Aseptic Revision Total Hip Arthroplasty Using Modular Fluted Tapered Stems: Long-Term Follow-up of 515 Cases

• Published in: Journal of bone and joint surgery. American volume 2024-08, Vol.106 (16), p.1470-1478
• Main Authors: Carender, Christopher N, Larson, Dirk R, Trousdale, Robert T, Lewallen, David G, Berry, Daniel J, Abdel, Matthew P
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - instrumentation; Arthroplasty, Replacement, Hip - methods; Female; Follow-Up Studies; Hip Prosthesis - adverse effects; Humans; Male; Middle Aged; Prosthesis Design; Prosthesis Failure; Reoperation - statistics & numerical data; Retrospective Studies
• ISSN: 0021-9355; 1535-1386; 1535-1386
• DOI: 10.2106/JBJS.23.00921

Modular fluted tapered (MFT) femoral components are frequently utilized in aseptic revision total hip arthroplasties (THAs). However, long-term follow-up has been limited. The purpose of this study was to update our prior series at long-term follow-up, with specific emphasis on implant survivorship, radiographic results, and complications in a large cohort of aseptic revision THAs using MFT stems. We retrospectively identified 515 aseptic femoral revisions performed with 2 MFT stem designs in the total joint registry of a single tertiary care academic institution from 1999 to 2013. Serial radiographs were reviewed for subsidence of >5 mm. The mean follow-up (and standard deviation) was 10 ± 5 years (range, 2 to 21 years). A competing risk model accounting for death was utilized. The 15-year cumulative incidence of any revision was 12%. There were 57 revisions, 27 of which involved revision of the fluted tapered component (FTC). Dislocation (n = 19), periprosthetic joint infection (n = 15), and aseptic loosening of the FTC (n = 11) were the most common reasons for revision. The 15-year cumulative incidence of any reoperation was 16%. The 15-year cumulative incidences were 6% for any FTC revision and 2% for FTC revision for aseptic loosening. Stem subsidence of >5 mm occurred in 2% of unrevised cases, and all but 1 stem was stable at the most recent follow-up. This large series of MFT stems used in aseptic revision THAs had a 2% incidence of subsequent revision of the FTC for aseptic loosening at 15 years. Dislocation and infection were the most common reasons for any revision. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.