Abstract
The aim of this study was to present the clinical and functional results of revision surgery after failed hip endoprostheses using the Modular Universal Tumour And Revision System (MUTARS®). Functional results of the hip endoprostheses were recorded by applying the Harris hip score. The extent of the presurgical radiological bone defect was measured according to the classification system of the German orthopaedic association (DGOOC). Indications for revision surgery on 45 patients (21 female, 24 male) were aseptic loosening (19 patients), infection (16 patients), or periprosthetic fracture (Vancouver classification B2, B3 and C, in nine patients). Revision surgery was performed after 8.6 years on average (min. 0.6; max. 14.25 years). Large defects of the proximal femur (80% medial or lateral diaphysis; 20% meta-diaphysis according to DGOOC classification) were adequately reconstructed. The average follow-up was 38.6 months. Complications occurred in eight patients: one luxation, two aseptic loosenings, and five reinfections were diagnosed. The Harris hip score (presurgical 30; postsurgical 78) showed significant improvement after revision surgery. Regarding the extent of the patients’ bone defects, good functional results were achieved. The comparatively low number of luxations and loosenings is due to the high modularity of the prosthesis with arbitrary antetorsion in the hip joint. However, high reinfection rates in mega-implants still constitute a problem and should be the subject of further studies.
Similar content being viewed by others
References
Bettin D, Katthagen BD (1997) The German Society of Orthopedics and Traumatology classification of bone defects in total hip endoprostheses revision operations. Z Orthop Ihre Grenzgeb 135:281–284
Ulrich SD, Seyler TM, Bennett D, Delanois RE, Saleh KJ, Thongtrangan I, Kuskowski M, Cheng EY, Sharkey PF, Parvizi J, Stiehl JB, Mont MA (2008) Total hip arthroplasties: what are the reasons for revision?. Int Orthop 32:597–604. doi:10.1007/s00264-007-0364-3
Wirtz DC, Heller KD, Holzwarth U, Siebert C, Pitto RP, Zeiler G, Blencke BA, Forst R (2000) A modular femoral implant for uncemented stem revision in THR. Int Orthop 24:134–138
Wirtz DC, Niethard FU (1997) Etiology, diagnosis and therapy of aseptic hip prosthesis loosening—a status assessment. Z Orthop Ihre Grenzgeb 135:270–280
Malchau H, Herberts P, Ahnfelt L (1993) Prognosis of total hip replacement in Sweden. Follow-up of 92,675 operations performed 1978–1990. Acta Orthop Scand 64:497–506
Engh CA, Glassman AH, Griffin WL, Mayer JG (1988) Results of cementless revision for failed cemented total hip arthroplasty. Clin Orthop:91–110
Hedley AK, Gruen TA, Ruoff DP (1988) Revision of failed total hip arthroplasties with uncemented porous-coated anatomic components. Clin Orthop 235:75–90
Wagner H, Wagner M (1993) Femur revision prosthesis. Z Orthop Ihre Grenzgeb 131:574–577
Gustilo RB, Pasternak HS (1988) Revision total hip arthroplasty with titanium ingrowth prosthesis and bone grafting for failed cemented femoral component loosening. Clin Orthop:111–119
Gosheger G, Hillmann A, Lindner N, Rodl R, Hoffmann C, Burger H, Winkelmann W (2001) Soft tissue reconstruction of megaprostheses using a trevira tube. Clin Orthop 235:264–271
Gosheger G, Winkelmann W (2000) Mutars—a modular tumor and revision system. Experiences at the Munster Tumor Center. Orthopade 29(Suppl 1):S54–S55
Kent M, Rachha R, Sood M (2009) A technique for the fabrication of a reinforced moulded articulating cement spacer in two-stage revision total hip arthroplasty. Int Orthop. doi:10.1007/s00264-009-0847-5
