Mid to long-term results of total hip revision with cementless modular tapered stem

Abstract

Objective To evaluate medium and long term results of the revision total hip replacement with the cementless, modular, tapered stem. Methods From May 2000 to May 2011, the patients with tumors, prosthetic infections and follow-up for less than five years were excluded; 37 patients (39 hips) underwent total hip revision surgery with cementless modular tapered stem in the First Affiliated Hospital of Soochow University due to aseptic loosening and bone defect of femur. This study included 21 hips revised with the Lima (Lima-Lto, Udine, Italy) prosthesis and 18 hips revised with the Link MP (Waldemar Link, Hamburg, Germany) prosthesis. The time from primary total hip arthroplasty to revision was four to 15 years, (10.4±3.7) years on average. First revision was given in all the patients. Pre-revision diagnosis showed type IIIa (Paprosky classification) in 28 hips, type IIIb in 11 hips. All the bearing surfaces using ceramic-ceramic hip bearings. Harris scores were compared by t test, while the bone defection type was analysed by chi-square test. Results The mean follow-up time was (11.6±2.3) years (range, 6~16 years). Among the patients, 26 patients were evaluated at a minimum follow-up time of 10 years. There was no significant difference in femoral defect between two kinds of prosthesis revision (χ2=0.434; P>0.05). The Harris hip score was (43±10) preoperatively and maintain (90±3) at the latest follow-up (t=32.334; P 0.05). The X-ray films showed bone ingrowths fixation in 38 hips (97.4%) and fibrous stable fixation in one hip (2.6%). The average stem subsidence was (2.1±2.3)mm(range, 0-10 mm). There was no re-revision of the femoral stem for any reason. Conclusion The mid-long term results of revision total hip replacement with the cementless, modular, tapered stem are encouraging in Paprosky type IIIa and IIIb femoral defect associated aseptic loosening of the femoral stem. Key words: Arthroplasty, replacement, hip; Reoperation; Prosthesis design