Skip to main content
Top
Published in: Archives of Orthopaedic and Trauma Surgery 1/2009

01-01-2009 | Orthopaedic Surgery

Short-term results of hip revisions with a curved cementless modular stem in association with the surgical approach

Authors: Bernd Fink, Alexandra Grossmann, Svenja Schubring, Martin S. Schulz, Martin Fuerst

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2009

Login to get access

Abstract

Introduction

A prospective study was designed to test the hypothesis that short-term results after hip revisions are in association with the surgical approach with lower clinical scores for the transfemoral approach.

Materials and methods

A total of 120 hip revision operations with the modular cementless revision stem “Revitan Curved” (Zimmer GmbH, Winterthur, Switzerland), of which 42 replacements involved an endofemoral (posterolateral) approach and 78 implantations a transfemoral approach, were followed up over a period of at least 24 months.

Results

In the early post-operative stage, stems implanted transfemoral were associated with significantly lower Harris Hip Scores and a significantly more frequent appearance of Trendelenburg signs. The differences lessened at the end of the follow-up period. Within the group of transfemoral implantation, all six stems with a circular fixation zone measuring less than 3 cm had subsided and two of these had become loose; none of the stems with greater fixation zones exhibited these properties. In the case of the endofemoral implants, three stems exhibited sinking but there did not appear to be any relationship between this event and length of fixation zone.

