Distal fixation stems for revision of total hip replacement

Retrospective survival analysis of the use of uncemented modular tapered stems for revision in periprosthetic Vancouver B-type fractures. Is instability a threat to survival?

INTRODUCTION AND OBJECTIVES

Periprosthetic hip fractures show increasing incidence and complexity, representing a challenge for the surgeon. We aimed to evaluate the survival of uncemented modular tapered stems in the treatment of periprosthetic Vancouver B2 and B3 type fractures and review the main complications and factors associated with decreased survival.

MATERIALS AND METHODS

We performed a retrospective study of patients submitted to revision arthroplasty for treatment of periprosthetic femoral stem Vancouver B2 and B3 type fractures with an uncemented modular fluted tapered stem (MRP-Titan). Demographic and radiographic parameters were analyzed. The survival rate (free of reoperation) was calculated at 2- and 5-years using the Kaplan-Meier survivorship analysis.

RESULTS

Thirty-nine patients were included with a mean age of 73.5 years and a mean follow-up of 5 years. Arthroplasty survivorship at 2 years was 73.7% and at 5 years was 67.5% (mean 8.4 years; range 6.7-10.2). Survivorship was inferior in the patients with episodes of instability (mean 2.5 years; range 0-5.42) (p<0.001). At least one episode of instability occurred in 26.3% of patients and 60% of these patients had a femoral head size 32mm or lower. At least one episode of instability occurred in 71.4% of patients with a greater trochanter fracture (p=0.008). The consolidation rate was 90.6% and the mortality rate was 23.7%. In the group of patients that died, 55.6% were submitted to at least one revision surgery (p=0.044).

CONCLUSION

Survivorship of an uncemented modular stem (MRP-Titan) in revision for PHF is significantly reduced by episodes of instability.

Surgical management of hip prosthetic failure in metallosis: A case series and literature review

Local and remote complications can be observed in hip prosthesis failures associated with metallosis. Structural changes in the periprosthetic bone and soft tissues may not always be precisely assessed preoperatively due to metal artifacts. The unpredictability of the damage extension, potentially leading to complex and insidious surgeries, requires the availability of alternative surgical plan(s) for the reconstruction of the joint. The aim of the study is to present and analyze, with the literature data support, practical tips for the revision of the prosthetic components, the management of ARMD and of intraoperative complications in the unusual scenario of metallosis.

Midterm results and complications rates in vancouver type B2 and B3 periprosthetic femoral fractures treated with modular fluted tapered stems

Evaluate the mid-term success rate of these stems in periprosthetic femur fractures and to analyze the complications observed with the use of these stems.

METHODS

Thirty five patients that underwent hip revision surgery secondary to Vancouver type B2 and B3 periprosthetic femur fracture were evaluated. In all cases, modular fluted tapered stems were used.

RESULTS

Average follow-up was 42 months. Average Postoperative Harris Hip Score (HHS) was 78.11. Fracture healing was obtained in a 100% of the patients. Average implant survival was 50 months.

CONCLUSION

Modular fluted tapered stems demonstrated a high rate implant stability, proximal femoral bone reconstitution, and fracture healing.