Conservative femoral revision using short cementless stems with a tapered rectangular shape for selected Paprosky II-IV bone defects: an average seven-year follow-up

• Published in: Arthroplasty 2024-06, Vol.6 (1), p.38-11, Article 38
• Main Authors: Li, Yicheng, Zhang, Xiaogang, Ji, Baochao, Yushan, Nuerailijiang, Wulamu, Wuhuzi, Guo, Xiaobin, Cao, Li
• Format: Article
• Language: English
• Subjects: Bone defect; Cementless stem; Conservative femoral revision; Rectangular; Short; Tapered
• ISSN: 2524-7948; 2524-7948
• DOI: 10.1186/s42836-024-00251-5

The use of long stems for severe femoral bone defects is suggested by many scholars, but it is associated with further bone loss, intraoperative fracture, increased surgical trauma, and complications. With better bone retention, simple and quick surgical procedures, and minimal complications, the short cementless stems with a tapered rectangular shape may be an alternative for femoral revision. This study aimed to evaluate the results of this type of stem in treating selected Paprosky II-IV bone defects. This retrospective study included 73 patients (76 hips involved) who underwent conservative femoral revision using the short cementless stems with a tapered rectangular shape between January 2012 and December 2020. The preoperative femoral bone defects were identified as follows: 54 cases of type II, 11 cases of type IIIA, 7 cases of type IIIB, and 4 cases of type IV. Indications for revision included aseptic loosening (76.3%) and prosthetic joint infection (23.7%). Six cementless stems with a tapered rectangular shape from three companies were used in all patients. Among them, SLR-Plus, SL-Plus MIA, and Corail stems were employed in most patients (40.8%, 23.7%, and 17.1%, respectively). The average length of these stems measured 171.7 mm (SD 27 mm; 122-215 mm). Radiographic results, Harris hip scores (HHS), complications, and survivorship were analyzed. The follow-up lasted for 7 years on average (range 3-11 years). The subsidence was observed in three hips (3.9%), and all stems achieved stable bone ingrowth. Proximal femoral bone restoration in the residual osteolytic area was found in 67 hips (88.2%), constant defects in nine hips (11.8%), and increasing defects in 0 cases. There was no evidence of stem fractures and stem loosening in this series. The mean HHS significantly improved from 32 (range 15-50) preoperatively to 82 (range 68-94) at the last follow-up (t = - 36.297, P