S-ROM Modular Stem Research Articles

Outcomes after Total Hip Arthroplasty Using a Cementless S-ROM Modular Stem for Patients with High Hip Dislocation Secondary to Hip Pyogenic Arthritis.

ObjectiveTo evaluate the midterm results of the cementless S‐ROM modular femoral stem used with subtrochanteric transverse shortening osteotomy for the treatment of high hip dislocation secondary to hip pyogenic arthritis.MethodsWe retrospectively reviewed the data of 49 patients (49 hips) with an average infection quiescent period of 37.4 years who underwent cementless total hip arthroplasty (THA) with simultaneous subtrochanteric transverse shortening osteotomy from July 2008 to June 2012. There were 23 men and 26 women with a mean age of 44.3 years at the time of surgery. The following clinical outcomes were evaluated: the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, Harris hip score (HSS), modified Merle d'Aubigne‐Postel hip (MAP) score, low back pain visual analog scale score, 12‐item short‐form health survey questionnaire score, limp, and Trendelenburg sign. Radiographic outcomes and complications were also evaluated.ResultsThe mean follow‐up period was 8.7 years (range, 5.5–10 years). No infection recurrence was observed after THA. The average HSS significantly improved from 45.0 to 84.8. The WOMAC score improved from 70.1 ± 3.5 (range, 65–76) to 43.1 ± 13.4 (range, 21–67). The modified MAP score improved from 5.9 ± 1.9 (range, 3–9) to 14.3 ± 2.4 (range, 11–18). The low back pain visual analog scale score, 12‐item short‐form health survey questionnaire score, limp, and Trendelenburg sign also improved significantly. The average limb length discrepancy decreased from 39.6 mm (range, 30–55 mm) to 7.2 mm (range, 0–22 mm). Two patients had temporary sciatic nerve paralysis but recovered within 6 months without any functional defects; one had an intraoperative fracture fixed by cerclage wires. One hip required revision surgery because of femoral stem aseptic loosening.ConclusionsThe cementless S‐ROM modular femoral stem used with subtrochanteric transverse shortening osteotomy is safe and effective for high hip dislocation secondary to pyogenic arthritis and provides satisfactory midterm results. Significant improvements in clinical function were observed, as were high rates of stable fixation of the cementless implant, restoration of more normal limb lengths, and a low incidence of complications.

Medium-term outcomes of the S-ROM modular femoral stem in revision hip replacement.

The objective of this study was to analyse results achieved with the S-ROM modular stem in revision surgery. A retrospective observational study was conducted from 2007 to 2015 including 51 patients who had a follow-up of ≥ 2years and complete medical history. The mean age was 66.5years old (34-87). The main reason for revision was aseptic loosening (38 cases, 74.5%), followed by infection (10, 19.6%), instability (2, 3.9%) and an adverse reaction associated with a metal-on-metal hip implant (1, 2%). Using the Paprosky classification, there were 22 cases of type I (43.1%), 27 of type II (52.9%) and 2 of type IIIA (4%). At the end of the follow-up, radiological parameters were assessed using Engh's criteria. Pre- and postoperative clinical status was assessed using the Harris Hip Score, a visual analogue scale and the Merle D'Aubigné score. The mean follow-up period was 5.7years (2-10). The mean Harris Hip Score improved from 45.5 points (22-65) to 85.8 (55-100) (p < 0.001), and the final mean Merle D'Aubigné scores were 5.2, 4.6 and 5.6 for pain, ability to walk and mobility, respectively. Osseointegration was confirmed in all except one patient with fibrous non-union. No aseptic loosening has been recorded. Postoperative complications were deep infection in four cases (7.8%) and dislocation in three (5.9%). This study indicates good medium-term outcomes using a modular hip replacement system with porous-coated proximal sleeves in revision surgery in patients with Paprosky type I and II defects.

