RESUMEN
Background: Early firm fixation of the femoral implant is crucial in total hip arthroplasty (THA) with unstable metaphysis or a large degree of femoral bone loss. This study aimed to evaluate the outcomes of THA using a novel cementless modular, fluted, tapered stem in such cases. Methods: From 2015 to 2020, 105 hips (101 patients) had surgery performed by two surgeons at two tertiary hospitals using a cementless modular, fluted, tapered stem for periprosthetic fractures, massive bone loss, prosthetic joint infection sequelae, or tumorous condition. Clinical outcomes, radiographic results, and survivorship of the implant were evaluated. Results: The average follow-up period was 2.8 years (range, 1-6.2 years). The Koval grade was 2.7 ± 1.7 preoperatively and maintained at 1.2 ± 0.8 at the latest follow-up. The plain radiograph showed bone ingrowth fixation in 89 hips (84.8%). The average stem subsidence at postoperative 1 year was 1.6 ± 3.2 mm (range, 0-11.0 mm). Five reoperations (4.8%) were needed, including 1 for acute periprosthetic fracture, 1 for recurrent dislocation, and 3 for chronic periprosthetic joint infection. Kaplan-Meier survivorship with reoperation for any reason as the endpoint was 94.1%. Conclusions: The early- to mid-term results of THA with the novel cementless modular, fluted, tapered THA stem system were satisfactory clinically and radiologically. The shortcomings inherent to its modularity were not identified. This modular femoral system may provide adequate fixation and be a practical option in the setting of complicated THA.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Fracturas Periprotésicas , Humanos , Pueblos del Este de Asia , Resultado del Tratamiento , Diseño de Prótesis , Estudios Retrospectivos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Fracturas Periprotésicas/cirugía , Reoperación , Estudios de SeguimientoRESUMEN
AIMS: The aim of this study is to report the long-term outcomes of instrumented femoral revisions with impaction allograft bone grafting (IBG) using the X-change femoral revision system at 30 years after introduction of the technique. METHODS: We updated the outcomes of our previous study, based on 208 consecutive revisions using IBG and the X-change femoral revision system in combination with a cemented polished stem, performed in our tertiary care institute between 1991 and 2007. Kaplan-Meier survival analyses were used to determine the survival rate of the revisions with endpoint revision for any reason and aseptic loosening. Secondary outcomes were radiological loosening and patient-reported outcome measures. RESULTS: Mean age at revision total hip arthroplasty (THA) was 64.9 years (30 to 86). The most prevalent diagnosis for the femoral revision was aseptic loosening. At review in May 2021, 81 patients (85 hips) were still alive and 118 patients (120 hips; 58%) had died. Three patients (3 hips; 1%) were lost to follow-up at 11, 15, and 16 years after surgery, respectively. Data of all deceased and lost patients were included until final follow-up. The mean follow-up was 13.4 years (0 to 28). During the follow-up, 22 re-revisions were performed. The most common reason for re-revision was infection (n = 12; 54%). The survival with endpoint re-revision for any reason was 86% (95% confidence interval (CI) 79 to 91) at 20 years and 74% (95% CI 43 to 89) at 25 years after surgery. The survival for endpoint re-revision for aseptic loosening was 97% (95% CI 91 to 99) after both 20 and 25 years. CONCLUSION: We conclude that femoral IBG is a valuable technique that can reconstitute femoral bone loss in the long term. After 25 years of follow-up, few re-revisions for aseptic loosening were required. Also, the overall revision rate is very acceptable at a long follow-up. This technique is especially attractive for younger patients facing femoral revisions with extensive bone loss.Cite this article: Bone Joint J 2022;104-B(9):1039-1046.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Artroplastia de Reemplazo de Cadera/métodos , Cementos para Huesos , Trasplante Óseo/métodos , Estudios de Seguimiento , Humanos , Estudios Prospectivos , Diseño de Prótesis , Falla de Prótesis , Reoperación/métodos , Resultado del TratamientoRESUMEN
