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

Abstract Background: Revision total hip arthroplasty is frequently accompanied by bone loss. The purpose of this study is to evaluate mid- to long-term results of revision total hip arthroplasty for massive femoral bone loss using cementless modular, fluted, tapered stems.Methods: During the period of 2007 to 2015 at a single hospital, 34 hips (33 patients) underwent primary revision surgery with cementless modular, fluted, tapered stems due to massive bone loss, and patients with prosthetic joint infection (PJI) or tumours were excluded. The hips were revised with the LINK MP (Waldemar Link, Hamburg, Germany) prosthesis. Bone loss was categorized by the Paprosky classification for prosthesis loosening and Vancouver classification for peri-prosthetic fracture. All revision bearing surfaces were ceramic-on-ceramic (CoC). Clinical outcomes, radiographic outcomes and survivorship were evaluated.Results: The mean follow-up was 9.1±2.5 years (range, 5-13 years). The Harris hip score was 43.6±11.5 preoperatively and maintained at 86.5±6.6 at the time of latest follow-up (p<0. 05). The X-ray showed bone ingrowth fixation in 30 hips (88%), fibrous stable fixation in 3 hips (9%) and instability in 1 hip (3%). The average stem subsidence was 3.9±2.2 mm (range, 1 to 10 mm). The survivorship of prostheses with re-revision for any reason was 95% (95% CI, 12.0 to 13.0) at the 10-year follow-up. Three (9%) re-revisions were needed, including 1 for aseptic loosening, 1 for dislocation and 1 for infection.Conclusions: The mid- to long-term results of revision total hip arthroplasty with the cementless modular, fluted, tapered stem (LINK MP stem) are encouraging for massive femoral bone loss.

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Cementation of a dual-mobility cup into a well-fixed cementless shell in patients with high risk of dislocation undergoing revision total hip arthroplasty

Hip International ◽

10.1177/1120700019873617 ◽

2019 ◽

pp. 112070001987361 ◽

Cited By ~ 3

Author(s):

Jesús Moreta ◽

Iker Uriarte ◽

Xabier Foruria ◽

Ioar Urra ◽

Urko Aguirre ◽

...

Keyword(s):

High Risk ◽

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Hip Arthroplasty ◽

Recurrent Dislocation ◽

Revision Total Hip Arthroplasty ◽

Dual Mobility ◽

Total Hip ◽

Revision Tha

Background: Cementation of polyethylene liners into well-fixed cementless metal shells has become an option during revision total hip arthroplasty (THA). We report the results of cementing a dual-mobility (DM) component into a stable acetabular shell in high-risk patients undergoing revision THA. Methods: A single-centre series of 10 patients undergoing revision THA with a DM cup cemented into an existing well-fixed shell between 2012 and 2016 were retrospectively reviewed. Failure due to aseptic loosening or instability and implant survival at last follow-up were analysed. The average age was 79.2 years and mean follow-up was 3.5 years. Indications were recurrent hip dislocation in 8 cases and intraoperative instability with moderate abductor insufficiency in 2 cases. In cases with recurrent dislocation, the aetiology of instability was classified by Wera type. Results: At the latest follow-up, Harris Hip Scores had improved from 49.3 preoperatively to 71.3 postoperatively ( p = 0.098). In the 8 patients with recurrent dislocation, 4 cases (50%) had an unclear aetiology (Wera type 6), 2 (25%) abductor deficiency (Wera type 3) and 2 (25%) late polyethylene wear (type 5). Postoperative recurrent dislocation occurred in 1 hip (10%). No cases of intraprosthetic dislocation, aseptic loosening of the previous shell or dissociation at the cement-cup interface were identified. Conclusion: Although the follow-up of this series is short, cementation of a DM cup into a previous well-fixed socket seems to be a viable option to treat and prevent instability after revision THA, without providing constraint at the cement-cup interface.

