Reproducible fixation with a tapered, fluted, modular, titanium stem in revision hip arthroplasty at 8–15 years follow-up

Rodríguez, José A.; Deshmukh, Ajit; Robinson, Jonathan; Cornell, Charles N.; Rasquinha, Vijay J.; Ranawat, Amar S.; Ranawat, Chitranjan S.

doi:10.1016/j.arth.2013.12.035

Cited by 59 publications

(50 citation statements)

References 35 publications

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“…In all 24 cases, the same scenario of an effective osteointegration of the distal component almost up to the junction itself and a missing medial bone support of the proximal component could be seen [1], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. Even though modular revision stems can have various fracture mechanisms, the described scenario seems to be the most reasonable for breakage of the junction [16].…”

Section: Introductionmentioning

confidence: 62%

What can the surgeon do to reduce the risk of junction breakage in modular revision stems?

Fink

2018

Arthroplasty Today

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Modular revision stems are very common in hip arthroplasty, but junction fracture remains a known failure mechanism. A review of the literature with description of cases with junction breakage of modular revision stems showed that in all 24 analyzed cases, there was a common finding: the combination of an effective osteointegration of the distal component and missing medial bone support of the proximal component. The result was a bending stress point of the stem construction in the region of the junction. A technique using the combination of short distal component and longer proximal components may alter this stress pattern, allow proximal implant support, and reduce the risk of junction fracture. Moreover, filling of gaps between the modular component and the medial region of the femoral calcar in endofemoral implantation, a double osteotomy in significant bowed femurs, and treating medial bone defects with structural allografts additionally can reduce the risk of junction breakage.

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Section: Introductionmentioning

confidence: 62%

What can the surgeon do to reduce the risk of junction breakage in modular revision stems?

Fink

2018

Arthroplasty Today

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“…We believed that the nonmodular design would show results comparable to published results with modular stems [23,28,30,31,33]. Several studies [6,14,20] support this view, however some of the medium-to long-term studies [6,14] reflect use of early designs of this prosthesis.…”

Section: Introductionmentioning

confidence: 66%

Nonmodular Tapered Fluted Titanium Stems Osseointegrate Reliably at Short Term in Revision THAs

Sandiford

Garbuz

Masri

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background The ideal femoral component for revision THA is undecided. Cylindrical nonmodular stems have been associated with stress shielding, whereas junctional fractures have been reported with tapered fluted modular titanium stems. We have used a tapered fluted nonmodular titanium femoral component (Wagner Self-locking [SL] femoral stem) to mitigate this risk. This component has been used extensively in Europe by its designer surgeons, but to our knowledge, it has not been studied in North America. Added to this, the design of the component has changed since early reports.

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“…Reliable fixation may be achieved using a modular titanium fluted, tapered stem. 13,16,18,[20][21][22] This design allows the tapered femoral component to "wedge" into the remaining isthmus, with the flutes providing rotational stability. It must be noted, however, that subsidence is still common when this method of reconstruction is selected and great care must be taken to insert a large enough implant to gain adequate fixation without fracturing the femur during stem insertion.…”

Section: Type Iiib Femoral Bone Lossmentioning

confidence: 98%

“…13,14 In this scenario, we prefer to use a modular titanium fluted stem. [15][16][17][18] In the case of femoral remodeling resulting in retroversion, a modular titanium fluted stem is also chosen. This allows the surgeon to appropriately antevert the stem.…”

Section: Type Iiia Femoral Bone Lossmentioning

confidence: 99%

Classifying femoral bone deficiency: Picking the right tool for the job

Balkissoon

Sershon

Paprosky

et al. 2015

Seminars in Arthroplasty

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The number of total hip arthroplasties continues to increase each year, and with it grows the demand for surgeons prepared to manage complicated revisions. To date, the Paprosky classification system is the most commonly used, well-described, and successfully implemented classification system for periprosthetic femoral bone loss. In this review, the Paprosky femoral bone loss classification is presented in detail, using illustrative examples of cases encountered by the contributing authors.

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Reproducible fixation with a tapered, fluted, modular, titanium stem in revision hip arthroplasty at 8–15 years follow-up

Cited by 59 publications

References 35 publications

What can the surgeon do to reduce the risk of junction breakage in modular revision stems?

What can the surgeon do to reduce the risk of junction breakage in modular revision stems?

Nonmodular Tapered Fluted Titanium Stems Osseointegrate Reliably at Short Term in Revision THAs

Classifying femoral bone deficiency: Picking the right tool for the job

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