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01-04-2015 | Original Paper

Long, titanium, cemented stems decreased late periprosthetic fractures and revisions in patients with severe bone loss and previous revision

Authors: Hernigou Philippe, Dupuys Nicolas, Delambre Jerome, Guissou Isaac, Poignard Alexandre, Allain Jerome, Charles Henri Flouzat Lachaniette

Published in: International Orthopaedics | Issue 4/2015

Purpose

Long, cementless, femoral stem revisions are being used with increasing frequency. There is a relative lack of studies of late fractures after cementless implants, particularly in those patients who had a previous stem revision and are at higher risk for periprosthetic fracture after revision. In this paper, we review risk factors for periprosthetic fracture and revisions of long, cementless, locked stems and report implant survival compared with conventional, cemented, long-stem hip revision arthroplasties in such a group of patients.

Methods

We used data recorded in our institution. Between 1996 and 2002, 85 cementless femoral stem Aura™ (distal locked stem) prostheses were implanted in 85 patients. Of the 85 revisions with long, cementless stems, 32 were performed after one stem revision, 20 after two stem revisions and 12 after three stem revisions. Between 2003 and 2010, 124 femoral revision stems were performed in 124 patients using an extensively long, titanium femoral stem (Ceraver Osteal™). Kaplan-Meier analysis was used to determine implant survival. The Cox regression model was used to study risk factors for reoperation and revision.

Results

The increase in stem length corresponded to a mean of 4.5 ± 2.1 femoral canal diameters and was not significantly different (p = 0.02) between the two groups. Cardiopulmonary distress, intraoperative or postoperative complications were not significantly different between the two groups. There was an overall increased risk of pain, periprosthetic fractures and revision for the cementless prostheses compared with the cemented stems. With regard to thigh pain at the last follow-up, most patients (95 %) reported no pain in the cemented group, while 15 % of the cementless group experienced thigh pain under stress and 6 % had incapacitating pain. In the cemented group, stem re-revision was not required in any hip; there was no periprosthetic fracture; five stems had radiological loosening but in the absence of pain were not revised. Among patients of the cementless group, 21 % sustained failure or revision of their interlocked stem with periprosthetic fractures observed in 15 cases; factors which contributed significantly to a higher risk of fracture included the number of previous revisions; the average time between surgery and failure was 3.2 years after one revision, 2.8 years after two revisions, and 1.6 years after three revisions.

Conclusions

The long, cementless, locked stem showed more early complications compared with recementing of long-stem prosthesis. We therefore recommend the use of cemented long stems in patients with severe bone loss and previous revision.

Fink B, Grossmann A, Schubring S, Schulz MS, Fuerst M (2009) Short-term results of hip revisions with a curved cementless modular stem in association with the surgical approach. Arch Orthop Trauma Surg 129:65–73CrossRefPubMed

Garbuz DS, Masri BA, Duncan CP (1998) Periprosthetic fractures of the femur: principles of prevention and management. Instr Course Lect 47:237–242PubMed

Gie GA, Linder L, Ling RS, Simon JP, Slooff TJ, Timperley AJ (1993) Impacted cancellous allografts and cement for revision total hip arthroplasty. J Bone Joint Surg Br 75:14–21PubMed

Gosens T, van Langelaan EJ (2005) Clinical and radiological outcome of hydroxyapatite-coated femoral stem in revision hip arthroplasty. Int Orthop 4:219–223CrossRef

Howie DW, Wimhurst JA, McGee MA, Carbone TA, Badaruddin BS (2007) Revision total hip replacement using cemented collarless double-taper femoral components. J Bone Joint Surg Br 89:879–886CrossRefPubMed

Hultmark P, Karrholm J, Stromberg C, Herberts P, Mose CH, Malchau H (2000) Cemented first-time revisions of the femoral component: prospective 7–13 years follow-up using second generation and third-generation technique. J Arthroplast 15:551–561CrossRef

Malhotra R, Dua A, Kiran EK, Bhan S (2007) Femoral revision using long hydroxyapatite-coated interlocking stem. Arch Orthop Trauma Surg 128:355–362CrossRefPubMed

Courpied JP, Postel M (1989) Allogreffes massives pour reconstruction de la diaphyse fémorale. Rev Chir Orthop 75(Suppl 1):53–54

Vastel L, Lemoine CT, Kerboull M, Courpied JP (2007) Structural allograft and cemented long-stem prosthesis for complex revision hip arthroplasty: use of a trochanteric claw plate improves final hip function. Int Orthop 6:851–857CrossRef

10.

Berry DJ (2003) Periprosthetic fractures associated with osteolyis: a problem on the rise. J Arthroplasty 18:107–111CrossRefPubMed

11.

Kelley SS (1994) Periprosthetic femoral fractures. J Am Acad Orthop Surg 2:164–172PubMed

12.

Lewallen DG, Berry DJ (1998) Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date. Instr Course Lect 47:243–249PubMed

13.

Lindahl H, Eisler T, Oden A et al (2006) Risk factors associated with the late periprosthetic femoral fracture. In: Lindahl H (ed) The periprosthetic femur fracture: a study from the Swedish National Hip Arthroplasty Register. Department of Orthopaedics, Sahlgenska Academy, Goteberg University, Goteberg

14.

Lindahl H, Garellick G, Regner H et al (2006) Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am 88:1215–1222CrossRefPubMed

15.

