Femoral revision with conical stem of distal fixation.
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Published:
Feb 12, 2017
Keywords:
Hip, revision, distal stem fixation
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Abstract
BackgroundProximal bone loss at the femoral stem is the main challenge facing surgeons at the time of revisión total hip arthroplasty. The aim of revision surgeries to obtain a stable placement of components and to restore joint kinematics. ObjectivesThe purpose of this paper is to present our experience in hip revisions with tapered distal stem fixation with a minimum follow-up of 2 years. Evaluate the survival of the implants used, Harris hip score, complications and reinterventions associated with the use of these stems for complex femoral revision surgeries.Study Design & MethodsSeries of Cases. We evaluated 37 patients (39 hips) between 2010 and 2014 in which non-cemented femoral stems were used (28 modular and 11 non-modular).The average age was 63.5 years (SD 13.3). Study patients included 18 (48.64%) women and 19 (51.35%) men. Causes of reoperation included 14 (35.89%) cases of aseptic loosening, 14 (35.89%) infections, 7 (17.94%) periprosthetic fractures, 3 (7.69%) stem fracture and 1 (2.56%) for instability. Mean follow-up was 42 months (range, 24-74 months).ResultsThe survival of the femoral stem for any reason according to Kaplan-Meier's analysis was 92.3%. The average Harris score improved from 37 (10-77) points before the operation to 81 points (33-96) at last follow-up. Four patients (10,2 %) presented dislocation; one (2,5 %) deep infection; one (2,5 %) had an intra-operative fracture; subsidence took place in 3 (7,6 %) patients and it was necessary to reurse 2 (5,1 %) femoral implants.ConclusionsThe femoral stem has showed satisfactory results in 2 to 6 years of follow-up in several conditions of femoral revision surgeries. It requires a simple technique with clinical improvement that has been widely published in the literature.
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Salcedo Zunino, L. A., Núñez, J. E., Mangupli, M. M., Pioli, I., Gomez, J., & Allende, B. L. (2017). Femoral revision with conical stem of distal fixation. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 82(1), 40-47. https://doi.org/10.15417/632
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Clinical Research
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References
1. Bohm P, Bischel O. The use of tapered stems for femoral revision surgery. Clin Orthop Relat Res. 2004; 420:148–159.
2. Engh CA Jr, Hopper RH Jr, Engh CA Sr. Distal ingrowth components.Clin Orthop Relat Res. 2004; 420:135–141.
3. Sculco, P. K., Abdel, M. P., Hanssen, A. D., & Lewallen, D. G. (2016). The management of bone loss in revision total knee arthroplasty.Bone Joint J, 98-B(1 Supple A), 120-124. Accessed May 12, 2016
4. McAuley JP, Engh CA Jr. Femoral fixation in the face of considerable bone loss: cylindrical and extensively coated femoral components. Clin Orthop Relat Res. 2004; 429:215–221.
5. Sporer SM, Paprosky WG. Revision total hip arthroplasty: the limits of fully coated stems. Clin Orthop Relat Res. 2003;417: 203–209.
6. Sporer SM, Paprosky WG. Femoral fixation in the face of considerable bone loss: the use of modular stems. Clin Orthop Relat Res. 2004;429:227–231.
7. Ling RS, Timperley AJ, Linder L. Histology of cancellus impaction grafting in the femur. J Bone Joint Surg Br 1993; 75:14-21.
8. Lopreite F, Garabano G, Mana Pastrian D, Dal Lago J, Del Sel H. Utilización de tallos femorales largos cementados asociados a injerto óseo molido e impactado en revisiones de cadera. Rev Asoc Argent Ortop Traumatol; 77: 104-111
9. Dalury DF, Gonzales RA, Adams MJ. Minimum 5-year results in 96 consecutive hips treated with a tapered titanium stem system. J Arthroplasty 2010; 25: 104-7.
10. Leopold SS, Rosenberg AG. Current status of impaction allografting for revision of a femoral component. Instr Course Lect 2000; 49: 111-8.
11. Malkani AL, Settecerri JJ, Sim FH, Chao EY, Wallrichs SL. Long-term results of proximal femoral replacement for nonneoplastic disorders. J Bone Joint Surg Br 1995; 77: 351-6.
