High Failure at a Minimum 5-Year Follow-Up in Primary Total Hip Arthroplasty Using a Modular Femoral Trunnion (original) (raw)
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Modular Femoral Sleeve and Stem Implant Provides Long-term Total Hip Survivorship
Clinical Orthopaedics & Related Research, 2010
Background A femoral implant with a modular sleeve and stem has been designed to allow independent and complete metaphyseal-diaphyseal fit and fill as well as independent rotation to accommodate anteversion at the time of THA. Questions/purposes In a prospective study we asked whether such a modular femoral sleeve and stem implant used during THA could provide (1) high long-term survivorship; (2) radiographically stable implants without radiolucencies, stress shielding, or osteolysis; and (3) high clinical scores in patients 15 to 20 years after a primary THA. Patients and Methods We prospectively evaluated 31 hips that underwent a primary THA using a modular femoral component for clinical outcome (Harris hip score) and radiographic outcome (implant stability, femoral loosening, osteolysis and stress shielding) at a minimum followup of 15 years (mean, 17 years; range, 15-20.2 years). Results There were no femoral revisions for aseptic loosening; all hips had radiographic evidence of bone ingrowth. Two well-ingrown components were revised for late hematogenous infection. Some degree of proximal femoral disuse atrophy from stress shielding occurred in 23 hips (74%) but was nonprogressive and did not result in any failures or complications. Femoral osteolysis occurred in 18 hips (58%), but we cannot definitively determine whether or not the modular junction contributed to this. Conclusions These data suggest this modular femoral stem can provide long-term survivorship with no cases of aseptic loosening at 15 to 20 years after primary THA. However, it may be prudent when using this femoral stem to consider an articulation with an alternative bearing or, if the modularity is not needed to address femoral anteversion and metaphyseal-diaphyseal mismatch, to consider a nonmodular femoral stem. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Medium-term outcome in patients treated with total hip arthroplasty using a modular femoral stem
Hip International, 2012
The clinical, radiographic and quality of life results of total hip arthroplasty using the MODULUS cementless modular femoral stem were reviewed. 48 patients who had a total hip arthroplasty using the MODULUS femoral stem were identified. Six had bilateral procedures, resulting in 60 hips with complete clinical and radiographic data. Mean age at implantation was 50 years (range 33 to 82). Mean follow-up was 59 months (range 50 months to 73). There were two early post-operative dislocations (within 2 days). One patient required further surgery to remove heterotopic bone. Mean Harris Hip Score increased from 37 points preoperatively (range, 7 to 66) to 89 points at final review (range, 65 to 100 points). Radiographic evaluation revealed that all implants were stable without evidence of osteolysis but three patients (5%) exhibited heterotopic ossification. Quality of life was evaluated with the SF36. The physical component increased from 29.2 points (range, 18.5 to 46.0) to 51.7 points (range 42.9 to 60.6) and the mental component from 375 points (range, 19.5 to 50.0) to 50 points (range 32,8 to 62.0).
Medicina
Background and Objectives: Increased revision rate of dual-modular (DM) femoral stems in primary total hip arthroplasty (THA) because of modular-neck breakage and adverse local tissue reactions (ALTRs) to additional junction damage products is well established and some designs have been recalled from the market. However, some long-term studies of specific DM stems did not confirm the inferiority of these stems compared to standard single-modular (SM) stems, and a head-to-head comparison THA is missing. The objectives of this multicentre study were to determine the survivorship and complication rates of a common DM stem design compared to a similar SM stem. Materials and Methods: In a time frame from January 2012 to November 2015, a cohort of 807 patients (882 hips) consecutively underwent primary cementless THAs at two orthopaedic centres. 377 hips were treated with a Zweimüller-type DM stem THA system and 505 hips with a similar SM stem THA system, both including a modern press-fit...
2020
BackgroundContemporary uncemented femoral revision hip systems have become commonly used over the past decade and have enabled the reconstruction of leg length, offset and anteversionas independent variables through the use of modular junctions. Modular junction failures between the proximal body and distal stem have been described withrevision systems, although this is rare. We sought to identify the survivorship of one revision system in a salvage arthroplasty scenario where no host bone support of the modular junction was present.MethodsFrom a series of 136 patients, 15 patients (16 hips) were identified without host bone support of the modular junction with a mean radiological follow up of over 6 years(76 months +/- 35 months).ResultsThere have been no cases of prosthetic fracture over the follow-up duration, withtwo revisions performed for reasons of aseptic loosening and infection. The mean BMI of the study group was 30.2 with 78% of the cohort classified as overweight or obes...
