Modular Fluted Tapered Stems in Revision Total Hip Arthroplasty. Multicenter Study. Medium-term Results and Complication Rate
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Published:
Apr 14, 2021
Keywords:
Hip joint, arthroplasty, hip replacement, femur, prosthesis failure
Main Article Content
Abstract
Background: The number of arthroplasties performed every year is increasing; therefore, a greater number of revisions is expected in the coming decades. Modular fluted tapered stems have become the gold standard for their results in different series of patients. The objective of this article is to evaluate the results, complications and the survival rate of these stems in hip revisions with a medium-term follow-up.
Materials and Methods: Retrospective, multicenter analysis. One hundred eighty-two patients who had undergone hip revision surgery between 2007 and 2017 were included. One hundred eighty-five modular fluted tapered stems were placed. Femoral bone stock defects were classified according to Paprosky and Burnett; and periprosthetic femur fractures according to Vancouver classification. Patients were evaluated clinically with Harris Hip Score (HHS) and radiographically 3 months after surgery and every year to assess stem stability, subsidence and loosening, as well as osteotomy healing.
Results: Average follow-up was 55.18 months. Postoperative HHS had an average of 80.28 (SD = 12.8, 95% CI = [78.5, 82.97]). There were no postoperative complications in 75.4% of the patients. The most frequent complications were instability in 7.6% and implant subsidence in 11.5%. At the end of the follow-up, 95.05% of the patients had a stable implant.
Conclusion: Modular fluted tapered stems provide a reliable, reproducible solution for the management of femoral component revisions at medium-term.
Level of Evidence: IV
Materials and Methods: Retrospective, multicenter analysis. One hundred eighty-two patients who had undergone hip revision surgery between 2007 and 2017 were included. One hundred eighty-five modular fluted tapered stems were placed. Femoral bone stock defects were classified according to Paprosky and Burnett; and periprosthetic femur fractures according to Vancouver classification. Patients were evaluated clinically with Harris Hip Score (HHS) and radiographically 3 months after surgery and every year to assess stem stability, subsidence and loosening, as well as osteotomy healing.
Results: Average follow-up was 55.18 months. Postoperative HHS had an average of 80.28 (SD = 12.8, 95% CI = [78.5, 82.97]). There were no postoperative complications in 75.4% of the patients. The most frequent complications were instability in 7.6% and implant subsidence in 11.5%. At the end of the follow-up, 95.05% of the patients had a stable implant.
Conclusion: Modular fluted tapered stems provide a reliable, reproducible solution for the management of femoral component revisions at medium-term.
Level of Evidence: IV
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How to Cite
Iglesias, S. L., Vanoli, F., Pérez Alamino, L., Pioli, I., Gómez, J., Lopreite, F. A., Maletti, P., del Sel, H., & Allende, B. L. (2021). Modular Fluted Tapered Stems in Revision Total Hip Arthroplasty. Multicenter Study. Medium-term Results and Complication Rate. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(2), 197-206. https://doi.org/10.15417/issn.1852-7434.2021.86.2.1118
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Clinical Research
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References
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United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
2. Gie GA, Linder L, Ling RS, Simon JP, Slooff TJ, Timperley AJ. Impacted cancellous allografts and cement for
revision total hip arthroplasty. J Bone Joint Surg Br 1993;75(1):14-21. https://doi.org/10.1302/0301-620X.75B1.8421012
3. Engh CA, Glassman AH, Griffin WL, Mayer JG. Results of cementless revision for failed cemented total hip
arthroplasty. Clin Orthop Relat Res 1988;(235):91-110. PMID: 3416544
4. Krishnamurthy AB, MacDonald SJ, Paprosky WG. 5- to 13-year follow-up study on cementless femoral
components in revision surgery. J Arthroplasty 1997;12(8):839-47. https://doi.org/10.1016/s0883-5403(97)90152-2
5. Lawrence JM, Engh CA, Macalino GE, Lauro GR. Outcome of revision hip arthroplasty done without cement. J
Bone Joint Surg 1994;76(7):965-73. https://doi.org/10.2106/00004623-199407000-00002
6. Wimmer MD, Randau TM, Deml MC, Ascherl R, Nöth U, Forst R, et al. Impaction grafting in the femur in
cementless modular revision total hip arthroplasty: a descriptive outcome analysis of 243 cases with the MRPTITAN revision implant. BMC Musculoskelet Disord 2013;14(1):19. https://doi.org/10.1186/1471-2474-14-19
7. Oshima S, Yasunaga Y, Yamasaki T, Yoshida T, Hori J, Ochi M. Midterm results of femoral impaction bone grafting with an allograft combined with hydroxyapatite in revision total hip arthroplasty. J Arthroplasty 2012;27(3):470-6. https://doi.org/10.1016/j.arth.2011.07.012
8. Ten Have BLEF, Brouwer MD RW, van Biezen FC, Verhaar JAN. Femoral revision surgery with impaction bone
grafting: 31 hips followed prospectively for ten to 15 years. J Bone Joint Surg Br 2012;94(5):615-8.
