Revision total hip arthroplasty in patients with extensive proximal femoral bone loss using a fluted tapered modular femoral component.
Revision total hip arthroplasty (THA) is challenging when there is severe loss of bone in the proximal femur. The purpose of this study was to evaluate the clinical and radiographic outcomes of revision THA in patients with severe proximal femoral bone loss treated with a fluted, tapered, modular femoral component. Between January 1998 and December 2004, 92 revision THAs were performed in 92 patients using a single fluted, tapered, modular femoral stem design. Pre-operative diagnoses included aseptic loosening, infection and peri-prosthetic fracture. Bone loss was categorised pre-operatively as Paprosky types III-IV, or Vancouver B3 in patients with a peri-prosthetic fracture. The mean clinical follow-up was 6.4 years (2 to 12). A total of 47 patients had peri-operative complications, 27 of whom required further surgery. However, most of these further operations involved retention of a well-fixed femoral stem, and 88/92 femoral components (97%) remained in situ. Of the four components requiring revision, three were revised for infection and were well fixed at the time of revision; only one (1%) was revised for aseptic loosening. The most common complications were post-operative instability (17 hips, 19%) and intra-operative femoral fracture during insertion of the stem (11 hips, 12%). Diaphyseal stress shielding was noted in 20 hips (22%). There were no fractures of the femoral component. At the final follow-up 78% of patients had minimal or no pain. Revision THA in patients with extensive proximal femoral bone loss using the Link MP fluted, tapered, modular stem led to a high rate of osseointegration of the stem at mid-term follow-up. Cite this article: Bone Joint J 2015; 97-B:312-17.
Stanford University, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, California 94063, USA.
D F
DF
Amanatullah
London Health Sciences Centre, 339 Windermere Road, London, Ontario N6K 4R1, Canada.
J L
JL
Howard
Mayo Clinic, 200 First Street SW, Gonda 14, Rochester, Minnesota 55905, USA.
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H
Siman
Mayo Clinic, 200 First Street SW, Gonda 14, Rochester, Minnesota 55905, USA.
R T
RT
Trousdale
Mayo Clinic, 200 First Street SW, Gonda 14, Rochester, Minnesota 55905, USA.
T M
TM
Mabry
Mayo Clinic, 200 First Street SW, Gonda 14, Rochester, Minnesota 55905, USA.
D J
DJ
Berry
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D015519:Bone Density; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D061646:Operative Time; D016348:Osseointegration; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011474:Prosthesis Design; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
total hip arthroplasty; proximal bone deficiency; revision