Hip Pelvis.  2015 Sep;27(3):135-140. 10.5371/hp.2015.27.3.135.

Mid-term Results of Revision Total Hip Arthroplasty Using Modular Cementless Femoral Stems

• Jang HG
• Lee KJ
• Min BW
• Ye HU
• Lim KH

• KMID: 2069142
• DOI: http://doi.org/10.5371/hp.2015.27.3.135

Abstract

PURPOSE
The purpose of this study was to evaluate the clinical and radiological results of revision total hip arthroplasty using modular distal fixation stems for proximal femoral deficiency.
MATERIALS AND METHODS
Forty-five patients (47 hips) were analyzed more than 24 months after revision total hip arthroplasty that used modular distal fixation stems and was performed between 2006 and 2012. There were proximal femoral defects in all cases. Preoperative femoral defect classification revealed Paprosky type II in 31 cases, type IIIA in 7, and type IIIB in 9. The mean duration of follow-up was 53.4 (25-100) months. We evaluated the Harris hip score (HHS), walking ability according to Koval as clinical parameters, stem stability, and stem position change as radiographic parameters. Kaplan-Meier survival analysis was performed.
RESULTS
The average HHS improved form 39.5 points to 91.3 points and walking ability also improved in most cases; all patients had stable fixation of the femoral stem. Postoperative complications included 5 cases of infection and 2 cases of dislocation. The survival rate with the end point of re-revision surgery due to infection or dislocation was 86% after 8-year follow-up.
CONCLUSION
Cementless revision total hip arthroplasty using modular femoral stems is useful because the stems can be stably fixed on the diaphyseal portion of the femur, which has relatively good bone quality at mid-term follow-up.

Keyword

Hip; Bone defect; Revision arthroplasty; Modular femoral stem

MeSH Terms

Arthroplasty, Replacement, Hip*
Classification
Dislocations
Femur
Follow-Up Studies
Hip
Humans
Postoperative Complications
Survival Rate
Walking

Figure

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  Fig. 1 A photograph showing a Revitan® stem (Zimmer, Warsaw, IN, USA).

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  Fig. 2 A 64-year-old female who had received revision total hip arthroplasty. (A) A preoperative radiograph showing a severe bone defect of the proximal femur. (B) A postoperative radiograph showing revision total hip arthroplasty with a Revitan® stem (Zimmer, Warsaw, IN, USA) and allobone graft. (C) A postoperative radiograph taken 2 years later. (D) A radiograph taken 4 years later showing a stable prosthesis with bone ingrowth and good union.

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  Fig. 3 A 58-year-old male who had received revision total hip arthroplasty. (A) A preoperative radiograph showing stem loosening. (B) A postoperative radiograph showing revision total hip arthroplasty with a Revitan® stem (Zimmer, Warsaw, IN, USA) and allobone graft. (C) A postoperative radiograph taken 2 years later. (D) A radiograph taken 6.8 years later showing a stable prosthesis with bone ingrowth and good union.

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  Fig.4 Kaplan-Meier overall survival rate.

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