Are Short Fully Coated Stems Adequate for “Simple” Femoral Revisions?

Tetreault, Matthew W.; Shukla, Sanjai K.; Yi, Paul H.; Sporer, Scott M.; Valle, Craig J. Della

doi:10.1007/s11999-013-3167-4

Cited by 31 publications

(33 citation statements)

References 29 publications

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“…Therefore, other reconstruction methods should be elected. 27,28 The present study implies that in the presence of insufficient bone support the surgeon should either adapt his surgical technique or use a non-modular stem. Notably, the present study also showed that approximately 65% of patients received the shortest possible distal stem length (i.e., 140 mm).…”

Section: Discussionmentioning

confidence: 86%

Short proximal components in modular revision stems carry a higher risk for stem fractures

2019

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Introduction: Fractures of modular hip revision stems are not uncommon. The current study examined implant-related factors on stem fracture. We hypothesised that in a modular stem the fracture risk is increased with the use of a short proximal implant component. Materials and methods: Anonymised data of all 32 patients in Switzerland with a Revitan modular hip system who had a stem fracture were obtained from the manufacturer. Implant and patient data were compared with all components implanted in Switzerland during the same time interval. Results: Between 2002 and 2017, 4834 Revitan stems were implanted, of which 32 fractured. A smaller size of the proximal stem component was significantly associated with a higher fracture risk ( p < 0.001). Compared with the control group, the proportion of male patients was higher among the fracture cases, patients were younger, and they had a higher body weight ( p < 0.001, respectively). Conclusions: The present study suggests that small proximal stem components increase the load at the modular junction due to size and lack of bony support. Surgeons should therefore avoid short proximal components so that the mid-stem junction lies as distally as possible and the risk of fracture is minimised.

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Section: Discussionmentioning

confidence: 86%

Short proximal components in modular revision stems carry a higher risk for stem fractures

2019

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“…In 2014, Tetreault et al 26 published their results after hip revision with a primary stem in the largest cohort treated up to then with this technique. A total of 144 patients were evaluated after 4-year follow-up to determine the percentage of revisions (Paprosky femoral bone defect types I and IIIA) that could benefit from primary stem implantation.…”

Section: Discussionmentioning

confidence: 99%

Primary cementless stems in septic hip revision: Indications and results

Cavagnaro

Chiarlone

Divano

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: The aim of our work is to evaluate results obtained from a cohort of patients affected by periprosthetic joint infection and treated with a primary cementless stem in a two-stage technique framework. Methods: Eighty-four patients were evaluated at a mean follow-up of 37.4 months. The main demographic, surgical, clinical, and radiographic data were recorded. A femoral window for stem removal was performed in 33 patients. Results: Statistically significant improvement was noted for both the Harris Hip score and the Oxford Hip score. Postsurgical complications included thigh pain in three patients, subsidence (>2 mm) in one patient, implant dislocation in two patients, cup revision in one patient, implant revision for septic failure in two patients, and stem revision for varus position in one patient. The stem survivorship rate was 96.3%. There were no significant differences between the groups in which a cortical window was created or not. Conclusion: Femoral stem revision with primary cementless stems is a viable option in selected patients undergoing two-stage hip revision surgery. Correct indication is a cornerstone of good outcome. The use of a cortical window does not affect the final outcome or implant survivorship rate.

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“…We specifically selected these femoral defects because both monoblock and modular stems have been successfully used for these less severe femoral defects, but it is not known whether either possesses distinct advantages. In higher grade femoral defects (3b or 4) when less than 4 cm of isthmus is available for distal fixation, a higher rate of failed osseointegration has been demonstrated with monoblock cylindrical femoral components, and other methods of reconstruction are recommended [18].…”

Section: Introductionmentioning

confidence: 99%

Is There a Benefit to Modularity in ‘Simpler’ Femoral Revisions?

Huddleston

Tetreault

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Modular revision femoral components allow the surgeon to make more precise intraoperative adjustments in anteversion and sizing, which may afford lower dislocation rates and improved osseointegration, but may not offer distinct advantages when compared with less expensive monoblock revision stems. Questions/purposes We compared modular and monoblock femoral components for revision of Paprosky Type I to IIIA femoral defects to determine (1) survivorship of the stems; and (2) complications denoted as intraoperative fracture, dislocation, or failure of osseointegration. Methods Between 2004 and 2010, participating surgeons at three centers revised 416 total hip arthroplasties (THAs) with Paprosky Type I to IIIA femoral defects. Of those with minimum 2-year followup (343 THAs, mean followup 51 ± 13 months), 150 (44%) were treated with modular stems and 193 (56%) were treated with monoblock, cylindrical, fully porous-coated stems. During this time, modular stems were generally chosen when there was remodeling of the proximal femur into retroversion and/or larger canal diameters (usually [ 18 mm). A total of 27 patients died (6%) with stems intact before 2 years, 46 THAs (13%) were lost to followup before 2 years for reasons other than death, and there was no differential loss to followup between the study groups. The modular stems included 101 with a cylindrical distal geometry (67%) and 49 with a tapered geometry (33%). Mean age (64 versus 68 years), percentage of women (53% versus 47%), and body mass index (31 versus 30 kg/m 2 ) were not different between the two cohorts, whereas there was trend toward a slightly greater case complexity in the modular group (55% versus 65% Type 3a femoral defects, p = 0.06). KaplanMeier survivorship was calculated for the endpoint of Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Conclusions Although rerevisions were less common in patients treated with modular stems, aseptic complications such as intraoperative fractures were more common in that group, and the sample was too small to evaluate corrosionrelated or fatigue concerns associated with modularity. We cannot therefore conclude from this that one design is superior to the other. Larger studies and pooled analyses will need to be performed to answer this question, but we believe modularity should be avoided in more straightforward cases if possible. Level of Evidence Level III, therapeutic study.

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Are Short Fully Coated Stems Adequate for “Simple” Femoral Revisions?

Cited by 31 publications

References 29 publications

Short proximal components in modular revision stems carry a higher risk for stem fractures

Short proximal components in modular revision stems carry a higher risk for stem fractures

Primary cementless stems in septic hip revision: Indications and results

Is There a Benefit to Modularity in ‘Simpler’ Femoral Revisions?

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