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

Fink, Bernd

doi:10.1016/j.artd.2018.03.002

Cited by 33 publications

(18 citation statements)

References 19 publications

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“…Among the fracture cases, 77% of the stem fractures occurred with the 2 shortest proximal stem sizes. In line with Fink, 24 the present study found that the mid-stem junction of a modular stem must lie as distally as possible, in an area where there typically is better and sufficient bone support. However, long stem combinations carry the risk of periprosthetic fractures and the use of stems that are too thin, which increase the risk of subsidence.…”

Section: Discussionsupporting

confidence: 83%

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Short proximal components in modular revision stems carry a higher risk for stem fractures

2019

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Introduction: Fractures of modular hip revision stems are not uncommon. The current study examined implant-related factors on stem fracture. We hypothesised that in a modular stem the fracture risk is increased with the use of a short proximal implant component. Materials and methods: Anonymised data of all 32 patients in Switzerland with a Revitan modular hip system who had a stem fracture were obtained from the manufacturer. Implant and patient data were compared with all components implanted in Switzerland during the same time interval. Results: Between 2002 and 2017, 4834 Revitan stems were implanted, of which 32 fractured. A smaller size of the proximal stem component was significantly associated with a higher fracture risk ( p < 0.001). Compared with the control group, the proportion of male patients was higher among the fracture cases, patients were younger, and they had a higher body weight ( p < 0.001, respectively). Conclusions: The present study suggests that small proximal stem components increase the load at the modular junction due to size and lack of bony support. Surgeons should therefore avoid short proximal components so that the mid-stem junction lies as distally as possible and the risk of fracture is minimised.

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Section: Discussionsupporting

confidence: 83%

“…choose the combination of a short distal component and a longer proximal component. 24 In general, the mid-stem junction should be positioned distal to the trochanter minor, in an area of better and sufficient bone support.…”

Section: Discussionmentioning

confidence: 99%

Short proximal components in modular revision stems carry a higher risk for stem fractures

2019

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“…No case of stem or neck-fracture occurred. Nevertheless patients certainly need to be counseled regarding this mode of failure particularly when other risk factors such as obesity and lack of proximal bone support leading to increased bending forces are present [43,44].…”

Section: Plos Onementioning

confidence: 99%

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

et al. 2020

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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.

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“…2 / The placement method and the choice of the implant size. After an analysis of 24 cases of implant fracture at this level, B. Fink [26] stressed the need to distalize the metaphyseal-stem junction in the femur (usually below the lesser trochanter). He recommends using shorter diaphyseal implants that follow the anatomical curvature of the femur to achieve a more distal press-t, in combination with long metaphyses.…”

Section: Discussionmentioning

confidence: 99%

Implant Breakage Risk for Modular Fluted Tapered Stems in Revision Total Hip Arthroplasty at 5-Year Follow-Up

Lucena¹,

Cavaignac²,

Chiron³

et al. 2020

Preprint

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Background: Modular stems in revision total hip arthroplasties allow diaphyseal fixation and optimal restoration of the architecture of the proximal femur. Several studies report metaphyseal implant breakage in the mid- to long-term and therefore a huge impact on survivorship. We aimed to evaluate a specific design of uncemented modular fluted tapered stems (MFT) to analyze survivorship and clinical and radiological outcomes.Methods: In a retrospective study, we identified 99 patients who had surgery using the same design of MFT implant between 2012 and 2014. Patients were mainly male in 53% and mean age was 73 years. Indications were 33 aseptic loosening, 24 periprosthetic fractures, 23 periprosthetic joint infection, 1 instability and 18 were complex primary arthroplasties. Survivorship, complications and clinical outcomes, were assessed. Mean follow-up was 5 years.Results: There was no implant breakage. At 5-year follow-up, the survivorship free of revision for aseptic loosening and free of revision for any reason of the femoral stem were 100% and 99%, respectively. At last follow-up, they were 94% and 81%, respectively. Six implants were revised. A mean stem subsidence of 6 mm was noted in 9 cases; 1 was revised for aseptic loosening. The Harris hip score was 89. The risk of revision was significantly higher for shorter diaphyseal implants (p=0.026).Conclusion: At mid-term follow-up of 5 years, the MFT studied reported an excellent survivorship and clinical outcomes with no specific complications. Unlike literature reports, no specific complications occurred with this design. Satisfying clinical outcomes and limited subsidence are consistent with previous reports though.Level of evidence: IV – Case series

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

Cited by 33 publications

References 19 publications

Short proximal components in modular revision stems carry a higher risk for stem fractures

Short proximal components in modular revision stems carry a higher risk for stem fractures

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

Implant Breakage Risk for Modular Fluted Tapered Stems in Revision Total Hip Arthroplasty at 5-Year Follow-Up

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