Hip Pelvis.  2012 Jun;24(2):87-93. 10.5371/hp.2012.24.2.87.

Risk Factors Related to Modular Femoral Stem Failures in Revision Hip Arthroplasty

• Park JH
• Park MS
• Kim DY

• KMID: 1439096
• DOI: http://doi.org/10.5371/hp.2012.24.2.87

Abstract

PURPOSE
The purpose of this study was to analyze failure rates and causes of hip arthroplasty revisions associated with the use of cementless modular femoral stems.
MATERIALS AND METHODS
This study comprised 93 patients(100 hips) that were followed up for more than two years after revision involving modular femoral stem arthroplasty. The clinical results were evaluated using the Harris Hip Score and the radiologic results were evaluated using leg length discrepancy, subsidence and bone formation assessments. We analyzed the relationship between the number of hip surgeries performed and the bone deficiencies and failures observed. Preoperative femoral bone deficiencies were described by Paprosky Grade; Grade I or II were identified in 24 hips, IIIa in 4 hips, IIIb in 28 hips and IV in 3 hips.
RESULTS
We observed 80 hips with aseptic loosening, 10 hips with infection after previous revision, 8 hips with periprosthetic fractures and 2 hips with dislocations. Clinical results improved from a preoperative score of 42 (HHS) to a postoperative mean score of 81.5. The cause of early failure in 4 hips was identified as femoral stem subsidence, and the cause of late failure in 3 hips was due to infection. According to the comparison analysis, there was no statistical significance between femoral bone deficiency (P=0.727) and application of cement (P=0.087), but hips with previous revision surgery showed a higher rate of failure (P=0.024).
CONCLUSION
Cementless modular stems produced satisfactory results. The main cause of failure was subsidence. A significant risk factor for failure was hips which had undergone previous revision surgery.

Keyword

Total hip revision; Femoral bone deficiency; Cementless modular femoral stem

MeSH Terms

Arthroplasty
Dislocations
Hip
Leg
Osteogenesis
Periprosthetic Fractures
Risk Factors

Figure

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  Fig. 1 A 43 year-old man underwent revision surgery with Link MP stem. (A) Preoperative radiograph showing cemented femoral stem subsidence, and a stable acetabular cup. (B) Radiograph made four years postoperatively, showing the Link MP is fixed well and modular femoral component is short.

• 

  Fig. 2 A 55 year-old man underwent revision surgery with Lima MP stem. (A) Preoperative radiograph showing a loosening and migration of the cementless acetabular cup, and a stable femoral stem with a skirted long neck. (B) Radiograph made five years postoperatively, showing a well fixed acetabular cemented cage and a stable modular femoral stem with multiple cerclage.

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