Lindahl H, Malchau H, Herberts P, Garellick G (2005) Periprosthetic femoral fractures: classification and demographics of 1049 periprosthetic femoral fractures from the swedish national Hip arthroplasty register. J Arthroplasty 20:857–865CrossRefPubMed

16.

Yamada H, Yoshihara Y, Henmi O, Morita M, Shiromoto Y, Kawano T, Kanaji A, Ando K, Nakagawa M, Kosaki N, Fukaya E (2009) Cementless total hip replacement: past, present, and future. J Orthop Sci 14:228–241CrossRefPubMedCentralPubMed

17.

Wu CC, Au MK, Wu SS, Lin LC (1999) Risk factors for postoperative femoral fracture in cementless hip arthroplasty. J Formos Med Assoc 98:190–194PubMed

18.

Della Valle CJ, Paprosky WG (2004) The femur in revision total hip arthroplasty evaluation and classification. Clin Orthop Relat Res 420:55–62CrossRefPubMed

19.

Pitto RP, Schramm M, Hohmann D, Kossler M (1999) Relevance of the drainage along the linea aspera for the reduction of fat embolism during cemented total hip arthroplasty. A prospective, randomized clinical trial. Arch Orthop Trauma Surg 119:146–150CrossRefPubMed

20.

Nich C, Sedel L (2006) Bone substitution in revision hip replacement. Int Orthop 30:525–531CrossRefPubMedCentralPubMed

21.

Boisgard S, Moreau PE, Tixier H, Levai JP (2001) Reconstruction osseuse, inégalité de longueur des membres, taux de luxation de 52 prothèses de Wagner, en révision d’arthroplasties totales de hanche au recul moyen de 44 moi. Rev Chir Orthop 87:147–154PubMed

22.

Bohm P, Bischel O (2001) Femoral revision with the Wagner SL revision stem: evaluation of 129 revisions followed for a mean of 4.8 years. J Bone Jt Surg Am 83:1023–1031CrossRef

23.

Vives P, Plaquet JL, Leclair A, Blejwas D, Filloux JF (1992) Tige de reprise verrouillée pour descellement des prothèses totales de hanche. Conception. Résultats préliminaires. Acta Orthop Belg 59:28–35

24.

Kavanagh BF, Ilstrup DM, Fitzgerald RH Jr (1985) Revision total hip arthroplasty. J Bone Joint Surg Am 67:517–526PubMed

25.

Kavanagh BF (1992) Femoral fractures associated with total hip arthroplasty. Orthop Clin North Am 23:249–257PubMed

26.

Sarvilinna R, Huhtala HS, Sovelius RT et al (2004) Factors predisposing to periprosthetic fracture after hip arthroplasty: a case–control study. Acta Orthop Scand 75:16–20CrossRefPubMed

27.

Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD Jr, Ranawat CS (1985) Results of revision for mechanical failure after cemented total hip replacement, 1979–1982. A 2–5 year follow-up. J Bone Joint Surg Am 67:1074–1085PubMed

28.

Sierra RJ, Charity J, Tsiridis E, Timperley JA, Gie GA (2008) The use of long cemented stems for femoral impaction grafting in revision total hip arthroplasty. J Bone Joint Surg Am 90:1330–1336CrossRefPubMed

29.

So K, Kuroda Y, Matsuda S, Akiyama H (2013) Revision total hip replacement with a cemented long femoral component: minimum 9-year follow-up results. Arch Orthop Trauma Surg 133:869–874CrossRefPubMed

30.

Mann KA, Ayers DC, Damron TA (1997) Effects of stem length on mechanics of the femoral hip component after cemented revision. J Orthop Res 15:62–68CrossRefPubMed

31.

Retpen JB, Jensen JS (1993) Risk factors for recurrent aseptic loosening of the femoral component after cemented revision. J Arthroplast 8:471–478CrossRef

32.

Hamadouche M, Boutin P, Daussange J, Bolander ME, Sedel L (2002) Alumina-on-alumina total hip arthroplasty: a minimum 18.5-year follow-up study. J Bone Joint Surg Am 84(A):69–77PubMed

33.

Hinrichs F, Kuhl M, Boudriot U, Griss P (2003) A comparative clinical outcome evaluation of smooth (10–13 year results) versus rough surface finish (5–8 year results) in an otherwise identically designed cemented titanium alloy stem. Arch Orthop Trauma Surg 123:268–72CrossRefPubMed

34.

Mertl P, Philippot R, Rosset P, Migaud H, Tabutin J, Van de Velde D (2011) Distal locking stem for revision femoral loosening and peri-prosthetic fractures. Int Orthop 35:275–282CrossRefPubMedCentralPubMed

35.

Weiss RJ, Stark A, Karrholm J (2011) A modular cementless stem versus cemented long-stem prostheses in revision surgery of the hip: a population-based study from the Swedish Hip Arthroplasty Register. Acta Orthop 82:136–142CrossRefPubMedCentralPubMed

Title: Long, titanium, cemented stems decreased late periprosthetic fractures and revisions in patients with severe bone loss and previous revision
Authors: Hernigou Philippe
Dupuys Nicolas
Delambre Jerome
Guissou Isaac
Poignard Alexandre
Allain Jerome
Charles Henri Flouzat Lachaniette
Publication date: 01-04-2015
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 4/2015
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-014-2528-2

At a glance: The STEP trials

Springer Medicine

Long, titanium, cemented stems decreased late periprosthetic fractures and revisions in patients with severe bone loss and previous revision

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Purpose

Methods

Results

Conclusions

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