12. Lakstein D, Kosashvili Y, Backstein D, Safir O, Lee P, Gross AE. Revision total hip arthroplasty with a modular tapered stem. Hip Int. 2010 Apr-Jun; 20(2): 136–142.
13. Kang MN, Huddleston JI, Hwang K, Imrie S, Goodman SB. Early outcome of a modular femoral component in revisión total hip arthroplasty. J Arthroplasty 2008; 23: 220-5.
14. Grünig R, Morscher E, Ochsner PE. Three-to 7-year results with the uncemented SL femoral revision prosthesis. Arch Orthop Trauma Surg 1997; 116: 187-97.
15. Weber M, Hempfing A, Orler R, Ganz R. Femoral revision using the Wagner stem: results at 2-9 years. Int Orthop 2002; 26: 36-9.
16. Cameron HU. Orthopaedic crossfire - Stem modularity is unnecessary in revision total hip arthroplasty: in opposition. J Arthroplasty 2003; 18 (Suppl 1): 101-3.
17. Barrack RL. Orthopaedic crossfire - Stem modularity is unnecessary in revision total hip arthroplasty: in the affirmative. J Arthroplasty 2003; 18 (Suppl 1): 98-100.
18. Wirtz DC, Heller KD, Holzwarth U, et al. A modular femoral implant for uncemented stem revision in THR. Int Orthop 2000; 24: 134-8.
19. Della Valle CJ, Paprosky WG. Classification and an algorithmic approach to the reconstruction of femoral deficiency in revisión total hip arthroplasty. J Bone Joint Surg Am. 2003; 85:1–6.
20. Wagner H, Wagner M. Cone prosthesis for the hip joint. Arch Orthop Trauma Surg 2000; 120: 88-95.
21. StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP.
22. Hungerford DS, Jones LC. The rationale of cementless revisión of cemented arthroplasty failures. Clin Orthop Relat Res. 1988;235:12–24
23. Moreland JR, Moreno MA. Cementless femoral revisión arthroplasty of the hip: minimum 5 years followup. Clin Orthop Relat Res. 2001;393:194–201.
24. 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-yearaverage follow-up study. J Bone Joint Surg Am. 1996;78:325–330.
25. Wagner H, Wagner M. Konische Schaftverankerung Zementfreier Hüftprothesen- Primärimplantation und Prothesenwechsel. In Morscher EW (ed). Endoprothetik. Berlin: Springer-Verlag; 1995:278–288.)
26. Jibodh S, Schwarzkopf R, Shawn A, Malchau H. Revision Hip Arthroplasty with A Modular Cementless Stem: Mid-Term Follow Up. The Journal of Arthroplasty. J Arthroplasty. 2013 Aug;28(7):1167-72
27. Dou Y, Zhou Y, Tang Q, Yang D, Liu J. Leg-length discrepancy after revision hip arthroplasty: are modular stems superior? J Arthroplasty. 2013;28(4):676-679
28. Rodriguez JA, Deshmukh AJ, Robinson J, et al. Reproducible fixation with a tapered, fluted, modular, titanium stem in revisión hip arthroplasty at 8-15 years follow-up. J Arthroplasty. 2014;29(9 Suppl):214-218.
29. 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. 2015; 97(3):312-317.
30. Revision Total Hip Arthroplasty Study Group. A comparison of modular tapered versus modular cylindrical stems for complex femoral revisions. J Arthroplasty. 2013;28(8 Suppl):71-73
31. Krishnamurthy AB, MacDonald SJ, Paprosky WG. 5- to 13-year follow-up study on cementless femoral components in revisión surgery. J Arthroplasty. 1997;12(8):839-847.
32. Mitchell PA, Masri BA, Garbuz DS, et al. Cementless revision for infection following total hip arthroplasty. Instr Course Lect 2003; 52:323.
