High Survival of Modular Tapered Stems for Proximal Femoral Bone Defects at 5 to 10 Years Followup

Houwelingen, Andrew P. Van; Duncan, Clivе P.; Masri, Bassam A.; Greidanus, Nelson V.; Garbuz, Donald S.

doi:10.1007/s11999-012-2552-8

Cited by 120 publications

(102 citation statements)

References 33 publications

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“…Given the failures of monoblock cylindrical stems in patients with the most severe defects (Paprosky Type IIIB/IV) [26], it has been suggested that these patients may be best treated with a modular tapered stem; however, few studies have specifically studied this issue [21,27,28]. Stems with a tapered distal geometry may be able to gain stability in a shorter isthmic segment than a cylindrical stem, whereas their modularity allows the surgeon to adjust length, offset, and version.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, modularity of the stem allows for impaction of the distal segment until secure axial stability is obtained and then using the varied available modular options in the proximal segment to adjust for leg length, offset, and version. However, there are few data describing survivorship and hip scores associated with this newer stem design in patients with severe femoral bone loss [21,27,28].…”

Section: Introductionmentioning

confidence: 99%

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Modular Tapered Implants for Severe Femoral Bone Loss in THA: Reliable Osseointegration but Frequent Complications

Brown

Tetreault

Cipriano

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Modular tapered stems have been suggested as the optimal implants for patients with severe femoral bone loss (Paprosky Type IIIB and IV) undergoing revision total hip arthroplasty (THA); however, there are few data describing survivorship and hip scores associated with this treatment. Questions/purposes At minimum 2 years, we sought to determine the (1) survivorship of these implants; (2) radiographic evidence of osseointegration; and (3) the Harris hip scores of patients revised with a modular tapered stem for severe femoral bone loss including the complications associated with their use. Methods Between 1999 and 2010, we performed 1124 femoral revisions; of those, 135 (12%) were performed using a modular tapered stem. General indications for use of this device included bone loss, poor quality bone, leg length discrepancy, difficulty adjusting version, proximal femoral remodeling, and ectatic medullary canals in the setting of revision THA. This report reviewed 70 of those that were performed in Type IIIB and IV femurs. Of those 70 patients, 11 had died and one was lost before 2-year followup; the remaining 58 (83%, 33 with a Type IIIB femur and 25 with a Type IV femur) were followed for a minimum of 24 months (average, 67 months; range, 24-151 months). Survivorship free from revision, radiographic analysis for signs of subsidence or stem loosening, and Harris hip scores were tallied. Results One patient underwent stem revision for early subsidence followed by failure of ingrowth for a survivorship free from repeat revision of 98% (57 of 58 patients). Five other stems (for a total of six [10%]) subsided early but nonetheless achieved radiographic signs of ingrowth and were not revised again. All other stems demonstrated osseointegration without subsidence and remained radiographically well fixed. In patients with surviving implants, the mean Harris hip score improved from 34 (range, 11-49) preoperatively to 74 (range, 14-

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Modular Tapered Implants for Severe Femoral Bone Loss in THA: Reliable Osseointegration but Frequent Complications

Brown

Tetreault

Cipriano

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Multiple reports from one institution have demonstrated the success of modular tapered stems for cases of proximal femoral bone loss. The authors demonstrated high mid-term survival rates of 90-94%, maintenance or improvement of bone stock and low subsidence rates [4,13]. Higher outcome scores, better bone restoration and less intraoperative fractures were also found with modular tapered stems compared with fully porous coated cobalt-chromium stems [11,12].…”

Section: Discussionmentioning

confidence: 90%

“…Cortical deficiency extending to between lesser trochanter and isthmus the modular junction are reported in the literature on multiple stem designs [3][4][5][6][7]. Manufacturers have developed methods for strengthening the taper junction.…”

Section: Cmentioning

confidence: 99%

Modular Femoral Tapered Revision Stems in Total Hip Arthroplasty

Frye¹,

Berend²,

Morris³

et al. 2013

Reconstructive Review

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Background: Modular component options can assist the surgeon in addressing complex femoral reconstructions in total hip arthroplasty by allowing for customization of version control and proximal to distal sizing. We review the early clinical results of a single modular femoral revision system that offers 3 proximal body types, 5 distal stem geometries, and a wide range of offset, sizing and auxiliary options.Methods: A query of our practice's arthroplasty registry revealed 60 patients (61 hips) who signed an IRB-approved general research consent allowing retrospective review, and underwent total hip arthroplasty performed with the modular femoral revision system between December 2009 and April 2012. There were 35 men (58%) and 25 women (42%). Mean age was 65.1 years (range, 35-94) and BMI was 31.3 kg.m2 (range, 14-53). Procedures were complex primary in 1 hip, conversion in 6 (10%), revision in 32 (53%), and two-staged exchange for infection in 22 (33%). Two-thirds of procedures included complete acetabular revision (n=40), while 31% (19) involved liner change only and 2 were isolated femoral revisions.Results: At an average follow-up of 1.5 years (maximum: 3.7 years) there have been no revisions or failures of the femoral component. Average Harris hip scores (0 to 100 possible) improved from 44.2 preoperatively to 66.0 at most recent evaluation, while the pain component (0 to 44 possible) improved from 15.8 to 31.2. Complications requiring surgical intervention included intraoperative periprosthetic femur fracture in one patient returned to the operating suite same day for open reduction internal fixation, which further required incision and debridement for super-

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“…Here, the fixation zone in the femur usually lies higher up the stem resulting in the use of longer revision stems with a bypass of the isthmus. As a result, there is a higher risk of intraoperative fracture, which helps explain why van Houweligen and colleagues [6] observed an intraoperative fracture percentage of 16% with this type of stem.…”

mentioning

confidence: 96%

Letter to the Editor: Is There a Benefit to Modularity in ‘Simpler’ Femoral Revisions?

Fink

2016

Clinical Orthopaedics &Amp; Related Research

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High Survival of Modular Tapered Stems for Proximal Femoral Bone Defects at 5 to 10 Years Followup

Cited by 120 publications

References 33 publications

Modular Tapered Implants for Severe Femoral Bone Loss in THA: Reliable Osseointegration but Frequent Complications

Modular Tapered Implants for Severe Femoral Bone Loss in THA: Reliable Osseointegration but Frequent Complications

Modular Femoral Tapered Revision Stems in Total Hip Arthroplasty

Letter to the Editor: Is There a Benefit to Modularity in ‘Simpler’ Femoral Revisions?

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