Subsidence of monoblock and modular titanium fluted tapered stems in revision hip arthroplasty: A retrospective multicentre comparison study

Eoghan Pomeroy; Seán O Flynn; Mihai Grigoras; Terence P Murphy; Alexandra I Stavrakis; Fiachra E Rowan

doi:10.1016/j.jcot.2022.102021

Subsidence of monoblock and modular titanium fluted tapered stems in revision hip arthroplasty: A retrospective multicentre comparison study

J Clin Orthop Trauma. 2022 Sep 13:34:102021. doi: 10.1016/j.jcot.2022.102021. eCollection 2022 Nov.

Authors

Eoghan Pomeroy¹, Seán O Flynn¹, Mihai Grigoras¹, Terence P Murphy¹, Alexandra I Stavrakis², Fiachra E Rowan¹

Affiliations

¹ Department of Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland.
² Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 76-143 CHS, Los Angeles, CA, 90095-6902, USA.

Abstract

Background: Tapered, fluted, titanium (TFT) stems have shown good clinical outcomes in revision total hip arthroplasty (rTHA), however concerns exist regarding early subsidence. This study compares subsidence between a modern monoblock 3-degree and a modular 2-degree TFT stem in rTHA.

Methods: A retrospective, international multicentre comparative study was conducted including 64 rTHA in 63 patients. A monoblock TFT stem was used in 37 cases and a modular TFT stem was used in 27 cases. Patient demographics, Paprosky femoral bone loss classification, bicortical contact and stem subsidence were recorded at minimum four week follow up.

Results: There was no statistically significant difference in overall subsidence (p = 0.318) or the rate of subsidence >10 mm between stems. Mean subsidence was 2.13 mm in the monoblock group and 3.15 mm in the modular group. Two stems subsided >10 mm: one in each group. There was no difference in bicortical contact between groups (p = 0.98). No re-revisions were performed.

Conclusions: We found no difference in subsidence between the two stems. Surgeons may consider the use of monoblock stems in rTHA as they have comparably low rates of subsidence and eliminate the small but potentially catastrophic risk of implant fracture at modular junctions associated with modular stems.

Keywords: Hip replacement; Modular; Monoblock; Revision; Subsidence.