Abstract
BackgroundBoth cylindrical and tapered stems are commonly used in revision total hip arthroplasty. However, whether the geometry of prosthesis stem has an effect on patient prognosis is unclear. We assume that the tapered stem results in better clinical outcome than the cylindrical stem.MethodsA multicenter review of 120 femoral revisions with Paprosky I, II, and III defects using cobalt chrome cylindrical stem (54 hips) or titanium tapered stem (66 hips) was performed with an average follow-up of 6 years. Demographic data were comparable between groups.ResultsNo significant group differences were found in surgery time, bleeding volume, postoperative Harris Hip Score, level of overall satisfaction, and 8-year cumulative survival. However, intraoperative fractures occurred significantly less in the tapered group (4.5%) than in the cylindrical group (14.8%), and stem subsidence was significantly less in the tapered group (2.17 mm) than in the cylindrical group (4.17 mm). A higher ratio of bone repair and lower bone loss were observed in the tapered group compared with the cylindrical group. The postoperative thigh pain rate was higher in the cylindrical group (12.9%) than in the tapered group (4.5%).ConclusionBoth cylindrical stem and tapered stem can achieve satisfactory mid-term clinical results in revision total hip arthroplasty. The tapered stem has better bone restoration of proximal femur, lower incidence of intraoperative fractures, and lower postoperative thigh pain rate compared with the cylindrical stem.
Highlights
Both cylindrical and tapered stems are commonly used in revision total hip arthroplasty
The Visual Analogue Scale (VAS) score in the cylindrical and tapered groups decreased from 7.6 ± 1.6 to 2.0 ± 0.4 (P < 0.05) and from 7.5 ± 1.2 to 1.8 ± 0.2 (P < 0.05), respectively
At the last follow-up, no significant difference was observed in the Harris Hip Score between the two groups (P > 0.05), but the VAS score of the cylindrical group was higher than that of the tapered group (P = 0.047) (Fig. 1)
Summary
Both cylindrical and tapered stems are commonly used in revision total hip arthroplasty. With the increase of primary THA worldwide, especially in younger patient populations, the number of cases requiring revision hip arthroplasty has been increasing due to aseptic loosening, fracture, and dislocation of Cemented prostheses are mostly used in the early femoral revision of the hip joint. The distal part of the prosthesis is cylindrical, and the prosthesis can cross the defective area of the proximal femur. With the help of the close compression between the prosthesis and the distal femoral medullary cavity, the initial rotation stability and axial stability of the prosthesis can be achieved, thereby creating conditions for secondary bone growth. Several studies have shown that good clinical and imaging results can be obtained when extensively coated cylindrical stem is used in revision THA [2, 6, 7]. In some patients with Paprosky type III femoral defects, the failure rate of these femoral stems is high [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