33. Haddad FS, Muirhead-Allwood SK, Manktelow AR, et al. Two-stage uncemented revision hip arthroplasty for infection. J Bone Joint Surg Br 2000;82(5):689
34. Meek RM, Garbuz DS, Masri BA, et al. Intraoperative fracture of the femur in revision total hip arthroplasty with a diaphyseal fitting stem. J Bone Joint Surg Am 2004;86-A(3):480.
35. Chappell JD, Lachiewicz PF. Fracture of the femur in revision hip arthroplasty with a fully porous-coated component. J Arthroplasty 2005;20(2):234.
36. Zalzal P, Gandhi R, Petruccelli D, et al. Fractures at the tip of long-stem prostheses used for revision hip arthroplasty. J Arthroplasty 2003;18(6):741
37. Bohm P, Bischel O. Femoral revision with the Wagner SL revisión stem: evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years. J Bone Joint Surg Am.2001;83:1023–1031
38. Grunig R, Morscher E, Ochsner PE. Three- to 7-year results with the uncemented SL femoral revision prosthesis. Arch Orthop Trauma Surg. 1997;116:187–197
39. Lakstein D, Backstein D, Safir O, et al. Revision total hip arthroplasty with a porous coated modular stem: 5 to 10 years follow-up. Clin Orthop Relat Res 2010;468(5): 1310
2. Engh CA Jr, Hopper RH Jr, Engh CA Sr. Distal ingrowth components.Clin Orthop Relat Res. 2004; 420:135–141.
3. Sculco, P. K., Abdel, M. P., Hanssen, A. D., & Lewallen, D. G. (2016). The management of bone loss in revision total knee arthroplasty.Bone Joint J, 98-B(1 Supple A), 120-124. Accessed May 12, 2016
4. McAuley JP, Engh CA Jr. Femoral fixation in the face of considerable bone loss: cylindrical and extensively coated femoral components. Clin Orthop Relat Res. 2004; 429:215–221.
5. Sporer SM, Paprosky WG. Revision total hip arthroplasty: the limits of fully coated stems. Clin Orthop Relat Res. 2003;417: 203–209.
6. Sporer SM, Paprosky WG. Femoral fixation in the face of considerable bone loss: the use of modular stems. Clin Orthop Relat Res. 2004;429:227–231.
7. Ling RS, Timperley AJ, Linder L. Histology of cancellus impaction grafting in the femur. J Bone Joint Surg Br 1993; 75:14-21.
8. Lopreite F, Garabano G, Mana Pastrian D, Dal Lago J, Del Sel H. Utilización de tallos femorales largos cementados asociados a injerto óseo molido e impactado en revisiones de cadera. Rev Asoc Argent Ortop Traumatol; 77: 104-111
9. Dalury DF, Gonzales RA, Adams MJ. Minimum 5-year results in 96 consecutive hips treated with a tapered titanium stem system. J Arthroplasty 2010; 25: 104-7.
10. Leopold SS, Rosenberg AG. Current status of impaction allografting for revision of a femoral component. Instr Course Lect 2000; 49: 111-8.
11. Malkani AL, Settecerri JJ, Sim FH, Chao EY, Wallrichs SL. Long-term results of proximal femoral replacement for nonneoplastic disorders. J Bone Joint Surg Br 1995; 77: 351-6.
12. Lakstein D, Kosashvili Y, Backstein D, Safir O, Lee P, Gross AE. Revision total hip arthroplasty with a modular tapered stem. Hip Int. 2010 Apr-Jun; 20(2): 136–142.
13. Kang MN, Huddleston JI, Hwang K, Imrie S, Goodman SB. Early outcome of a modular femoral component in revisión total hip arthroplasty. J Arthroplasty 2008; 23: 220-5.
14. Grünig R, Morscher E, Ochsner PE. Three-to 7-year results with the uncemented SL femoral revision prosthesis. Arch Orthop Trauma Surg 1997; 116: 187-97.
15. Weber M, Hempfing A, Orler R, Ganz R. Femoral revision using the Wagner stem: results at 2-9 years. Int Orthop 2002; 26: 36-9.
16. Cameron HU. Orthopaedic crossfire - Stem modularity is unnecessary in revision total hip arthroplasty: in opposition. J Arthroplasty 2003; 18 (Suppl 1): 101-3.
