Revision arthroplasty for periprosthetic femoral fracture using an uncemented modular tapered conical stem

Assunção, Ruy E. da; Pollard, T. C. B.; Hrycaiczuk, Alex; Curry, J. I.; Glyn-Jones, S; Taylor, A

doi:10.1302/0301-620x.97b8.34431

Cited by 28 publications

(32 citation statements)

References 59 publications

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“…Despite the modularity that confers intraoperative flexibility, allowing the surgeon to optimise length, offset and version, dislocation remained the most frequently encountered complication in 4-16.3% of cases as reported in the recent literature. 12,16,19,21,23,37 Our study confirms this finding with a dislocation rate of 16%.…”

Section: Discussionsupporting

confidence: 87%

Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes

et al. 2020

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Introduction: The aim of the study was to evaluate the mortality and the outcomes of femoral revision in periprosthetic femoral fractures (PFF) using a titanium modular fluted tapered stem. Methods: We retrospectively reviewed femoral revisions performed for PFF with a titanium modular fluted tapered stem in 25 patients. The average age was 74.32 years. In 21 patients the type of fracture was Vancouver B2 and type B3 in 4 cases. The mean follow-up was 29.16 (0.83–104.1) months SD ± 29.49. Results: The 30-day and 1-year mortality were 8% and 12% respectively. The mean value of the Charlson Comorbidity Index was 4.8 and the mean value of ASA score was 2.4. The average time to surgery from admittance was 5.45 days with 20% of patients operated on within 48 hours. A significant correlation was found between ASA score and mortality. The mean HHS was 76 points; good-excellent results were recorded in 56% of patients. 72% had no pain and 28% had slight pain (VAS 1–3). 52% of patients were able to walk without pain, limp or aids. The mean implant subsidence was 1.57 mm and superior to 5 mm in 2 cases. As complications we recorded 4 implant dislocations (16%) and 2 infections. Reoperation rate was 12%. Conclusions: Femoral revision with a modular fluted tapered stem in patients with periprosthetic fractures results in good clinical and radiological outcomes. However, mortality remains high and, despite the modularity design, dislocation is the most frequent complication.

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Section: Discussionsupporting

confidence: 87%

Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes

et al. 2020

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“…Four patients were excluded due to a follow-up that was incomplete or too short. Finally, 18 patients (12 females, 6 male) with a mean age of 75.5 ± 6.9 (60-89) years at revision surgery and a BMI of 28.0 ± 4.4 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) kg/m² were included. In addition, patients suffered from 5 ± 2 (1-12) internal (diabetes mellitus, hypertension, etc.)…”

Section: Resultsmentioning

confidence: 99%

Hip Revision Arthroplasty of Periprosthetic Fractures Vancouver B2 and B3 with a Modular Revision Stem: Short-Term Results and Review of Literature

Schreiner

Steidle

Schmidutz³

et al. 2020

Z Orthop Unfall

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Background Periprosthetic fractures Vancouver type B2/B3 after total hip arthroplasty (THA) is a challenging entity with increasing numbers. Limited data are available for this type of fracture treated with modular stems. Therefore, this study evaluated the outcome of Vancouver type B2/B3 fractures treated with a modular hip revision stem using a subproximal/distal anchorage and compared it to the current literature. Materials and Methods A consecutive series of periprosthetic Vancouver type B2/B3 fractures treated with a modular revision stem was retrospectively (2013 – 2016) evaluated. Assessment included the clinical (HHS, pain, ROM) as well as the radiological outcome (subsidence, loosening, facture healing). In adddition, the surgical technique is described in detail and results are compared with the current literature. Results A total of 18 patients (female/male 12/6) with Vancouver B2/B3 (n = 12/6) fractures with a mean age of 75.5 (60 – 89) years were included. The revision stem was inserted via a modified transgluteal approach (n = 16) or classical transfemoral approach (n = 2). The mean follow-up was 18.5 months, with a mean Harris Hip Score of 72.5 ± 18.7 (35.0 – 99.0) points. The fracture healing rate was 94.4% (n = 17) with osseous integration according to Engh in all cases. Dislocations of the greater trochanter were recorded in seven patients (38.9%). According to Beals and Towers, all results were rated excellent or good. No implant-related failure or relevant subsidence during this time was observed. Major complications were observed in five patients with two periprosthetic joint infections and two cases of major revision surgery. Conclusion This study assessing Vancouver B2/3 fractures shows reproducible, good, short-term results in terms of subsidence and clinical functional outcome by the use of a modular revision stem. The transfemoral approach together with the modular stem allows for a stable fixation and good fracture healing. However, our data and review of the literature also documents the difficulties and higher complication rate associated with Vancouver B2/3 fractures.

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“…25,26 Radiological fracture union or osteotomy site union was defined as the presence of bridging bone across the main fracture site or osteotomy site in two orthogonal planes. 27 All intraoperative or postoperative complications were also recorded, including fractures, dislocations, nerve palsies, infection, or need for subsequent surgeries. Kaplan-Meier survival analysis was performed using revision of the stem for any reason, revision of the stem for aseptic loosening, and any reoperation as end points.…”

Section: Methodsmentioning

confidence: 99%

Clinical, radiographic, and survivorship analysis of a modular fluted tapered stem in revision hip arthroplasty

Picado

Savarese

Cardamoni

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: Modular fluted tapered stems are one of the most commonly used implants in femoral revision surgery. Due to the relative lack of studies on the Restoration modular fluted tapered stem, we conducted a study to evaluate its short- to mid-term clinical, radiographic, and survival outcomes. Methods: We identified all 45 patients treated with this revision stem at our institution. Five patients did not complete the minimum 2-year follow-up, leaving 40 patients (41 hips) for assessment. Mean follow-up was 5.1 years (range 2–11 years). Clinical outcomes were assessed using the Harris hip score (HHS). Radiographs were evaluated for subsidence and loosening. Kaplan–Meier survival analysis was performed using revision of the stem for any reason as end point. Results: The mean HHS improved from 44.6 points preoperatively to 78.4 points at the most recent follow-up ( p < 0.0001). Nonprogressive subsidence occurred in 83% of the hips (mean 2.8 mm; range 1–7 mm). One stem (2.4%) showed progressive subsidence (20 mm) and was considered loose. The most common cause for reoperation was dislocation (three hips, 7.3%). The 10-year survivorship with revision of the stem for any reason as the end point was 93.5% (95% CI, 84.9–100%). Conclusion: There was a significant improvement in the HHS and a low likelihood of revision at short- to mid-term follow-up, adding to the current evidence base for use of this implant in revision surgery. A longer follow-up and a larger number of cases are necessary to fully evaluate its role and performance.

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Revision arthroplasty for periprosthetic femoral fracture using an uncemented modular tapered conical stem

Cited by 28 publications

References 59 publications

Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes

Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes

Hip Revision Arthroplasty of Periprosthetic Fractures Vancouver B2 and B3 with a Modular Revision Stem: Short-Term Results and Review of Literature

Clinical, radiographic, and survivorship analysis of a modular fluted tapered stem in revision hip arthroplasty

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