Clinical results in early and mid term of using the S-ROM femoral stem in revision

To investigate and the clinical effect of S-ROM modular stem in femur reconstruction in hip revision arthroplasty. From January 2008 to January 2016, 21 patients received revision hip arthroplasties using S-ROM stems. There were 5 males and 16 females with an average of 48.33 years old(range, 29 to 73 years old). There were 13 cases caused by aseptic loosening, 4 cases by infection, 2 cases by nonunion of sub-tuberosity osteotomy, 1 case for repeated dislocation, 1 case for traumatic great trochanter fracture. Primary THA reasons:12 cases for DDH(9 cases for Crowe IV), 5 cases for femoral neck fracture, 2 cases for necrosis of femoral head, 2 cases for proximal femoral deformity caused by early infection. The femur bone defects included Paprosky II in 11 cases, IIIa in 9, and IIIb in 1. Harris hip score , pain score and hip flexion were recorded before and after operation. The subjective satisfaction was recorded at the last follow-up. The operation time and blood loss were 189 min(125 to 290 min) and 867 ml (200 to 2 000 ml). At the final followup, the pain score improved from (17.14±9.56) points preoperatively to (41.71±2.03) points (t=11.42, P=0.00). The function score improved from (24.01±11.02) points preoperatively to (49.95±5.38) points (t=9.73, P=0.00). Harris hip score improved from (41.15±14.81) points preoperatively to(91.67±5.83) points(t=15.33, P=0.00). The degree of hip flexion increased from (93.10±27.27) points preoperatively to (121.90±16.62) points at the last follow-up (t=4.59, P=0.00). The mean subjective satisfaction was 9.48(10 points system), 14 of which were completely satisfactory. The last follow-up hip X-ray showed 21 cases of bone ingrowth, and other femoral stem without loosening or sinking sign significantly. There were 5 cases with bone anchor syndrome around proximal femoral cuff. There were 5 cases of proximal femur fracture, 3 cases of lesser trochanter fracture, 2 cases of greater trochanter fracture intra-operatively. Due to femoral canal stenosis, there were 4 cases of pre-tied wire at lesser trochanter to prevent fractures. There was 1 case of traumatic femoral fracture around stems with a distal oblique fracture, open reduction and locking plate fixation was performed. Other patients had no nerve stretch injury, dislocation, infection and lower limb deep vein thrombosis and other complications at the final follow-up. S-ROM prosthesis has satisfactory results in hip revision arthroplasty with Paprosky II and III femoral defects. Especially for patients with Crowe IV DDH and other proximal femoral deformities, it is possible to adapt to the medullary cavity morphology. Excellent initial stability, less complications and long-term biological fixation can be achieved with S-ROM in femur revision.

Long-term comparison of porous and hydroxyapatite sleeves in femoral revision using the S-ROM modular stem

We prospectively evaluated the results of a single-surgeon series of 28 femoral revision arthroplasties using the S-ROM modular stem with either a porous-coated sleeve (15 hips) or a hydroxyapatite-coated sleeve (13 hips) after a mean of 10 years (range, 8-14 years). Three femoral stems underwent repeat femoral revision for aseptic loosening in association with Paprosky type III bone defects after a mean of 9 years in vivo (range, 8-10 years). One on these 3 had a porous-coated sleeve and the other 2 had a hydroxyapatite-coated sleeve. With repeat revision for any reason as the end point, femoral component survival was 83.8% at 10 years for the entire series, and 93.3% for the porous-coated sleeve group and 76.2% for the hydroxyapatite-coated sleeve group, respectively (log-rank test, P=0.588). No significant difference was detected between the 2 groups regarding postoperative Harris hip scores, bone ingrowth, stress-shielding, osteolysis, or complication rates. At a mean of 10 years postoperatively, hydroxyapatite-coated sleeves offered no clinical benefit over porous-coated sleeves for revision hip replacement using the S-ROM modular stem. Our findings also indicate that hydroxyapatite-coated sleeves did not reduce late mechanical stem failures in cases with a deficient femur.

Total Hip Arthroplasty Using the S-ROM Modular Stem After Joint-Preserving Procedures for Osteonecrosis of the Femoral Head

The aim of this study was to test the hypothesis that a previous joint-preserving procedure for osteonecrosis of the femoral head (ONFH) would compromise the outcome of a subsequent total hip arthroplasty. The clinical and radiographic results of total hip arthroplasty using the S-ROM stem (DePuy/Johnson & Johnson, Leeds, UK) in 36 hips with failed joint-preserving procedures for ONFH were compared with those in a matched control group of 39 osteonecrotic hips without a previous joint-preserving procedure. After a mean follow-up of 4.6 years, with the exception of 1 reoperation for polyethylene wear and osteolysis, no revisions due to mechanical failure of the prostheses had been performed in the study cohort of 36 hips. However, the study group had a longer operative time, more perioperative blood loss, a higher rate of intraoperative complications, and poorer postoperative ranges of hip motion than those in the control group. These results confirm the hypothesis that a previous joint-preserving procedure for ONFH poses technical challenges for a subsequent total hip reconstruction and might have a detrimental effect on the short-term clinical outcome.

