Cementless modular hip revision arthroplasty using the MRP Titan Revision Stem: outcome of 79 hips after an average of 4�years? follow-up

Schuh, Alexander; Werber, S.; Holzwarth, U.; Zeiler, Günther

doi:10.1007/s00402-004-0656-7

Cited by 63 publications

(35 citation statements)

References 13 publications

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“…Rotational stability can be achieved distally with the fluted, polished and split stem [19]. In accordance with this concept, we detected smaller relative movements of the proximal stem in bearing conditions I and III compared to the MRP®, which mainly transfers loads to the diaphysis due to its conical and fluted stem [17,18]. Therefore less micro-movements of the distal stem were detected for the MRP®.…”

Section: Discussionmentioning

confidence: 54%

“…To simulate a more common clinical situation-bridging the proximal defect zone [3,9,10,17,18] by the use of a more diaphyseal fixating revision stem-the MRP® stem (Peter Brehm GmbH, Weisendorf, Germany) was included (Fig. 1).…”

Section: Experimental Study Protocolmentioning

confidence: 99%

“…The aim of this study was to analyse the influence of strut grafts on the primary stability of revision stems in femora with proximal defects. Two commonly used revision stems [5,[15][16][17][18] with different fixation philosophies [19] were included to assess this influence for different load transfers from stem to femur.…”

Section: Introductionmentioning

confidence: 99%

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Strut grafts in revision hip arthroplasty faced with femoral bone defects: an experimental analysis

Kinkel

Thomsen

Nadorf

et al. 2014

International Orthopaedics (SICOT)

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Purpose In total hip arthroplasty fixation of revision stems can be demanding due to femoral bone loss. Strut grafts are often used for bone augmentation and stabilization of the newly inserted prosthesis. The aim of this study was to assess the effect of strut grafts on primary stability under various stem fixation conditions. Methods Two different revision stems (cylindrical and conical shape) were implanted into synthetic femora. Following a semicircular transfemoral osteotomy, three deficient femoral bearings were simulated (bony lid reattached with cable wires; weakened lid reattached with cable wires; strut grafts placed to the weakened lid with cable wires). Relative micromovements were measured between prostheses and bones due to an axial moment applied to the stems. Results Relative movements correlated to the stem shape. The cylindrical stem showed higher movements increasing significantly with a weakened bony lid and portrayed a slight decrease of movements with strut graft application. No unequivocal influence of the weakened lid could be detected for the conical implant. Strut graft application did not show an additional stabilizing effect. Conclusions The primary stability of the cylindrical fixation concept decreases with impaired fixation conditions of the femur. A clear restabilizing effect with strut grafts could not be proven. A decrease of primary stability due to the impaired bone could not be observed for the conical stem shape. Additionally, strut grafts do not enhance fixation for this stem shape. We conclude that surgeons should not rely on a stabilizing effect of strut grafts in revision hip surgery.

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Section: Discussionmentioning

confidence: 54%

Section: Experimental Study Protocolmentioning

confidence: 99%

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Strut grafts in revision hip arthroplasty faced with femoral bone defects: an experimental analysis

Kinkel

Thomsen

Nadorf

et al. 2014

International Orthopaedics (SICOT)

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“…The treatment has been described using extensively coated femoral stems [3,13,26], modular stems with distal tapers [10,12,14,15,17,19,22], and impaction bone grafting with cemented polished stems [4,7,16,21,23,25,27]. Femoral impaction grafting, first reported by Gie et al in 1993 [5], has the advantage of adding bone to the deficient femur, but it is a time-consuming procedure with reported risks of fracture ranging from 5% to 12% [1,5,7,9].…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, the relative ease of insertion of the more recently available modular tapered stems [10,12,14,15,17,22] resulted in our performing fewer impaction bone grafting procedures in patients needing femoral revision. However, if we are to compare impaction bone grafting survival with modular tapered stems, then it is crucial to study longer followup to either confirm or refute the results of others.…”

Section: Introductionmentioning

confidence: 99%

What is the Long-term Survival of Impaction Allografting of the Femur?

Garvin¹,

Konigsberg²,

Ommen³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Revision hip surgery of the femur for patients with substantial bone loss is challenging. We previously reported 41 patients (44 hips) treated with femoral impaction grafting followed for a minimum of 2 years. The survivorship, using femoral reoperation for symptomatic aseptic loosening as the end point, was 97% at 8 years. However, data on longer term survival are crucial to adequately compare this surgical technique with other types of revision hip arthroplasty procedures. Questions/purposes We therefore asked what the survivorship of impaction bone grafting was at longer followup, if the severity of bone loss was associated with failure, and finally, if longer length stems had improved survival compared with shorter stems.Methods Between 1993 and 2002, 78 femoral revisions were performed in 71 patients using impaction grafting. The average age of the patients was 67 years (range, 33-84 years). Sixty-nine of the 71 patients were available for followup evaluation. We obtained Harris hip scores preoperatively and postoperatively. Radiographs were measured for radiolucent lines. Patients were followed a minimum of 2 years (average, 10.6 years; range, 2-19 years).

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The Effect of the Stiffness of the stem of the Modular Revision Prosthesis MRP Titan Depending on Stem Diameter

Schuh¹,

Holzwarth²,

Zeiler³

2004

Materialwissenschaft Werkst

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The MRP-Titan revision stem has proved to be a very successful implant system in revision arthroplasty of the hip joint. With this revision system good and very good clinical and excellent radiographic results with spontaneous filling out of femur defects were published in studies. The observation, that an atrophy of the proximal femur could be recorded with stem diameters above 17 mm, lead us to carry out stiffness measurements on different diameters of the MRP-Titan revision stem.To determine the static bending characteristics, the bent 200 mm MRP-Titan revision stem was tested under axial stress in accordance with Euleŕs buckling cases. Various diameters from 13 to 22 mm were tested with a calibrated hydraulic MTS 810 axial piston testing machine (MTS Systems, Minneapolis, Minnesota, USA). Each test was carried out five times, the mean average value of the respective deflexion for each stem diameter was listed in a diagram.It turned out that deflexion decreased disproportionately from a stem diameter of > 18 mm. This correlated directly with an increased stiffness of the stem.With the MRP-Titan revision stem a reliable implant in revision arthroplasty has been made available. The clinical observation of a proximal femur atrophy with stem diameters > 17 mm could be correlated in the series of experiments with a corresponding exponential increase in stiffness. The aim of continuing development will be to reduce the stiffness of the individual implant, especially in larger stem diameters, through constructive and/or material science measures.

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Cementless modular hip revision arthroplasty using the MRP Titan Revision Stem: outcome of 79 hips after an average of 4�years? follow-up

Abstract: Given the encouraging results with the MRP Titan Revision Stem, the principle of uncemented diaphyseal fixation appears to solve most of the technical problems in cases of significant bone loss and obviously offers good preconditions for bony restoration.

Cited by 63 publications

References 13 publications

Strut grafts in revision hip arthroplasty faced with femoral bone defects: an experimental analysis

Strut grafts in revision hip arthroplasty faced with femoral bone defects: an experimental analysis

What is the Long-term Survival of Impaction Allografting of the Femur?

The Effect of the Stiffness of the stem of the Modular Revision Prosthesis MRP Titan Depending on Stem Diameter

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