The Journal of Arthroplasty, 2009
Femoral deficiency has been shown to adversely affect the results of revision total hip arthroplasty. Tapered titanium modular stems allow distal fixation of the fluted, conical portion of the implant in the setting of proximal bone loss. One hundred two consecutive hips with proximal bone loss underwent revision femoral reconstruction between 1998 and 2002 at 3 centers using the Link MP modular stem. Forty-three hips had Mallory type 3C femoral deficiency. Ninety-seven hips were observed for an average of 45 months (range, 24-72; median, 36 months). Clinically, mean Harris hip score improved from 36 to 84 (range, 54-99). Radiographically, 93 hips were considered stable, with no circumferential lucencies at the distal fixation surface. Three hips migrated and required revision, along with one periprosthetic fracture. Five other hips had nonprogressive migration of 1 to 2 mm.
Journal of orthopaedics, 2021
IntroductionThe objective of this study was to assess if the fracture and/or non-union of extended trochanteric osteotomy (ETO) affected the behavior and survival of modular fluted and tapered distal fixation stems in revision total hip arthroplasties (rTHA).MethodsWe retrospectively analyzed 52 rTHA in 52 patients. Preoperative diagnoses were mechanical loosening (42 cases), septic loosening (8), periprosthetic fracture (1), and femoral stem fracture (1). According to the Paprosky classification, femoral bone stock deficiencies were 19 type-II, 26 type IIIA, and 7 type IIIB. We assessed the behavior of the osteotomy (union, fracture, migration) and the survival and behavior (integration and subsidence) of prosthetic femoral stems.ResultsETO union and non-union rates were 84.61% (44 patients) and 15.38% (8 cases) respectively. There were twelve (23%) intra-operative fractures of the osteotomy fragment and 11 (21.15%) migrations (4.5 mm on average). We observed bone union in 39 (75%) stems and 13 (25%) stable fibrous unions. Nine (17.3%) stems subsided 7 mm (2–15 mm) on average before becoming stable. Stem subsidence and integration was not significantly affected by ETO fracture/no fracture or union/non-union. The postoperative Harris Hip Score (HHS) improved significantly as compared to the pre-operative HHS (38.41 ± 3.54 vs 85.29 ± 3.36; p < 0.01). Patients were followed up for 55 (24–100) months. The overall implant survival at the end of follow-up was 100%.ConclusionsIn this series, neither the non-union nor the intra-operative fracture of the ETO segment affected the behavior or medium-term survival of femoral stems.
Management of Significant Femoral Bone Loss with Use of Modular Stems
Seminars in Arthroplasty, 2008
Significant femoral bone loss can be encountered in the multiply revised patient. Deficient proximal bone requires either a bulk allograft or a femoral component that allows stable distal fixation. Extensively coated stems have shown excellent results for many revisions but have shown higher rates of failure among patients with femoral remodeling in retroversion, an enlarged endosteal diameter, or an ectatic canal. A modular tapered stem is an alternative in this subset of patients. A modular tapered implant provides axial and rotational stability through the use of distal splines while the proximal body segments can allow independent adjustment of leg length, offset, and anteversion. We previously reported the 1-to 4-year (average 2 years) results of modular tapered femoral prosthesis in cementless femoral revisions. In the previous study there were 16 patients all with Type IIIB or IV Paprosky femurs. This is a follow-up of that article reporting on 24 patients, all with Type IIIB or IV Paprosky femurs with a follow-up of 2 to 5 years (average 3 years). We revised one component for subsidence, one component was revised for fracture at the modular junction, and one component was revised for sepsis. Semin Arthro 19:152-158
Revision total hip arthroplasty with modular femoral stems
The Journal of arthroplasty, 2014
As the rate of revision total hip arthroplasty (THA) rises, attention must be paid to potential complications relating to bone loss, soft tissue deficiencies, and loss of tissue planes. Using modular femoral stems in revision surgery allows for varying amounts of bone loss in the proximal and distal femur while letting the surgeon adjust rotation, leg length, and offset. We retrospectively reviewed 125 patients that underwent revision THA with a modular femoral component system and had minimum 2 year follow-up. Ten patients required reoperations for infection, recurrent dislocation, or fracture treatment. There was no evidence of radiographic loosening or mechanical failure in the remaining patients. Modular femoral components provide excellent intraoperative flexibility and significant radiographic and clinical benefits as seen in this patient cohort.
Orthopaedics & traumatology, surgery & research : OTSR, 2013
The modular concept has been recommended in femoral revision surgery with extensive bone loss, but entails mechanical complications: disassembly and fracture. The present retrospective study assessed the Mark I Extrême™ modular prosthesis at a minimum 5 years' follow-up. A cementless modular femoral stem facilitates revision in case of extensive bone loss, providing satisfactory results without risk of junction failure. Thirty-three prostheses presenting aseptic loosening, including 3 with periprosthetic fracture, in 23 female and 9 male patients, with a mean age of 65 years (range, 49-83 years), were reviewed at a mean 6.3 years' follow-up (range, 5-9 years). Bone loss was assessed on the SOFCOT (17/33 grade 3 or 4) and Paprosky classifications (19/33 grade III or IV). One patient died; another was lost to follow-up, leaving 31 hips for analysis. Clinical assessment comprised Postel Merle d'Aubigné (PMA) and Harris Hip scores (HHS); radiological assessment used the Engh...