Abstract
BackgroundModular stems are widely used in revision total hip arthroplasty (THA) with aseptic loosening being a common reason for revision. Despite the good results reported on the use of modular stem designs, there are only few studies focusing on aseptic revisions and few studies on a hexagonal stem design. The goal of this study is to determine stem survival, clinical and functional outcome along with possible risk factors for implant failure in aseptic revision THA.MethodsWe retrospectively identified 53 patients with aseptic THA revision using a modular hexagonal stem with a minimum follow-up of two years. Femoral bone loss, radiographic and clinical outcomes as well as function measured using the Harris Hip Score (HHS) was assessed. Patients’ previous medical history was analyzed for comorbidities and the body mass index. Stem survival was calculated using the Kaplan-Meier method. Possible risk factors for implant failure were analyzed using the log-rank test. The median age at revision was 69 (IQR 62–73) with a median follow up of 74 months.ResultsImplant survival rates amounted to 90.4% at 3 and 5 years. The median HHS improved by 47 points (34 (IQR 22–47) vs 81 (IQR 59–90) p<0.001). There was a reduced implant survival after 5 years when the revision stem was used following a previous cemented stem (83.4% vs 100%, p = 0.04).ConclusionA modular, hexagonal stem can be successfully used in aseptic revision THA with remarkable functional results and excellent survivorship. Revision of a cemented stem using this implant might result in reduced survival which must be considered when planning treatment.
Highlights
Total hip arthroplasty (THA) is a successful treatment option for osteoarthritis and leads to excellent outcomes in the long-term [1]
The median Harris Hip Score (HHS) improved by 47 points (34 (IQR 22–47) vs 81 (IQR 59–90) p
A modular, hexagonal stem can be successfully used in aseptic revision total hip arthroplasty (THA) with remarkable functional results and excellent survivorship
Summary
Total hip arthroplasty (THA) is a successful treatment option for osteoarthritis and leads to excellent outcomes in the long-term [1]. One of the most common reasons for revision surgery is aseptic loosening with 16.8% of revision THA performed for this indication. Despite offering great intraoperative variability to address different defects and reconstruct the hip’s center of rotation as well as leg length irrespective of the distal fixation in cases of major bone loss [7,8,11,12], there are downsides to modularity with previous studies reporting potential mechanical failures of the junctional sites such as fretting, fatigue fractures or corrosion [11,13,14,15]. Modular stems are widely used in revision total hip arthroplasty (THA) with aseptic loosening being a common reason for revision. The goal of this study is to determine stem survival, clinical and functional outcome along with possible risk factors for implant failure in aseptic revision THA
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