Brady OH, Garbuz DS, Masri BA, Duncan CP (1999) Classification of the hip. Orthop Clin North Am 30:215–220
Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755
Chandler H, Clark J, Murphy S, McCarthy J, Penenberg B, Danylchuk K, Roehr B (1994) Reconstruction of major segmental loss of the proximal femur in revision total hip arthroplasty. Clin Orthop 298:67–74
Malkani AL, Sim FH, Chao EY (1993) Custom-made segmental femoral replacement prosthesis in revision total hip arthroplasty. Orthop Clin North Am 24:727–733
Blackley HR, Davis AM, Hutchison CR, Gross AE (2001) Proximal femoral allografts for reconstruction of bone stock in revision arthroplasty of the hip. A nine to fifteen-year follow-up. J Bone Joint Surg Am 83-A:346–354
Baba T, Shitoto K (2009) Revision of total hip arthroplasty using the Kerboull and KT plates. Int Orthop. doi:10.1007/s00264-009-0789-y
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 31:851–857. doi:10.1007/s00264-006-0275-8
Wraighte PJ, Howard PW (2008) Femoral impaction bone allografting with an Exeter cemented collarless, polished, tapered stem in revision hip replacement: a mean follow-up of 10.5 years. J Bone Joint Surg Br 90:1000–1004
Frances A, Moro E, Cebrian JL, Marco F, Garcia-Lopez A, Serfaty D, Lopez-Duran L (2007) Reconstruction of bone defects with impacted allograft in femoral stem revision surgery. Int Orthop 31:457–464. doi:10.1007/s00264-006-0211-y
Schmale GA, Lachiewicz PF, Kelley SS (2000) Early failure of revision total hip arthroplasty with cemented precoated femoral components: comparison with uncemented components at 2 to 8 years. J Arthroplasty 15:718–729
Yoo JJ, Kwon YS, Koo KH, Yoon KS, Kim YM, Kim HJ (2009) One-stage cementless revision arthroplasty for infected hip replacements. Int Orthop 33:1195–1201. doi:10.1007/s00264-008-0640-x
Ogino D, Kawaji H, Konttinen L, Lehto M, Rantanen P, Malmivaara A, Konttinen L, Salo J (2008) Total hip replacement in patients eighty years of age and older. J Bone Joint Surg Am 90:1884–1890
Diekerhof CH, Barnaart LF, Rozing PM (2000) Long-term clinical results of cemented revision of primary cemented total hip arthroplasties. Acta Orthop Belg 66:376–381
Stöckl B, Kulhanek A, Steindl V, Mayr E, Krismer M (2007) Langzeitüberleben der zementierten Langschaftprothese LINK SP II nach Revisionsoperationen. 29 Jahrestagung der Österreichischen Gesellschaft für Orthopädie und Orthopädische Chirurgie, Wien
Tanzer M, Chan S, Brooks CE, Bobyn JD (2001) Primary cementless total hip arthroplasty using a modular femoral component: a minimum 6-year follow-up. J Arthroplasty 16:64–70
Crawford SA, Siney PD, Wroblewski BM (2000) Revision of failed total hip arthroplasty with a proximal femoral modular cemented stem. J Bone Joint Surg Br 82:684–688
Kavanagh BF, Ilstrup DM, Fitzgerald RH Jr (1985) Revision total hip arthroplasty. J Bone Joint Surg Am 67:517–526
Cameron HU (2002) The long-term success of modular proximal fixation stems in revision total hip arthroplasty. J Arthroplasty 17:138–141
Author information
Authors and Affiliations
Corresponding author
Additional information
Carsten Gebert and Martin Wessling contributed equally to this paper.
Rights and permissions
About this article
Cite this article
Gebert, C., Wessling, M., Götze, C. et al. The Modular Universal Tumour And Revision System (MUTARS®) in endoprosthetic revision surgery. International Orthopaedics (SICOT) 34, 1261–1265 (2010). https://doi.org/10.1007/s00264-010-1007-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-010-1007-7