Promising results of revision total hip arthroplasty using a hexagonal, modular, tapered stem in cases of aseptic loosening

Abstract

Background Modular stems are widely used in revision total hip arthroplasty (THA) with aseptic loosening being a common reason for revision. Despite the good results reported on the use of modular stem designs, there are only few studies focusing on aseptic revisions and few studies on a hexagonal stem design. The goal of this study is to determine stem survival, clinical and functional outcome along with possible risk factors for implant failure in aseptic revision THA. Methods We retrospectively identified 53 patients with aseptic THA revision using a modular hexagonal stem with a minimum follow-up of two years. Femoral bone loss, radiographic and clinical outcomes as well as function measured using the Harris Hip Score (HHS) was assessed. Patients' previous medical history was analyzed for comorbidities and the body mass index. Stem survival was calculated using the Kaplan-Meier method. Possible risk factors for implant failure were analyzed using the log-rank test. The median age at revision was 69 (IQR 62-73) with a median follow up of 74 months. Results Implant survival rates amounted to 90.4% at 3 and 5 years. The median HHS improved by 47 points (34 (IQR 22-47) vs 81 (IQR 59-90) p<0.001). There was a reduced implant survival after 5 years when the revision stem was used following a previous cemented stem (83.4% vs 100%, p = 0.04). Conclusion A modular, hexagonal stem can be successfully used in aseptic revision THA with remarkable functional results and excellent survivorship. Revision of a cemented stem using this implant might result in reduced survival which must be considered when planning treatment.

Aseptic Revision of Total Hip Arthroplasty With a Single Modular Femoral Stem and a Modified Extended Trochanteric Osteotomy—Treatment Assessment With the Forgotten Joint Score-12

“…Stem subsidence (>5 mm) was noted in 8.3% of cases (Fig. 1a and b), consistent with the values reported in the literature [32,33]. Using the Revitan shaft, subsidence rates as low as 2.9% have been reported [33], whereas other studies found rates as high as 14.7% [34] and 24% [35].…”

“…Fink et al published survival rates of this specific implant with distal cone-incone fixation of 97.3% at 5 years and 95.7% at a mean of 7.5 years with stem-related further revision for any reason as the endpoint [33]. Schwarze et al found survival rates of 90.4% at 5 years [32] but reported a reduced implant survival rate (83.4% after 5 years) when the revision stem replaced a cemented stem.…”

Distal fixation modular prosthesis for Paprosky type ⅢA/ⅢB femoral bone defect in revision total hip replacement： a short-term clinical follow-up study

“…[28] followed up with 136 patients undergoing revision surgery with distal xation modular prosthesis for an average of 4.6 years, success rate was 93.2%. In this study, up to the last follow-up, none of patients required re-revision caused by loosening, and the average prosthesis settlement value was 1.20 ± 0.89 mm, which was similar to most results found in clinical reports [26][27][28][29][30][31][32].…”

“…Schwarze et al [29] reported 519 revision surgeries with this prosthesis, average follow-up was 4.5 years, the mean Harris score increased from 51 preoperatively to 76 after surgery, and the 10-year survival rate was 96%. In a retrospective analysis research by El-Ashmawy et al [30], the OHS (Oxford Hip Score) of patients undergoing revision surgery with this prosthesis improved from 12 before surgery to 34 at last follow-up.…”

The Role of Single Positive Cultures in Presumed Aseptic Total Hip and Knee Revision Surgery—A Systematic Review of the Literature

“…Two or more UPCs of the same pathogen have been associated with decreased infectionfree and revision-free survival following planned THA and TKA revision [24,[33][34][35]. The most commonly reported pathogens isolated in patients with UPCs are low-virulent bacteria such as coagulase-negative Staphylococci and Cutibacterium acnes [24,33,[36][37][38][39][40][41][42].…”