https://doi.org/10.1302/0301-620X.94B5.27909
9. Mulroy WF, Harris WH. Revision total hip arthroplasty with use of so-called second-generation cementing
techniques for aseptic loosening of the femoral component. A fifteen-year-average follow-up study. J Bone Joint
Surg 1996;78(3):325-30. https://doi.org/10.2106/00004623-199603000-00002
10. Davis CM, Berry DJ, Harmsen WS. Cemented revision of failed uncemented femoral components of total hip
arthroplasty. J Bone Joint Surg Am 2003;85(7):1264-9. https://doi.org/10.2106/00004623-200307000-00012
11. Lin Min, Jing Peng, Hong Duan, Wenli Zhang, Yong Zhou, Chongqi Tu. Uncemented allograft-prosthetic composite reconstruction of the proximal femur. Indian J Orthop 2014;48(3):289-95. https://doi.org/10.4103/0019-5413.132521
12. Mayle Jr RE, Paprosky WG. Massive bone loss: Allograft-prosthetic composites and beyond. J Bone Joint Surg Br 2012;94(11 Suppl A):61-4. https://doi.org/10.1302/0301-620X.94B11.30791
13. Kato T, Otani T, Sugiyama H, Hayama T, Katsumata S, Marumo K. Cementless total hip arthroplasty in hip
dysplasia with an extensively porous-coated cylindrical stem modified for Asians: A 12-year follow-up study. J
Arthroplasty 2015;30(6):1014-8. https://doi.org/10.1016/j.arth.2015.01.033
14. Shen B, Huang Q, Yang J, Zhou Z, Kang P, Pei F. Extensively coated non-modular stem used in two-stage revision for infected total hip arthroplasty: Mid-term to long-term follow-up: non-modular stem for infected THA. Orthop Surg 2014;6(2):103-9. https://doi.org/10.1111/os.12107
15. Thomsen PB, Jensen NJF, Kampmann J, Hansen TB. Revision hip arthroplasty with an extensively porous-coated stem - Excellent long-term results also in severe femoral bone stock loss. Hip Int 2013;23(4):352-8.
https://doi.org/10.5301/hipint.5000032
16. Abdel MP, Lewallen DG, Berry DJ. Periprosthetic femur fractures treated with modular fluted, tapered stems. Clin Orthop Relat Res 2014;472(2):599-603. https://doi.org/10.1007/s11999-013-2936-4
17. Van Houwelingen AP, Duncan CP, Masri BA, Greidanus NV, Garbuz DS. High survival of modular tapered stems for proximal femoral bone defects at 5 to 10 years followup. Clin Orthop Relat Res 2013;471(2):454-62.
https://doi.org/10.1007/s11999-012-2552-8
18. Amanatullah DF, Howard JL, Siman H, Trousdale RT, Mabry TM, Berry DJ. Revision total hip arthroplasty in
patients with extensive proximal femoral bone loss using a fluted tapered modular femoral component. Bone Joint J Br 2015;97(3):312-7. https://doi.org/10.1302/0301-620X.97B3.34684
19. Rodriguez JA, Deshmukh AJ, Robinson J, Cornell CN, Rasquinha VJ, Ranawat AS, et al. Reproducible fixation
with a tapered, fluted, modular, titanium stem in revision hip arthroplasty at 8–15 years follow-up. J Arthroplasty
2014;29(9):214-8. https://doi.org/10.1016/j.arth.2013.12.035
20. Munro JT, Garbuz DS, Masri BA, Duncan CP. Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures. Clin Orthop Relat Res 2014;472(2):590-8. https://doi.org/10.1007/s11999-013-3087-3
