Conical Primary Cementless Stem in Revision Hip Arthroplasty: 94 Consecutive Implantations at a Mean Follow-Up of 12.7 years

Sergio Romagnoli; Matteo Marullo; Michele Corbella; Enrico Zero; Andrea Parente; Marco Bargagliotti

doi:10.1016/j.arth.2020.10.006

Conical Primary Cementless Stem in Revision Hip Arthroplasty: 94 Consecutive Implantations at a Mean Follow-Up of 12.7 years

J Arthroplasty. 2021 Mar;36(3):1080-1086. doi: 10.1016/j.arth.2020.10.006. Epub 2020 Oct 22.

Authors

Sergio Romagnoli¹, Matteo Marullo¹, Michele Corbella¹, Enrico Zero², Andrea Parente³, Marco Bargagliotti¹

Affiliations

¹ Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
² Department of Informatics, Bioengineering, Robotics and System Engineering of the University of Genoa, Genoa, Italy.
³ Orthopedics and Traumatology Department, University of Milan, Milan, Italy.

PMID: 33187858
DOI: 10.1016/j.arth.2020.10.006

Abstract

Background: Revision of a failed total hip arthroplasty (THA) poses technical challenges. The use of primary stems for revision can be advantageous for maintaining bone stock and reducing complications: small case series have reported promising results in the short-term to mid-term follow-up. The aim of this study was to evaluate the long-term clinical and functional results and survivorship of a consecutive series of THA femoral component revisions using a conical primary cementless stem (PCS).

Methods: Ninety-four stem revisions with a preoperative Paprosky I or II defect were analyzed at an average follow-up of 12.7 ± 5.4 years. Aseptic loosening was the reason for revision in 92.5% of cases. Twenty patients were lost to follow-up. Two subgroups were created: Group 1 (n = 59) underwent isolated stem revision; Group 2 (n = 15) underwent complete THA revision. All were evaluated preoperatively and postoperatively based on the Harris Hip Score (HHS), the Western Ontario and McMaster Universities Index (WOMAC) score, and the visual analog scale for pain (VAS). Residual trochanteric pain and length discrepancies were recorded. Radiographic evaluation included signs of osteolysis, subsidence, loosening, and heterotopic ossification.

Results: PCS survivorship was 100% at 5 years and 95.9% at 10 years. Overall, significant postoperative improvements (P < .01) were observed on the HHS (44.3 vs 86.9), WOMAC (42.8 vs 82.8), and VAS (7.0 vs 3.0). Postoperative scores on all scales were higher for Group 1 (P < .01). Three patients (4.1%) underwent further stem revision. Demarcation lines (1 mm) were found in 12 (16.2%) patients and significant heterotopic ossifications in 22 (29.7%).

Conclusion: The use of PCS for stem revision in failed THA with a limited femoral bone defect is a reliable option for both isolated stem revision and concomitant cup revision in well-selected patients.

Keywords: aseptic loosening; hip revision surgery; primary cementless stem; survivorship; total hip arthroplasty.

MeSH terms

Arthroplasty, Replacement, Hip* / adverse effects
Follow-Up Studies
Hip Prosthesis*
Humans
Ontario
Prosthesis Design
Prosthesis Failure
Reoperation
Retrospective Studies
Treatment Outcome