Cementless Total Hip Arthroplasty Using the Modular S-ROM Prosthesis Combined with Corrective Proximal Femoral Osteotomy

We present the results of total hip arthroplasty using S-ROM (Depuy, Warsaw, Ind) prosthesis combined with corrective femoral transverse osteotomy for hips with proximal femoral deformity. Fourteen hips were followed up for a mean of 61 months (range, 36-95 months), with a mean age at surgery of 55 years (range, 44-69 years). The average intraoperative blood loss was 638 mL, and the average operative time was 136 minutes. The average Harris Hip Score increased from 38.0 (range, 15.0-55.7) preoperatively to 82.0 (range, 34.6-92.7) at the latest follow-up. All the hips except for 1 acquired union of osteotomy and bone ingrowth. S-ROM modular stem, which gives sufficient rotational stability at both proximal and distal parts of the osteotomy, is useful for total hip arthroplasty combined with corrective femoral transverse osteotomy.

Leg Length Inequality in Total Hip Arthroplasty

Postoperative leg length inequality after total hip arthroplasty frequently leads to medical liability issues because no standard exists regarding the acceptable disparity. Modular stems allow control of offset, independent sizing of the distal femoral anatomy, as well as proximal medullary sizing. The authors compared the restoration of leg length in two cohort protocols. In the 2001 cohort, tapered stems were exclusively used, giving priority to fit and fill of the medullary canal. In the 2004 cohort, porous-tapered stems, or an S-ROM modular stem (DePuy Orthopaedics Inc., Warsaw, Ind) when needed, were used based on preoperative templating to restore the center of femoral head rotation. Prior to and after surgery, length from center measurements were taken (center of rotation of the femoral head to the top of the lesser trochanter) and the vertical vector to compare the difference in actual leg length. In the 2001 cohort, the mean increase of length from center was 9 mm (7 mm leg length). In the 2004 cohort, 25% of the hips were inappropriate for tapered stems. S-ROMs were used because a tapered stem would lengthen the leg. In the standard offset tapered stem, the mean increase of length from center was 6 mm (4 mm leg length). In the high offset tapered stem, the mean increase of length from center was 7 mm (5 mm leg length). In the S-ROM stem with varying offsets, the mean increase of length from center was 6 mm (4 mm leg length). Only the S-ROM consistently avoids overlengthening in the majority of patients.

Total hip replacement after upper femoral osteotomy. A clinical review.