21. Abdel MP. CORR Insights®: Can a conical implant successfully address complex anatomy in primary THA?
Radiographs and hip scores at early followup. Clin Orthop Relat Res 2016;474(2):465-6. https://doi.org/10.1007/s11999-015-4530-4
22. Park M-S, Lee J-H, Park J-H, Ham D-H, Rhee Y-K. A distal fluted, proximal modular femoral prosthesis in revision hip arthroplasty. J Arthroplasty 2010;25(6):932-8. https://doi.org/10.1016/j.arth.2009.06.031
23. Sculco PK, Abdel MP, Hanssen AD, Lewallen DG. The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment. Bone Joint J 2016;98-B(1 Suppl A):120-4. https://doi.org/10.1302/0301-620X.98B1.36345
24. Paprosky WG, Burnett RSJ. Assessment and classification of bone stock deficiency in revision total hip arthroplasty. Am J Orthop (Belle Mead NJ) 2002;31(8):459-64. PMID: 12216969
25. Ling RS, Timperley AJ, Linder L. Histology of cancellous impaction grafting in the femur. A case report. J Bone
Joint Surg Br 1993;75(5):693-6. https://doi.org/10.1302/0301-620X.75B5.8376422
26. Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect 1995;44:293-304.
PMID: 7797866
27. Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD Jr, Ranawat CS. Results of revision for mechanical failure after
cemented total hip replacement. 1979 to 1982. A two to five-year follow-up. J Bone Joint Surg Am 1985;67:1074-
85. PMID: 4030826
28. Park M-S, Lim Y-J, Chung W-C, Ham D-H, Lee S-H. Management of periprosthetic femur fractures treated with
distal fixation using a modular femoral stem using an anterolateral approach. J Arthroplasty 2009;24(8):1270-6.
https://doi.org/10.1016/j.arth.2009.07.013
29. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51(4):737-55. PMID: 5783851
30. Fink B, Urbansky K, Schuster P. Mid term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement. Bone Joint J 2014;96-B(7):889-95.
https://doi.org/10.1302/0301-620X.96B7.33280
31. Abdel MP, Cottino U, Larson DR, Hanssen AD, Lewallen DG, Berry DJ. Modular fluted tapered stems in aseptic
revision total hip arthroplasty. J Bone Joint Surg 2017;99(10):873-81. https://doi.org/10.2106/JBJS.16.00423
32. Garcia-Cimbrelo E, Garcia-Rey E, Cruz-Pardos A, Madero R. Stress-shielding of the proximal femur using an
extensively porous-coated femoral component without allograft in revision surgery: a 5- to 17-year follow-up study. J Bone Joint Surg Br 2010;92(10):1363-9. https://doi.org/10.1302/0301-620X.92B10.24317
33. Klauser W, Bangert Y, Lubinus P, Kendoff D. Medium-term follow-up of a modular tapered noncemented titanium stem in revision total hip arthroplasty: a single-surgeon experience. J Arthroplasty 2013;28(1):84-9.
https://doi.org/10.1016/j.arth.2012.07.001
34. Huang Y, Shao H, Zhou Y, Gu J, Tang H, Yang D. Femoral bone remodeling in revision total hip arthroplasty with use of modular compared with monoblock tapered fluted titanium stems: the role of stem length and stiffness. J Bone Joint Surg Am 2019;101(6):531-8. https://doi.org/10.2106/JBJS.18.00442
35. Salcedo Zunino LA, Núñez J, Mangupli MM, Pioli I, Gomez J, Allende BL. Revisión femoral con tallo cónico de
fijación distal. Rev Asoc Argent Ortop Traumatol 2017;82(1):40-2. https://www.aaot.org.ar/revista/2017/n1/7.pdf
United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
2. Gie GA, Linder L, Ling RS, Simon JP, Slooff TJ, Timperley AJ. Impacted cancellous allografts and cement for
revision total hip arthroplasty. J Bone Joint Surg Br 1993;75(1):14-21. https://doi.org/10.1302/0301-620X.75B1.8421012
