Medium Term Radiographic and Clinical Outcomes Using a Modular Tapered Hip Revision Implant

Abstract

Background The rate of revision hip arthroplasty surgery is rising. Surgeons must use implants with proven outcomes to help overcome the technical challenges faced during revision surgery. However, outcome studies using these implants are limited. The aim of this study is to investigate the radiographic and clinical outcomes of the Stryker Restoration stem, the most commonly used hip revision stem in the United Kingdom (UK). Methods A retrospective review of a single surgeon case series was performed. Immediate postoperative radiographs were analyzed for offset and leg length discrepancy. Radiographic evidence of subsidence was assessed using follow-up radiographs. Kaplan-Meier survival analysis was applied using explantation and reoperation as endpoints. Patient-reported outcomes were measured using the Oxford Hip Score and EQ-5D-5L. Results One hundred ninety-eight cases were identified. Mean follow-up duration was 51.8 months (range: 24-121). Stem survival during this period was 98%. Reoperation for any reason was 13%. Mean subsidence was 4.18 mm. Analysis of variance testing showed no difference in mean subsidence between revision indications. Mean offset and leg length discrepancies were measured at 4.5 mm and 4.3 mm, respectively. The mean Oxford Hip Score for participants was 27.6. Conclusions This series demonstrates excellent implant survival, with radiographic parameters for reconstruction and subsidence levels comparable to those in the existing literature. The tapered modular hip revision stem provides surgeons with the intraoperative flexibility to overcome some of the anatomical difficulties encountered during revision surgery; this is reflected in the radiographic and clinical outcomes of the cohort in this study.

Last generation fluted modular titanium stem in revision hip arthroplasty: a narrative review of mid- and long-term outcomes

“…Historically among the concerns regarding these implants, stem subsidence is one of the more feared ( Figure 5 ). Across the literature, this complication has been reported with a frequency varying wildly from 0.64 to 16 mm ( 29 ). Indeed, Parry et al tried to evaluate the possible reasons for stem subsidence.…”

EBRA Migration Analysis of a Modular, Distally Fixed Stem in Hip Revision Arthroplasty: A Clinical and Radiological Study

“…Thus, subsidence for the Modular Restoration Stem system (Stryker, Kalamazoo, Michigan, USA) was 2.5 mm (range 2–29) after 2.4 years, according to Patel et al [ 26 ]. When investigating the same stem, Jayasinghe et al reported an axial migration of 4.18 after 4.3 years [ 27 ]. For the Revitan stem (Zimmer Biomet, Warsaw, Indiana, USA), migration analysis by Girard et al showed an average subsidence of 3 mm after 5.9 years [ 20 ].…”

Modular versus monoblock stem in revision total hip arthroplasty: a systematic review and meta-analysis

“…The main reasons for rTHA are represented by aseptic loosening (a most significant percentage of 23.19%), followed by instability (22.43%) and infection (22.13%) ( 4 ). One of the most critical problems of revision surgery is bone loss in the femoral site ( 5 ). The femur metaphyseal bone loss makes implanting a primary proximal fitting stem impracticable because of the need to achieve stability and restore the correct biomechanical parameters (offset, limb length, femoral version) ( 6 ).…”