Conclusion

The surgical approach has an association with the short-time outcomes of hip revsions using cementless modular stems. Transfemoral implantation of the “Revitan curved” stem requires a fixation zone of at least 3 cm and a longer period of rehabilitation.
Literature
1.
go back to reference Bircher HP, Riede U, Lüem M, Ochsner PE (2001) Der Wert der SL-Revisionsprothese nach Wagner zur Überbrückung großer Femurdefekte. Technik und Resultate. Orthopäde 30:294–303PubMedCrossRef Bircher HP, Riede U, Lüem M, Ochsner PE (2001) Der Wert der SL-Revisionsprothese nach Wagner zur Überbrückung großer Femurdefekte. Technik und Resultate. Orthopäde 30:294–303PubMedCrossRef
2.
go back to reference Böhm P, Bischel O (2001) Femoral revision with the Wagner SL revision stem. J Bone Joint Surg 83-A:1023–1031PubMed Böhm P, Bischel O (2001) Femoral revision with the Wagner SL revision stem. J Bone Joint Surg 83-A:1023–1031PubMed
3.
go back to reference Böhm P, Bischel O (2001) The uncemented diaphysal fixation of femoral revision stems in case of large bone defects—analysis of twelve years experience with the Wagner SL revision stem. Z Orthop 139:229–239PubMedCrossRef Böhm P, Bischel O (2001) The uncemented diaphysal fixation of femoral revision stems in case of large bone defects—analysis of twelve years experience with the Wagner SL revision stem. Z Orthop 139:229–239PubMedCrossRef
4.
go back to reference Böhm P, Bischel O (2004) The use of tapered stems for femoral revision surgery. Clin Orthop Rel Res 420:148–159CrossRef Böhm P, Bischel O (2004) The use of tapered stems for femoral revision surgery. Clin Orthop Rel Res 420:148–159CrossRef
5.
go back to reference Challgahan JJ, Slavati EA, Pellicci PM, Wilson PD, Ranawat CS (1985) Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982. A two to five-year follow-up. J Bone Joint Surg 67-A:1074–1085 Challgahan JJ, Slavati EA, Pellicci PM, Wilson PD, Ranawat CS (1985) Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982. A two to five-year follow-up. J Bone Joint Surg 67-A:1074–1085
6.
go back to reference Chen WM, McAuley JP, Engh CA Jr, Hopper RH Jr, Engh CA (2000) Extended slide trochanteric osteotomy for revision total hip arthroplasty. J Bone Joint Surg 82-A:1215–1219 Chen WM, McAuley JP, Engh CA Jr, Hopper RH Jr, Engh CA (2000) Extended slide trochanteric osteotomy for revision total hip arthroplasty. J Bone Joint Surg 82-A:1215–1219
7.
go back to reference Della Valle CJ, Berger RA, Rosenberg AG, Jacobs JJ, Sheinkop MB, Paprosky WG (2003) Extended trochanteric osteotomy in complex primary total hip arthroplasty. A brief note. J Bone Joint Surg 85-A:2385–2390PubMed Della Valle CJ, Berger RA, Rosenberg AG, Jacobs JJ, Sheinkop MB, Paprosky WG (2003) Extended trochanteric osteotomy in complex primary total hip arthroplasty. A brief note. J Bone Joint Surg 85-A:2385–2390PubMed
8.
go back to reference Dohmae Y, Bechthold JE, Sherman RE, Puno RM, Gustilo RB (1988) Reduction in cement-bone interface shear strength between primary and revision arthroplasty. Clin Orthop Relat Res 36:214–220 Dohmae Y, Bechthold JE, Sherman RE, Puno RM, Gustilo RB (1988) Reduction in cement-bone interface shear strength between primary and revision arthroplasty. Clin Orthop Relat Res 36:214–220
9.
go back to reference Duncan DP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304PubMed Duncan DP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304PubMed
10.
go back to reference Fink B, Hahn M, Fuerst M, Thybaut L, Delling G (2005) Principle of fixation of the cementless modular revision stem Revitan. Unfallchirurg 108:1029–1037PubMedCrossRef Fink B, Hahn M, Fuerst M, Thybaut L, Delling G (2005) Principle of fixation of the cementless modular revision stem Revitan. Unfallchirurg 108:1029–1037PubMedCrossRef
11.
go back to reference Fink B, Grossmann A (2007) Modified transfemoral approach to revision arthroplasty with uncemented modular revision stems. Oper Orthop Traumatol 19:32–55PubMedCrossRef Fink B, Grossmann A (2007) Modified transfemoral approach to revision arthroplasty with uncemented modular revision stems. Oper Orthop Traumatol 19:32–55PubMedCrossRef
12.
go back to reference Fink B, Grossmann A, Schubring S, Schulz MS, Fuerst M (2007) A modified transfemoral approach using modular cementless revision stems. Clin Orthop Relat Res 462:105–114PubMedCrossRef Fink B, Grossmann A, Schubring S, Schulz MS, Fuerst M (2007) A modified transfemoral approach using modular cementless revision stems. Clin Orthop Relat Res 462:105–114PubMedCrossRef
13.
14.
