Cementless femoral revision in patients with a previous cemented prosthesis

Zeng, Min; Xie, Jie; Li, Ming‐Qing; Lin, Shaoru; Hu, Yihe

doi:10.1007/s00264-015-2696-8

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…The quality of the included studies was assessed independently by two reviewers. In this regard, the Newcastle–Ottawa Scale (NOS) for cohort studies was used [ 18 ]. When disagreement occurred, a third senior orthopedic surgeon was consulted for final consensus.…”

Section: Methodsmentioning

confidence: 99%

Efficacy and safety of modular versus monoblock stems in revision total hip arthroplasty: a systematic review and meta-analysis

Wang,

Li,

Zhang

et al. 2023

J Orthop Traumatol

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Background Both modular and monoblock tapered fluted titanium (TFT) stems are increasingly being used for revision total hip arthroplasty (rTHA). However, the differences between the two designs in clinical outcomes and complications are not yet clear. Here, we intend to compare the efficacy and safety of modular versus monoblock TFT stems in rTHA. Methods PubMed, Embase, Web of Science, and Cochrane Library databases were searched to include studies comparing modular and monoblock implants in rTHA. Data on the survivorship of stems, postoperative hip function, and complications were extracted following inclusion criteria. Inverse variance and Mantel–Haenszel methods in Review Manager (version 5.3 from Cochrane Collaboration) were used to evaluate differences between the two groups. Results Ten studies with a total of 2188 hips (1430 modular and 758 monoblock stems) were finally included. The main reason for the revision was aseptic loosening. Paprosky type III was the most common type in both groups. Both stems showed similar re-revision rates (modular vs monoblock: 10.3% vs 9.5%, P = 0.80) and Harris Hip Scores (WMD = 0.43, P = 0.46) for hip function. The intraoperative fracture rate was 11.6% and 5.0% (P = 0.0004) for modular and monoblock stems, respectively. The rate of subsidence > 10 mm was significantly higher in the monoblock group (4.5% vs 1.0%, P = 0.003). The application of extended trochanteric osteotomy was more popular in monoblock stems (22.7% vs 17.5%, P = 0.003). The incidence of postoperative complications such as periprosthetic femoral fracture and dislocation was similar between both stems. Conclusions No significant difference was found between modular and monoblock tapered stems as regards postoperative hip function, re-revision rates, and complications. Severe subsidence was more frequent in monoblock stems while modular ones were at higher risk of intraoperative fracture. Level of evidence: Level III, systematic review of randomized control and non-randomized studies. Trial Registration: We registered our study in the international prospective register of systematic reviews (PROSPERO) (CRD42020213642).

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Section: Methodsmentioning

confidence: 99%

Efficacy and safety of modular versus monoblock stems in revision total hip arthroplasty: a systematic review and meta-analysis

Wang,

Li,

Zhang

et al. 2023

J Orthop Traumatol

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“…A high incidence (range, 12-20%) of intraoperative fracture has been reported following procedures involving cementless long stems in revision THA with bone loss [36][37][38]. Only two intraoperative fractures (6.4%) occurred when the long stems were inserted in our series.…”

Section: Discussionmentioning

confidence: 61%

Minimum 8-year follow-up of revision THA with severe femoral bone defects using extensively porous-coated stems and cortical strut allografts

Ding

Ling

Yuan

et al. 2020

BMC Musculoskelet Disord

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Background: Revision total hip arthroplasty (THA) with severe femoral bone defects remains a major challenge. The purpose of this study is to report the minimum 8-year clinical and radiographic results of revision THA with severe femoral bone defects treated with extensively porous-coated stems and cortical strut allografts. Methods: We retrospectively identified 44 patients diagnosed with Paprosky type III and IV femoral bone defects between January 2006 and July 2011. The exclusion criteria were patients not eligible for surgery, revised with extensively porous-coated stems alone, lost to follow-up and deceased. A total of 31 patients treated with extensively porous-coated stems and cortical strut allografts were finally included in this study. The degree of femoral bone defects was categorized as Paprosky type IIIA in 19 patients, type IIIB in 9 patients and type IV in 3 patients. The mean duration of follow-up was 11.0 ± 1.5 (range, 8.1-13.5) years. Results: The mean Harris Hip Score improved significantly from 43.4 ± 10.5 points to 85.2 ± 6.6 points (P < 0.001). Similarly, WOMAC and SF-12 scores also significantly improved. Twenty-eight stems achieved stable bone ingrowth, two stems showed stable fibrous ingrowth, and one stem was radiologically unstable. Complete union and bridging between cortical strut allografts and host bone was achieved in all 31 patients. The femoral width was augmented with cortical strut allografts after revision surgery (an increase of 10.5 ± 0.5 mm) and showed a slight decrease of 2.5 ± 4.8 mm after the 10-year follow-up. Using re-revision for any reason as an endpoint, the Kaplan-Meier cumulative survival rate of the stem was 96.2% (95% confidence interval, 75.7-99.5%) at 10 years. Conclusion: Our data demonstrate that the use of extensively porous-coated stems combined with cortical strut allografts in revision THA with Paprosky type III and IV femoral bone defects can provide satisfactory clinical and radiographic outcomes with a minimum follow-up of 8 years.

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“…It will mainly be solved with modular and long-stemmed prosthesis, and the so-called "biological implantation^-i.e. cementless-is increasingly becoming the solution of choice [5,[9][10][11][12][13][14]. The declared aim is a rapid defect consolidation to gain longlasting results based on a sufficiently integrated stem [15,16].…”

Section: Introductionmentioning

confidence: 99%

Fixation pattern of conical and cylindrical modular revision hip stems in different size bone defects

Kinkel

Nadorf

Thomsen

et al. 2015

International Orthopaedics (SICOT)

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Cementless femoral revision in patients with a previous cemented prosthesis

Abstract: This supported that cementless fixation, with the use of extensively porous-coated stems or modular tapered stems, was efficient in patients with a previous failed cemented stem.

Cited by 6 publications

References 26 publications

Efficacy and safety of modular versus monoblock stems in revision total hip arthroplasty: a systematic review and meta-analysis

Efficacy and safety of modular versus monoblock stems in revision total hip arthroplasty: a systematic review and meta-analysis

Minimum 8-year follow-up of revision THA with severe femoral bone defects using extensively porous-coated stems and cortical strut allografts

Fixation pattern of conical and cylindrical modular revision hip stems in different size bone defects

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