17. Barrack RL. Orthopaedic crossfire - Stem modularity is unnecessary in revision total hip arthroplasty: in the affirmative. J Arthroplasty 2003; 18 (Suppl 1): 98-100.
18. Wirtz DC, Heller KD, Holzwarth U, et al. A modular femoral implant for uncemented stem revision in THR. Int Orthop 2000; 24: 134-8.
19. Della Valle CJ, Paprosky WG. Classification and an algorithmic approach to the reconstruction of femoral deficiency in revisión total hip arthroplasty. J Bone Joint Surg Am. 2003; 85:1–6.
20. Wagner H, Wagner M. Cone prosthesis for the hip joint. Arch Orthop Trauma Surg 2000; 120: 88-95.
21. StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP.
22. Hungerford DS, Jones LC. The rationale of cementless revisión of cemented arthroplasty failures. Clin Orthop Relat Res. 1988;235:12–24
23. Moreland JR, Moreno MA. Cementless femoral revisión arthroplasty of the hip: minimum 5 years followup. Clin Orthop Relat Res. 2001;393:194–201.
24. 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-yearaverage follow-up study. J Bone Joint Surg Am. 1996;78:325–330.
25. Wagner H, Wagner M. Konische Schaftverankerung Zementfreier Hüftprothesen- Primärimplantation und Prothesenwechsel. In Morscher EW (ed). Endoprothetik. Berlin: Springer-Verlag; 1995:278–288.)
26. Jibodh S, Schwarzkopf R, Shawn A, Malchau H. Revision Hip Arthroplasty with A Modular Cementless Stem: Mid-Term Follow Up. The Journal of Arthroplasty. J Arthroplasty. 2013 Aug;28(7):1167-72
27. Dou Y, Zhou Y, Tang Q, Yang D, Liu J. Leg-length discrepancy after revision hip arthroplasty: are modular stems superior? J Arthroplasty. 2013;28(4):676-679
28. Rodriguez JA, Deshmukh AJ, Robinson J, et al. Reproducible fixation with a tapered, fluted, modular, titanium stem in revisión hip arthroplasty at 8-15 years follow-up. J Arthroplasty. 2014;29(9 Suppl):214-218.
29. 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. 2015; 97(3):312-317.
30. Revision Total Hip Arthroplasty Study Group. A comparison of modular tapered versus modular cylindrical stems for complex femoral revisions. J Arthroplasty. 2013;28(8 Suppl):71-73
31. Krishnamurthy AB, MacDonald SJ, Paprosky WG. 5- to 13-year follow-up study on cementless femoral components in revisión surgery. J Arthroplasty. 1997;12(8):839-847.
32. Mitchell PA, Masri BA, Garbuz DS, et al. Cementless revision for infection following total hip arthroplasty. Instr Course Lect 2003; 52:323.
33. Haddad FS, Muirhead-Allwood SK, Manktelow AR, et al. Two-stage uncemented revision hip arthroplasty for infection. J Bone Joint Surg Br 2000;82(5):689
34. Meek RM, Garbuz DS, Masri BA, et al. Intraoperative fracture of the femur in revision total hip arthroplasty with a diaphyseal fitting stem. J Bone Joint Surg Am 2004;86-A(3):480.
35. Chappell JD, Lachiewicz PF. Fracture of the femur in revision hip arthroplasty with a fully porous-coated component. J Arthroplasty 2005;20(2):234.
36. Zalzal P, Gandhi R, Petruccelli D, et al. Fractures at the tip of long-stem prostheses used for revision hip arthroplasty. J Arthroplasty 2003;18(6):741
37. Bohm P, Bischel O. Femoral revision with the Wagner SL revisión stem: evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years. J Bone Joint Surg Am.2001;83:1023–1031
38. Grunig R, Morscher E, Ochsner PE. Three- to 7-year results with the uncemented SL femoral revision prosthesis. Arch Orthop Trauma Surg. 1997;116:187–197
39. Lakstein D, Backstein D, Safir O, et al. Revision total hip arthroplasty with a porous coated modular stem: 5 to 10 years follow-up. Clin Orthop Relat Res 2010;468(5): 1310