AIMS: The aim of this study was to evaluate the incidence of liner malseating in two commonly used dual-mobility (DM) designs. Secondary aims included determining the risk of dislocation, survival, and clinical outcomes. METHODS: We retrospectively identified 256 primary total hip arthroplasties (THAs) that included a DM component (144 Stryker MDM and 112 Zimmer-Biomet G7) in 233 patients, performed between January 2012 and December 2019. Postoperative radiographs were reviewed independently for malseating of the liner by five reviewers. The mean age of the patients at the time of THA was 66 years (18 to 93), 166 (65%) were female, and the mean BMI was 30 kg/m2 (17 to 57). The mean follow-up was 3.5 years (2.0 to 9.2). RESULTS: Three liners (1.2%) were malseated, including two MDMs (1.4%) and one G7 (0.9%). No clinical consequence was identified from malseating. The five-year survival free of dislocation was 97.1%, including two DM and one intraprosthetic dislocation. The five-year survival free of revision was 95.4%, with seven revisions. The mean Harris Hip Scores increased from 46 (24 to 69) preoperatively to 81 (40 to 100) at two years postoperatively (p < 0.001). CONCLUSION: The incidence of DM liner malseating after primary THA was low, with no known clinical consequences at mid-term follow-up. Malseating is not exclusive of design, and these findings emphasize the importance of careful evaluation of the liner after impaction to avoid this complication. Cite this article: Bone Joint J 2022;104-B(5):598-603.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Luxaciones Articulares , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Femenino , Prótesis de Cadera/efectos adversos , Humanos , Masculino , Diseño de Prótesis , Falla de Prótesis , Estudios RetrospectivosRESUMEN
BACKGROUND: In revision total hip arthroplasty (THA) cases with preserved femoral metaphyseal bone, tapered proximally porous-coated "primary" femoral stems may be an option. The objective of this study was to compare outcomes of patients with Paprosky I or II femoral bone loss undergoing revision THA with either a primary metaphyseal-engaging cementless stem or a revision diaphyseal-engaging stem. METHODS: This was a retrospective analysis of 70 patients with Paprosky I or II femoral bone loss who underwent femoral revision. 35 patients who were revised using a primary cementless femoral stem were compared with 35 patients who underwent femoral revision using a revision diaphyseal-engaging stem. The groups were similar regarding age, gender, body mass index, and American Society of Anesthesiologists. Clinical and radiographic outcomes and complications were compared over an average follow-up of 2.9 years (SD 1.4). RESULTS: Revision THA was most commonly performed for periprosthetic joint infection (N = 27, 38.6%). The groups were similar with regards to Paprosky femoral classification (P = .56), length of stay (P = .68), discharge disposition (P = .461), operative time (P = .20), and complications (P = .164). There were no significant differences between primary and revision femoral stem subsidence (0.12 vs. 0.75 mm, P = .18), leg length discrepancy (2.3 vs. 4.05 mm, P = .37), and Hip Disability and Osteoarthritis Outcome Score Jr (73.1 [SD 21.1] vs. 62.8 [SD 21.7], P = .088). No patient underwent additional revision surgery involving the femoral component. CONCLUSION: Use of modern primary cementless femoral stems is a viable option for revision hip arthroplasty in the setting of preserved proximal femoral metaphyseal bone. Outcomes are not inferior to those of revision stems and offer potential benefits.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Fémur/diagnóstico por imagen , Fémur/cirugía , Prótesis de Cadera/efectos adversos , Humanos , Diseño de Prótesis , Reoperación , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Both cylindrical and tapered stems are commonly used in revision total hip arthroplasty. However, whether the geometry of prosthesis stem has an effect on patient prognosis is unclear. We assume that the tapered stem results in better clinical outcome than the cylindrical stem. METHODS: A multicenter review of 120 femoral revisions with Paprosky I, II, and III defects using cobalt chrome cylindrical stem (54 hips) or titanium tapered stem (66 hips) was performed with an average follow-up of 6 years. Demographic data were comparable between groups. RESULTS: No significant group differences were found in surgery time, bleeding volume, postoperative Harris Hip Score, level of overall satisfaction, and 8-year cumulative survival. However, intraoperative fractures occurred significantly less in the tapered group (4.5%) than in the cylindrical group (14.8%), and stem subsidence was significantly less in the tapered group (2.17 mm) than in the cylindrical group (4.17 mm). A higher ratio of bone repair and lower bone loss were observed in the tapered group compared with the cylindrical group. The postoperative thigh pain rate was higher in the cylindrical group (12.9%) than in the tapered group (4.5%). CONCLUSION: Both cylindrical stem and tapered stem can achieve satisfactory mid-term clinical results in revision total hip arthroplasty. The tapered stem has better bone restoration of proximal femur, lower incidence of intraoperative fractures, and lower postoperative thigh pain rate compared with the cylindrical stem.