go back to reference Grünig R, Morscher E, Ochsner PE (1997) Three- to 7-year results with the uncemented SL femoral revision prosthesis. Arch Orthop Trauma Surg 116:187–197PubMedCrossRef Grünig R, Morscher E, Ochsner PE (1997) Three- to 7-year results with the uncemented SL femoral revision prosthesis. Arch Orthop Trauma Surg 116:187–197PubMedCrossRef
15.
go back to reference Gustilo RB, Pasternak HS (1988) Revision total hip arthroplasty with titanium ingrowth prosthesis and bone grafting for failed cemented femoral component loosening. Clin Orthop Relat Res 235:111–119PubMed Gustilo RB, Pasternak HS (1988) Revision total hip arthroplasty with titanium ingrowth prosthesis and bone grafting for failed cemented femoral component loosening. Clin Orthop Relat Res 235:111–119PubMed
16.
go back to reference Hartwig C-H, Böhm P, Czecg U, Reize P, Küsswetter W (1996) The Wagner revision stem in alloarthroplasty of the hip. Arch Orthop Trauma Surg 115:5–9PubMedCrossRef Hartwig C-H, Böhm P, Czecg U, Reize P, Küsswetter W (1996) The Wagner revision stem in alloarthroplasty of the hip. Arch Orthop Trauma Surg 115:5–9PubMedCrossRef
17.
go back to reference Hedley AD, Gruen TA, Ruoff OP (1988) Revision of failed total hip arthroplasties with uncemented porous-coated anatomic components. Clin Orthop Relat Res 235:75–90PubMed Hedley AD, Gruen TA, Ruoff OP (1988) Revision of failed total hip arthroplasties with uncemented porous-coated anatomic components. Clin Orthop Relat Res 235:75–90PubMed
18.
go back to reference Huffman GR, Ries MD (2003) Combined vertical and horizontal cable fixation of an extended trochanteric osteotomy site. J Bone Joint Surg 85-A:273–277PubMed Huffman GR, Ries MD (2003) Combined vertical and horizontal cable fixation of an extended trochanteric osteotomy site. J Bone Joint Surg 85-A:273–277PubMed
19.
go back to reference Isacson J, Stark A, Wallensten R (2000) The Wagner revision prosthesis consistently restores femoral bone structure. Int Orthop 24:139–142PubMedCrossRef Isacson J, Stark A, Wallensten R (2000) The Wagner revision prosthesis consistently restores femoral bone structure. Int Orthop 24:139–142PubMedCrossRef
20.
go back to reference Kolstad K, Adalberth G, Mallmin H, Milbrink J, Sahlsted B (1996) The Wagner revision stem for severe osteolysis. 31 hips followed for 1.5–5 years. Acta Orthop Scand 67:541–544PubMedCrossRef Kolstad K, Adalberth G, Mallmin H, Milbrink J, Sahlsted B (1996) The Wagner revision stem for severe osteolysis. 31 hips followed for 1.5–5 years. Acta Orthop Scand 67:541–544PubMedCrossRef
21.
go back to reference Krishnamurthy AB, MacDonald SJ, Paprosky WG (1997) 5- to 13-year follow-up study on cementless femoral components in revisions surgery. J Arthroplasty 12:839–847PubMedCrossRef Krishnamurthy AB, MacDonald SJ, Paprosky WG (1997) 5- to 13-year follow-up study on cementless femoral components in revisions surgery. J Arthroplasty 12:839–847PubMedCrossRef
22.
go back to reference Le Béguec P (2000) Système PFM-revision pour reprise d’une prothèse fémorale descellée. Maîtrise orthopédique 91 Le Béguec P (2000) Système PFM-revision pour reprise d’une prothèse fémorale descellée. Maîtrise orthopédique 91
23.
go back to reference Mardones R, Gonzalez C, Cabanela ME, Trousdale RT, Berry DJ (2005) Extended femoral osteotomy for revision of hip arthroplasty: results and complications. J Arthroplasty 20:79–83PubMedCrossRef Mardones R, Gonzalez C, Cabanela ME, Trousdale RT, Berry DJ (2005) Extended femoral osteotomy for revision of hip arthroplasty: results and complications. J Arthroplasty 20:79–83PubMedCrossRef
24.
go back to reference Miner TM, Momberger NG, Chong D, Paprosky WL (2001) The extended trochanteric osteotomy in revision hip arthroplasty: a critical review of 166 cases at mean 3-year, 9-month follow-up. J Arthroplasty 16:188–194PubMedCrossRef Miner TM, Momberger NG, Chong D, Paprosky WL (2001) The extended trochanteric osteotomy in revision hip arthroplasty: a critical review of 166 cases at mean 3-year, 9-month follow-up. J Arthroplasty 16:188–194PubMedCrossRef
25.
go back to reference Moreland JR, Bernstein ML (1995) Femoral revison hip arthroplasty with uncemented, porous-coated stems. Clin Orthop Rel Res 319:141–150 Moreland JR, Bernstein ML (1995) Femoral revison hip arthroplasty with uncemented, porous-coated stems. Clin Orthop Rel Res 319:141–150
26.
go back to reference Paprosky WG, Lawrence J, Cameron H (1990) Femoral defect classification. Clinical application. Orthop Rev 19(Suppl):9–15 Paprosky WG, Lawrence J, Cameron H (1990) Femoral defect classification. Clinical application. Orthop Rev 19(Suppl):9–15
27.
go back to reference Paprosky WG, Greidanus NV, Antoniou J (1999) Minimum 10-year results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res 369:230–242PubMedCrossRef Paprosky WG, Greidanus NV, Antoniou J (1999) Minimum 10-year results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res 369:230–242PubMedCrossRef