The Journal of Bone and Joint Surgery. British volumeVol. 64-B, No. 5 ArticlesFree AccessTotal hip replacement after upper femoral osteotomy. A clinical reviewGJ Benke, AS Baker, E DounisGJ BenkeSearch for more papers by this author, AS BakerSearch for more papers by this author, E DounisSearch for more papers by this authorPublished Online:1 Dec 1982https://doi.org/10.1302/0301-620X.64B5.7142264AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byComparison of Total Hip Arthroplasty Outcomes after Failed Femoral Wedge or Curved Varus OsteotomyThe Open Orthopaedics Journal, Vol. 12, No. 1THA Following Previous Varus or Valgus Osteotomy4 September 2017Outcomes of total hip arthroplasty in patients with osteonecrosis of the femoral head—a current review5 June 2015 | Current Reviews in Musculoskeletal Medicine, Vol. 8, No. 3Managing AVN following internal fixation: Treatment options and clinical resultsInjury, Vol. 46, No. 3Does Previous Osteotomy Compromise Total Hip Arthroplasty? A Systematic ReviewThe Journal of Arthroplasty, Vol. 30, No. 1Hip arthroplasty in patients with complex femoral deformity after surgical treatment of dysplasia12 December 2014 | Traumatology and Orthopedics of Russia, Vol. 20, No. 4Cemented total hip arthroplasty with retention of some existing hardware2 July 2014 | Case Reports, Vol. 2014, No. jul02 1Proximal femoral osteotomies in childrenOrthopaedics & Traumatology: Surgery & Research, Vol. 99, No. 1Ostéotomies de l'extrémité supérieure du fémur chez l'enfantTreatment of Femoral Head Aseptic Necrosi15 March 2011 | N.N. Priorov Journal of Traumatology and Orthopedics, Vol. 18, No. 1SAS Weekly Rounds: Avascular Necrosis1 September 2009 | HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery, Vol. 5, No. 2DeformityTotal Hip Arthroplasty After Failed Operative Treatment for Osteonecrosis of the Femoral HeadSeminars in Arthroplasty, Vol. 19, No. 4Total Hip Arthroplasty in Proximal Femoral Deformities and Retained HardwareSeminars in Arthroplasty, Vol. 19, No. 4Intertrochanteric Osteotomies Do Not Impair Long-term Outcome of Subsequent Cemented Total Hip ArthroplastiesClinical Orthopaedics & Related Research, Vol. 444Microsurgical Fibular Flap for Treatment of Avascular Necrosis of the Femoral HeadJournal of the American College of Surgeons, Vol. 202, No. 2The S-ROM Modular Stem for Femoral DeformitiesOrthopedics, Vol. 28, No. 9Total Hip Arthroplasty After Failed Transtrochanteric Rotational Osteotomy for Avascular Necrosis of the Femoral HeadThe Journal of Arthroplasty, Vol. 20, No. 5Proximal Femoral Deformity: Bent but Not BrokenOrthopedics, Vol. 27, No. 9Bone grafting for osteonecrosis of the femoral headSeminars in Arthroplasty, Vol. 15, No. 3Total hip arthroplasty in patients with osteonecrosisSeminars in Arthroplasty, Vol. 15, No. 3Femoral Osteotomies for Avascular Necrosis of the Femoral HeadClinical Orthopaedics and Related Research, Vol. 418Osteotomies as treatment for osteonecrosisCurrent Opinion in Orthopaedics, Vol. 14, No. 1Free Vascularized Fibular Grafting of the Femoral Head for the Treatment of OsteonecrosisTechniques in Orthopaedics, Vol. 16, No. 1The Role of Intertrochanteric Osteotomy in the Treatment of OsteonecrosisTechniques in Orthopaedics, Vol. 16, No. 1Coxarthrosis After Traumatic Hip Dislocation in the AdultClinical Orthopaedics and Related Research, Vol. 377MANAGEMENT OF OSTEONECROSIS IN SYSTEMIC LUPUS ERYTHEMATOSUSRheumatic Disease Clinics of North America, Vol. 26, No. 2Total Hip Arthroplasty in Patients With Proximal Femoral DeformityClinical Orthopaedics and Related Research, Vol. 369Total Hip Replacement Following Prior SurgeriesRevascularization of the Femoral Head in OsteonecrosisJournal of the American Academy of Orthopaedic Surgeons, Vol. 6, No. 1Coexistence of dissimilar metals after conversion of intertrochanteric osteotomy to total hip arthroplasty31 August 2016 | Acta Orthopaedica Scandinavica, Vol. 68, No. sup275Total Hip Arthroplasty With Femoral Osteotomy for Proximal Femoral DeformityClinical Orthopaedics and Related Research, Vol. 332Corrective Osteotomy for Osteonecrosis of the Femoral Head. The Results of a Long-Term Follow-up Study*The Journal of Bone & Joint Surgery, Vol. 78, No. 7Synoviorthese, SynovektomieNon-traumatic avascular necrosis of the femoral head.The Journal of Bone & Joint Surgery, Vol. 77, No. 3The Lower LimbTotal hip arthroplasty after McMurray's osteotomyThe Journal of Arthroplasty, Vol. 6Hip arthroplasty after biplanar femoral osteotomyThe Journal of Arthroplasty, Vol. 4, No. 1 Vol. 64-B, No. 5 Metrics History Published online 1 December 1982 Published in print 1 December 1982 InformationCopyright © 1982, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download