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Artroplastia de Reemplazo de Cadera/instrumentación , Cuello Femoral , Prótesis de Cadera/clasificación , Oseointegración/fisiología , Diseño de Prótesis , Anciano , Anciano de 80 o más Años , Femenino , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiología , Articulación de la Cadera/cirugía , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Falla de Prótesis/etiología , Radiografía , Reoperación/instrumentación , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: The ideal femoral component in revision total hip arthroplasty (rTHA) remains undetermined; however, tapered, fluted, titanium (TFT) stems are now widely used with favorable results in all types of revision scenarios. With both modular and monoblock TFT stem options, neither has been proven to be superior. Femoral stem subsidence has been linked to aseptic loosening, instability, and leg length discrepancy. This study aims to assess stem subsidence of modular and monoblock TFT stems at a single urban orthopedic specialty hospital within a tertiary academic medical center. METHODS: Electronic medical records of rTHAs performed between January 2013 and March 2018 utilizing modular and monoblock TFT stems were examined. Data collected included baseline demographics, surgical indication, femoral Paprosky classification, and stem subsidence at most recent follow up (3 months to 3 years). Two-sample t-tests and chi-squared tests were used for statistical analysis. RESULTS: A total of 186 patients (106 modular, 80 monoblock) were included in the analysis. Modular stems underwent significantly greater subsidence than monoblock stems at latest radiographic follow-up (3.9 ± 2.6 vs 2.3 ± 2.5 mm, P < .001). A significantly greater proportion of modular stems underwent >5 mm of subsidence at latest follow-up (29.2% vs 11.3%, P < .001). CONCLUSION: Monoblock TFT stems have displayed promising clinical results in prior studies, and now have been shown to decrease the incidence of postoperative subsidence. With the potential for stem subsidence to lead to aseptic loosening, limb length discrepancy, and instability, the orthopedic surgeon should weigh the risks and benefits of utilizing modular vs monoblock TFT stems in rTHA.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Artroplastia de Reemplazo de Cadera/efectos adversos , Fémur/cirugía , Humanos , Diseño de Prótesis , Falla de Prótesis , Reoperación , Estudios RetrospectivosRESUMEN
BACKGROUND: Nonmodular and modular femoral stems have been associated with complications after revision total hip arthroplasty (rTHA). As such, the ideal femoral component for rTHA remains undecided. This study aims to report outcomes of titanium, tapered-fluted, modular and nonmodular femoral components in rTHA. METHODS: From January 1, 2013 to September 30, 2017, all rTHAs using modular or nonmodular femoral stems were identified. Demographic data including age, gender, and American Society of Anesthesiologists scores were collected. Surgical details including operative time and implant cost were also collected. Clinical outcomes including length of stay, dislocation, infection, fracture, reoperation, and re-revision were collected. Statistical analysis was performed using chi-square test and Student's t-test for all categorical and continuous variables, respectively. RESULTS: One hundred forty-six rTHA cases (103 modular and 43 nonmodular) were identified with an average follow-up of 29 months (range 3-59 months). Nonmodular stems had a significantly lower cost when compared to modular implants (modular stems 120.8% higher cost; P < .001). The surgical time of nonmodular components was significantly greater (193 minutes vs 163 minutes; P = .029). There were no differences observed in any other surgical details or clinical outcomes assessed, including length of stay (P = .323), rate of re-revision of the femoral implant (P = .389), rate of re-operation (P = .383), and postop complications (P = .241), including infection (P = .095), dislocation (P = .778), and fracture (P = .959). CONCLUSIONS: Nonmodular components provide encouraging clinical results with significantly lower costs compared to modular implants in rTHA. The use of titanium, tapered-fluted, nonmodular components may offer a more cost-effective approach to rTHA compared to their modular counterparts.
Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Diseño de Prótesis/estadística & datos numéricos , Anciano , Distribución de Chi-Cuadrado , Femenino , Fémur/cirugía , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Prótesis de Cadera/efectos adversos , Humanos , Luxaciones Articulares , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Tempo Operativo , Complicaciones Posoperatorias/etiología , Diseño de Prótesis/efectos adversos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , TitanioRESUMEN
BACKGROUND: Both modular and nonmodular tapered fluted titanium stems are used in revision total hip arthroplasty (THA), with follow-up showing good results for both stems. We aimed to determine whether there were any differences in clinical outcomes, survivorship, or frequency of complications. METHODS: A retrospective review of 160 consecutive THAs (153 patients) revised with a tapered fluted modular titanium stem from 2002 to 2014 and 129 consecutive THAs (128 patients) revised with a tapered fluted nonmodular titanium stem between 2008 and 2014 was conducted. The patient's level of satisfaction, clinical assessment, and complications were examined. A Kaplan-Meier survivorship analysis was performed with the endpoint defined as any reoperation due to septic/aseptic complications. RESULTS: Mean duration of follow-up was longer in the modular group (6.3 years) than the nonmodular group (5.0 years; P = .003). No significant group differences were found in the postoperative Harris Hip Score, the level of overall satisfaction, the 8-year cumulative survival, the rate of infection, dislocation, or postoperative periprosthetic fractures. However, intraoperative fractures occurred significantly more frequently in the modular group (16.9%) than in the nonmodular group (7.0%; P = .011), and stem subsidence was significantly less in the modular group (0.95 mm) than in the nonmodular group (1.93 mm; P = .001). Two mechanical failures associated with the modular design occurred in the modular group. CONCLUSION: Both modular and nonmodular tapered fluted titanium stems provide satisfactory midterm results in revision THA. Although tapered fluted modular stems are gaining in popularity in revision THA, tapered fluted nonmodular stems should not be disregarded as a viable alternative, especially for relatively straightforward cases.
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Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera/estadística & datos numéricos , Diseño de Prótesis , Reoperación/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Femenino , Fémur/cirugía , Prótesis de Cadera/efectos adversos , Humanos , Luxaciones Articulares , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Fracturas Periprotésicas , Periodo Posoperatorio , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , TitanioRESUMEN
The effect of distal geometry in modular stems in revision THA remains unclear. The purpose of this study is to compare femoral revisions with modular tapered versus modular cylindrical stems in high-grade defects. A multicenter review of 105 femoral revisions with Paprosky III/IV defects using modular titanium stems (61 tapered; 44 cylindrical) was performed with an average follow-up of 5 years. Demographic data was comparable between groups. The tapered group had more IIIB and IV defects (51% vs. 20%; P < .01). The failure rate for component osseointegration was 1.6% in the tapered group and 15.9% in the cylindrical group (P = <.01). The rate of femoral component re-revision for any reason was 4.9% in the tapered group and 22.7% in the cylindrical group (P = .013). Modular tapered stems were associated with lower rates of stem failure and improved bone ongrowth compared to cylindrical stems despite being used in femurs with greater defects.