3. Engh CA, Glassman AH, Griffin WL, Mayer JG. Results of cementless revision for failed cemented total hip
arthroplasty. Clin Orthop Relat Res 1988;(235):91-110. PMID: 3416544
4. Krishnamurthy AB, MacDonald SJ, Paprosky WG. 5- to 13-year follow-up study on cementless femoral
components in revision surgery. J Arthroplasty 1997;12(8):839-47. https://doi.org/10.1016/s0883-5403(97)90152-2
5. Lawrence JM, Engh CA, Macalino GE, Lauro GR. Outcome of revision hip arthroplasty done without cement. J
Bone Joint Surg 1994;76(7):965-73. https://doi.org/10.2106/00004623-199407000-00002
6. Wimmer MD, Randau TM, Deml MC, Ascherl R, Nöth U, Forst R, et al. Impaction grafting in the femur in
cementless modular revision total hip arthroplasty: a descriptive outcome analysis of 243 cases with the MRPTITAN revision implant. BMC Musculoskelet Disord 2013;14(1):19. https://doi.org/10.1186/1471-2474-14-19
7. Oshima S, Yasunaga Y, Yamasaki T, Yoshida T, Hori J, Ochi M. Midterm results of femoral impaction bone grafting with an allograft combined with hydroxyapatite in revision total hip arthroplasty. J Arthroplasty 2012;27(3):470-6. https://doi.org/10.1016/j.arth.2011.07.012
8. Ten Have BLEF, Brouwer MD RW, van Biezen FC, Verhaar JAN. Femoral revision surgery with impaction bone
grafting: 31 hips followed prospectively for ten to 15 years. J Bone Joint Surg Br 2012;94(5):615-8.
https://doi.org/10.1302/0301-620X.94B5.27909
9. Mulroy WF, Harris WH. Revision total hip arthroplasty with use of so-called second-generation cementing
techniques for aseptic loosening of the femoral component. A fifteen-year-average follow-up study. J Bone Joint
Surg 1996;78(3):325-30. https://doi.org/10.2106/00004623-199603000-00002
10. Davis CM, Berry DJ, Harmsen WS. Cemented revision of failed uncemented femoral components of total hip
arthroplasty. J Bone Joint Surg Am 2003;85(7):1264-9. https://doi.org/10.2106/00004623-200307000-00012
11. Lin Min, Jing Peng, Hong Duan, Wenli Zhang, Yong Zhou, Chongqi Tu. Uncemented allograft-prosthetic composite reconstruction of the proximal femur. Indian J Orthop 2014;48(3):289-95. https://doi.org/10.4103/0019-5413.132521
12. Mayle Jr RE, Paprosky WG. Massive bone loss: Allograft-prosthetic composites and beyond. J Bone Joint Surg Br 2012;94(11 Suppl A):61-4. https://doi.org/10.1302/0301-620X.94B11.30791
13. Kato T, Otani T, Sugiyama H, Hayama T, Katsumata S, Marumo K. Cementless total hip arthroplasty in hip
dysplasia with an extensively porous-coated cylindrical stem modified for Asians: A 12-year follow-up study. J
Arthroplasty 2015;30(6):1014-8. https://doi.org/10.1016/j.arth.2015.01.033
14. Shen B, Huang Q, Yang J, Zhou Z, Kang P, Pei F. Extensively coated non-modular stem used in two-stage revision for infected total hip arthroplasty: Mid-term to long-term follow-up: non-modular stem for infected THA. Orthop Surg 2014;6(2):103-9. https://doi.org/10.1111/os.12107
15. Thomsen PB, Jensen NJF, Kampmann J, Hansen TB. Revision hip arthroplasty with an extensively porous-coated stem - Excellent long-term results also in severe femoral bone stock loss. Hip Int 2013;23(4):352-8.
https://doi.org/10.5301/hipint.5000032
16. Abdel MP, Lewallen DG, Berry DJ. Periprosthetic femur fractures treated with modular fluted, tapered stems. Clin Orthop Relat Res 2014;472(2):599-603. https://doi.org/10.1007/s11999-013-2936-4
17. Van Houwelingen AP, Duncan CP, Masri BA, Greidanus NV, Garbuz DS. High survival of modular tapered stems for proximal femoral bone defects at 5 to 10 years followup. Clin Orthop Relat Res 2013;471(2):454-62.