28.
go back to reference Paprosky WG, Weeden SH, Bowling JW Jr (2001) Component removal in revision total hip arthroplasty. Clin Orthop Relat Res 393:181–193PubMedCrossRef Paprosky WG, Weeden SH, Bowling JW Jr (2001) Component removal in revision total hip arthroplasty. Clin Orthop Relat Res 393:181–193PubMedCrossRef
29.
go back to reference Peters PC Jr, Head WC, Emerson RH Jr (1993) An extended trochanteric osteotomy for revision total hip replacement. J Bone Joint Surg 75-Br:158–159 Peters PC Jr, Head WC, Emerson RH Jr (1993) An extended trochanteric osteotomy for revision total hip replacement. J Bone Joint Surg 75-Br:158–159
30.
go back to reference Sieber HP, Le Bèguec P (2001) Einsatz des PFM-R-Schaftes bei Revisionseingriffen. In: Perka C, Zippel H (eds) Revisionsendoprothetik des Hüftgelenkes. Schaftrekonstruktion und perioperatives Management. Einhorn-Presse Verlag, pp 174–184 Sieber HP, Le Bèguec P (2001) Einsatz des PFM-R-Schaftes bei Revisionseingriffen. In: Perka C, Zippel H (eds) Revisionsendoprothetik des Hüftgelenkes. Schaftrekonstruktion und perioperatives Management. Einhorn-Presse Verlag, pp 174–184
31.
go back to reference Wagner H (1987) Revisionsprothese für das Hüftgelenk bei schwerem Knochenverlust. Orthopäde 16:295–300PubMed Wagner H (1987) Revisionsprothese für das Hüftgelenk bei schwerem Knochenverlust. Orthopäde 16:295–300PubMed
32.
go back to reference Wagner H (1989) Revisionsprothese für das Hüftgelenk. Orthopäde 18:438–453PubMed Wagner H (1989) Revisionsprothese für das Hüftgelenk. Orthopäde 18:438–453PubMed
34.
go back to reference Wagner H, Wagner M (1997) Hüftprothesenwechsel mit der Femur-Revisionsprothese. Erfahrungen von 10 Jahren. Med Orthop Tech 117:138–148 Wagner H, Wagner M (1997) Hüftprothesenwechsel mit der Femur-Revisionsprothese. Erfahrungen von 10 Jahren. Med Orthop Tech 117:138–148
35.
go back to reference Warren PJ, Thompson P, Flechter MDA (2002) Transfemoral implantation of the Wagner SL stem. The abolition of subsidence and enhancement of osteotomy union rate using Dall-Miles cables. Arch Orthop Trauma Surg 122:557–560PubMed Warren PJ, Thompson P, Flechter MDA (2002) Transfemoral implantation of the Wagner SL stem. The abolition of subsidence and enhancement of osteotomy union rate using Dall-Miles cables. Arch Orthop Trauma Surg 122:557–560PubMed
36.
go back to reference Weber M, Hempfing A, Orler R (2002) Femoral revision using the Wagener stem: results at 2–9 years. Int Orthop 26:36–39PubMedCrossRef Weber M, Hempfing A, Orler R (2002) Femoral revision using the Wagener stem: results at 2–9 years. Int Orthop 26:36–39PubMedCrossRef
37.
go back to reference Weeden SH, Paprosky WG (2002) Minimal 11-year follow-up of extensively porous-coated stems in femoral revision total hip arthroplasty. J Arthroplasty 17(4 Suppl 1):134–137PubMedCrossRef Weeden SH, Paprosky WG (2002) Minimal 11-year follow-up of extensively porous-coated stems in femoral revision total hip arthroplasty. J Arthroplasty 17(4 Suppl 1):134–137PubMedCrossRef
38.
go back to reference Wilkes RA, Birch J, Pearse MF, Lee M, Atkins RM (1994) The Wagner technique for revision arthroplasty of the hip: a review of 24 cases. J Orthop Rheum 7:196–198 Wilkes RA, Birch J, Pearse MF, Lee M, Atkins RM (1994) The Wagner technique for revision arthroplasty of the hip: a review of 24 cases. J Orthop Rheum 7:196–198
39.
go back to reference Wirtz DC, Niethard FU (1997) Ursachen, Diagnostik und Therapie der aseptischen Hüftendoprothesenlockerung—eine Standortbestimmung. Z Orthop 135:270–280PubMed Wirtz DC, Niethard FU (1997) Ursachen, Diagnostik und Therapie der aseptischen Hüftendoprothesenlockerung—eine Standortbestimmung. Z Orthop 135:270–280PubMed
40.
go back to reference Younger TI, Bradford MS, Magnus RE, Paprosky WG (1995) Extended proximal femoral osteotomy. A new technique for femoral revision arthroplasty. J Arthroplasty 10:329–338PubMedCrossRef Younger TI, Bradford MS, Magnus RE, Paprosky WG (1995) Extended proximal femoral osteotomy. A new technique for femoral revision arthroplasty. J Arthroplasty 10:329–338PubMedCrossRef
Metadata
Title
Short-term results of hip revisions with a curved cementless modular stem in association with the surgical approach
Authors
Bernd Fink
Alexandra Grossmann
Svenja Schubring
Martin S. Schulz
Martin Fuerst
Publication date
01-01-2009
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 1/2009
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-008-0617-7

Other articles of this Issue 1/2009

Archives of Orthopaedic and Trauma Surgery 1/2009 Go to the issue