and two of 85 aseptic revisions (2.3%) a periprosthetic infection. At the latest follow-up, the survival with revision of the stem as the endpoint was 95.7% (95% confidence interval 91.9% to 99.4%) and with aseptic loosening as the endpoint, was 100%. Peri-prosthetic fractures were not observed. We report excellent results with respect to subsidence, the risk of fracture, and loosening after femoral revision using a modular curved revision stem with distal cone-in-cone fixation. A successful outcome depends on careful pre-operative planning and the use of a transfemoral approach when the anatomy is distorted or a fracture is imminent, or residual cement or a partially-secured existing stem cannot be removed. The shortest appropriate stem should, in our opinion, be used and secured with > 3 cm fixation at the femoral isthmus, and distal interlocking screws should be used for additional stability when this goal cannot be realised. Cite this article: Bone Joint J 2014;96-B:889-95.07/2014; 96-B(7):889-95. DOI:10.1302/0301-620X.96B7.33280
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ABSTRACT: We retrospectively reviewed 123 patients who underwent cementless THA with modular femoral stem designs for revision THA or conversion of failed ORIF and found 75 patients available for analysis. The Harris Hip Score (HHS) improved from 52 ± 14 to 86 ± 11 (p < 0.001). The femoral stem was re-revised in eight patients (11%). The mean time to re-revision was 1.1 years (0.13 – 2.54). Reasons for re-revision included infection (n = 5, 7%), aseptic loosening (n = 2, 3%) and significant pain (n = 1, 1%). There were no failures of the modular junctions. PC stems had an increased rate of intraoperative fractures (PC 28% vs. STS 9%, p = 0.04). Modular cementless femoral stems provide acceptable mid-term results in revision THA.The Journal of arthroplasty 09/2014; 29(9). DOI:10.1016/j.arth.2014.04.042 · 2.37 Impact Factor