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Revision total hip arthroplasty with a modular tapered stem

Hip International ◽

10.1177/112070001002000202 ◽

2010 ◽

Vol 20 (2) ◽

pp. 136-142 ◽

Cited By ~ 9

Author(s):

Dror Lakstein ◽

Yona Kosashvili ◽

David Backstein ◽

Oleg Safir ◽

Paul Lee ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Tapered Stem

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Mid‐ to Long‐Term Outcomes of Cementless Modular, Fluted, Tapered Stem for Massive Femoral Bone Loss in Revision Total Hip Arthroplasty

Orthopaedic Surgery ◽

10.1111/os.12936 ◽

2021 ◽

Author(s):

Kai Zheng ◽

Ning Li ◽

Weicheng Zhang ◽

Yi Zhu ◽

Jun Zhou ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Bone Loss ◽

Hip Arthroplasty ◽

Revision Total Hip Arthroplasty ◽

Femoral Bone ◽

Long Term Outcomes ◽

Total Hip ◽

Tapered Stem

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Revision Total Hip Arthroplasty Using a Modular Tapered Stem With Distal Fixation

The Journal of Arthroplasty ◽

10.1016/j.arth.2008.11.106 ◽

2010 ◽

Vol 25 (3) ◽

pp. 348-354 ◽

Cited By ~ 44

Author(s):

Ole Ovesen ◽

Claus Emmeluth ◽

Christian Hofbauer ◽

Søren Overgaard

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Tapered Stem ◽

Distal Fixation

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Is modularity necessary when using a tapered stem in revision total hip arthroplasty?

Current Orthopaedic Practice ◽

10.1097/bco.0000000000000082 ◽

2014 ◽

Vol 25 (2) ◽

pp. 143-146

Author(s):

Adam J. Schwartz ◽

Mark J. Spangehl ◽

Christopher P. Beauchamp

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Tapered Stem

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Causes of Revision Total Hip Arthroplasty in Twenty Years: an Analysis of 1,353 Revisions

10.21203/rs.3.rs-79505/v1 ◽

2020 ◽

Author(s):

Jianming Gu ◽

Xiao Feng ◽

Hongyi Shao ◽

Yixin Zhou

Keyword(s):

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Infection Rate ◽

Hip Arthroplasty ◽

Periprosthetic Fracture ◽

National Database ◽

Revision Total Hip Arthroplasty ◽

Revision Thas ◽

Total Hip ◽

Revision Tha

Abstract BackgroundWith the increase in revision total hip arthroplasty (THA) cases, understanding its causes is essential for a surgeons' clinical decision-making. Studies have reported on revision THA epidemiology in developed countries; however, its epidemiology in China remains unclear. We reviewed revision THA causes in a tertiary center in China. MethodsWe retrospectively identified 1,353 revision THAs at our institution from January 1999 to December 2018 (20 years). The causes for revision THA were compared among patients who were grouped based on the time of revision surgery, age at revision, and number of revisions, using the Student's t-test. ResultsAseptic loosening (826 hips, 61.0%) and infection (151 hips, 11.2%) were the most common reasons for revision THA. Compared with the number of cases from January 1999 to December 2008, the number of cases from January 2009 to December 2018 increased 2.4-fold; the proportion of revisions due to aseptic loosening, periprosthetic fracture, instability, and osteolysis increased, and infection rate decreased. The infection rate was higher among patients aged over 60 years, whereas the incidence rate of aseptic loosening, periprosthetic fracture, and instability was higher among those aged 60 years or less. Infections (52.8%) were more common than aseptic loosening (37.4%) in second or subsequent revisions.ConclusionAseptic loosening and infection remain the most common causes of revision THAs at our center. Although the proportion of infections has decreased in the recent decade, a national database is necessary for a more comprehensive understanding of the causes of revision THAs in China. This work provides an understanding and comparison of the causes of revision THA in an orthopedic center among the Chinese population. This may reveal a potential change in revision THAs causes in the future, reminding surgeons to find a proper way to treat them.

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