Modular Fluted Tapered Stems in Aseptic Revision Total Hip Arthroplasty

• Published in: Journal of bone and joint surgery. American volume 2017-05, Vol.99 (10), p.873-881
• Main Authors: Abdel, Matthew P., Cottino, Umberto, Larson, Dirk R., Hanssen, Arlen D., Lewallen, David G., Berry, Daniel J.
• Format: Article
• Language: English
• Subjects: Aged; Arthroplasty, Replacement, Hip - instrumentation; Femur - surgery; Hip Joint - surgery; Hip Prosthesis; Humans; Osseointegration; Prosthesis Design; Prosthesis Failure; Reoperation
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.16.00423

Modular fluted tapered stems have become the most commonly employed category of femoral component in revision hip arthroplasty in North America as a result of favorable early results and simplicity of use. Despite wide adoption, the majority of published data are limited to relatively small series with modest follow-up. The goal of the current study was to determine the success rate and factors associated with success, failure, and complications of the use of modular fluted tapered stems in aseptic revision total hip arthroplasties (THAs) in a large patient cohort. We identified 519 aseptic femoral revisions during which a modular fluted tapered stem was utilized. Clinical outcomes, Kaplan-Meier survivorship, radiographic outcomes, and complications were assessed. The mean age at revision arthroplasty was 70 years, the mean body mass index (BMI) was 29 kg/m, and the mean duration of follow-up was 4.5 years (range, 2 to 14 years). The mean Harris hip score (HHS) improved significantly from 51 points preoperatively to 76 points at 2 years (p < 0.001). This improvement was maintained at the last follow-up evaluation (mean HHS = 75 points). At the time of the most recent follow-up, 16 femoral revisions had been performed: 6 because of aseptic loosening, 4 because of infection, 3 because of instability, 2 because of periprosthetic fracture, and 1 because of stem fracture. The 10-year survivorship was 96% with revision for any reason as the end point and 90% with any reoperation as the end point. Of the patients who were alive and had not undergone revision at the time of final follow-up, 12 had stem subsidence but all but 1 of these stems had stabilized after subsiding. Postoperative complications were noted in 12% of the cases. Repeat revision due to femoral component loosening was not correlated with the preoperative bone-loss category or patient demographic factors. In this large series, femoral revision with a modular fluted tapered stem provided a high rate of osseointegration and sustained improvement in clinical scores at the time of the last follow-up. There was also a high rate of successful implant fixation across all categories of preoperative bone loss and an acceptable rate of complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.