https://doi.org/10.1007/s11999-012-2552-8
18. Amanatullah DF, Howard JL, Siman H, Trousdale RT, Mabry TM, Berry DJ. Revision total hip arthroplasty in
patients with extensive proximal femoral bone loss using a fluted tapered modular femoral component. Bone Joint J Br 2015;97(3):312-7. https://doi.org/10.1302/0301-620X.97B3.34684
19. Rodriguez JA, Deshmukh AJ, Robinson J, Cornell CN, Rasquinha VJ, Ranawat AS, et al. Reproducible fixation
with a tapered, fluted, modular, titanium stem in revision hip arthroplasty at 8–15 years follow-up. J Arthroplasty
2014;29(9):214-8. https://doi.org/10.1016/j.arth.2013.12.035
20. Munro JT, Garbuz DS, Masri BA, Duncan CP. Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures. Clin Orthop Relat Res 2014;472(2):590-8. https://doi.org/10.1007/s11999-013-3087-3
21. Abdel MP. CORR Insights®: Can a conical implant successfully address complex anatomy in primary THA?
Radiographs and hip scores at early followup. Clin Orthop Relat Res 2016;474(2):465-6. https://doi.org/10.1007/s11999-015-4530-4
22. Park M-S, Lee J-H, Park J-H, Ham D-H, Rhee Y-K. A distal fluted, proximal modular femoral prosthesis in revision hip arthroplasty. J Arthroplasty 2010;25(6):932-8. https://doi.org/10.1016/j.arth.2009.06.031
23. Sculco PK, Abdel MP, Hanssen AD, Lewallen DG. The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment. Bone Joint J 2016;98-B(1 Suppl A):120-4. https://doi.org/10.1302/0301-620X.98B1.36345
24. Paprosky WG, Burnett RSJ. Assessment and classification of bone stock deficiency in revision total hip arthroplasty. Am J Orthop (Belle Mead NJ) 2002;31(8):459-64. PMID: 12216969
25. Ling RS, Timperley AJ, Linder L. Histology of cancellous impaction grafting in the femur. A case report. J Bone
Joint Surg Br 1993;75(5):693-6. https://doi.org/10.1302/0301-620X.75B5.8376422
26. Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect 1995;44:293-304.
PMID: 7797866
27. Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD Jr, Ranawat CS. Results of revision for mechanical failure after
cemented total hip replacement. 1979 to 1982. A two to five-year follow-up. J Bone Joint Surg Am 1985;67:1074-
85. PMID: 4030826
28. Park M-S, Lim Y-J, Chung W-C, Ham D-H, Lee S-H. Management of periprosthetic femur fractures treated with
distal fixation using a modular femoral stem using an anterolateral approach. J Arthroplasty 2009;24(8):1270-6.
https://doi.org/10.1016/j.arth.2009.07.013
29. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51(4):737-55. PMID: 5783851
30. Fink B, Urbansky K, Schuster P. Mid term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement. Bone Joint J 2014;96-B(7):889-95.
https://doi.org/10.1302/0301-620X.96B7.33280
31. Abdel MP, Cottino U, Larson DR, Hanssen AD, Lewallen DG, Berry DJ. Modular fluted tapered stems in aseptic
revision total hip arthroplasty. J Bone Joint Surg 2017;99(10):873-81. https://doi.org/10.2106/JBJS.16.00423
32. Garcia-Cimbrelo E, Garcia-Rey E, Cruz-Pardos A, Madero R. Stress-shielding of the proximal femur using an
extensively porous-coated femoral component without allograft in revision surgery: a 5- to 17-year follow-up study. J Bone Joint Surg Br 2010;92(10):1363-9. https://doi.org/10.1302/0301-620X.92B10.24317
33. Klauser W, Bangert Y, Lubinus P, Kendoff D. Medium-term follow-up of a modular tapered noncemented titanium stem in revision total hip arthroplasty: a single-surgeon experience. J Arthroplasty 2013;28(1):84-9.
https://doi.org/10.1016/j.arth.2012.07.001
34. Huang Y, Shao H, Zhou Y, Gu J, Tang H, Yang D. Femoral bone remodeling in revision total hip arthroplasty with use of modular compared with monoblock tapered fluted titanium stems: the role of stem length and stiffness. J Bone Joint Surg Am 2019;101(6):531-8. https://doi.org/10.2106/JBJS.18.00442
35. Salcedo Zunino LA, Núñez J, Mangupli MM, Pioli I, Gomez J, Allende BL. Revisión femoral con tallo cónico de
fijación distal. Rev Asoc Argent Ortop Traumatol 2017;82(1):40-2. https://www.aaot.org.ar/revista/2017/n1/7.pdf