title: Revision Hip Arthroplasty Using a Modular, Cementless Femoral Stem: Intermediate-Term Follow-Up.
abstract: Modular femoral stem provides flexibility in femoral reconstruction, ensuring improved "fit and fill". However, there are risks of junction failure and corrosion, as well as cost concerns in the use of modular femoral stems.
  
  
  
  We reviewed prospectively-gathered clinical and radiographic data on revision total hip arthroplasties (THAs) performed from 2001-2007 using modular, cementless femoral component performed by the 2 senior authors. Patients with a minimum follow-up of 7 years were included in this study.
  
  
  
  Sixty-four patients (68 hips) with a median age of 68 ± 14 years (range 40-92 years) at revision THA were included. The median follow-up was 11.0 ± 1.8 years (range 7-14). Harris hip score, femoral stem subsidence, and stem osseointegration were recorded. The Harris hip score improved from an average of 38.1-80.1 (P < .01). Five hips had one or more dislocations. Seven patients underwent reoperations, 3 of which did not involve the stem. Four stems required revision because of infection, recurrent dislocation, or suboptimal implant position. Survival rates for any reasons and revision for femoral stems were 90% and 94%, respectively, at the most recent follow-up. Four stems subsided more than 5 mm, but established stable osseointegration thereafter. Seven nonloose stems (10.2%) demonstrated radiolucent lines in Gruen zones 1 and 7. No complications regarding the modular junction were encountered.
  
  
  
  Modular, cementless, extensively porous-coated femoral components have demonstrated intermediate-term clinical and radiographic success. Initial distal intramedullary fixation ensures stability, and proximal modularity further maximizes fit and fill.
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
authors.forename: Sureshan
authors.initials: S
authors.lastname: Sivananthan
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California; Department of Orthopaedic Surgery, National University Hospital, Singapore.
authors.forename: Chin-Tat
authors.initials: CT
authors.lastname: Lim
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
authors.forename: Rapeepat
authors.initials: R
authors.lastname: Narkbunnam
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
authors.forename: Alex
authors.initials: A
authors.lastname: Sox-Harris
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
authors.forename: James I
authors.initials: JI
authors.lastname: Huddleston
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Goodman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D011474:Prosthesis Design; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data*
keywords: complications; modular stem; outcome; radiographic analysis; revision hip replacement