Skip to main content
SpringerLink
Log in

High Medium-term Survival of Zweymüller SLR-Plus® Stem Used in Femoral Revision

  • Original Article
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Revision after failed THA resulting from loosening of the femoral component can be challenging even for experienced surgeons. Aseptic loosening usually is associated with some degree of bone loss. We asked whether the Zweymüller SLR-Plus®, along with allograft reconstruction of the deficient femoral bone stock, would provide survivorship, osseointegration, and stability similar to or better than previously reported implants for femoral revision. We retrospectively reviewed 69 selected patients (70 hips) who underwent revision of the femoral component using the SLR-Plus® stem during a 10-year period. The indications for revision included aseptic and septic failure of biologic fixation, incorrect implantation, and periprosthetic fracture. Seven patients died and four were lost to followup. Fifty-eight of the 69 patients (59 hips) were available at a mean 8.3 ± 2.7 years (range, 4–14 years) after revision surgery. There were 14 men and 44 women (mean age, 69 years; range, 42–89 years). Four stems (7%) were rerevised. With rerevision for aseptic reasons, the survival at 10 years was 95% (95% confidence interval, 86%–98%). No femoral periprosthetic osteolysis occurred around the stem and 91% of stems appeared stable radiographically (osseointegration, fibrous). Based on the survival data, we believe the SLR-Plus® stems are reliable for patients undergoing hip revision surgery with central bone loss.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6A–B
Fig. 7

Similar content being viewed by others

References

  1. Amstutz HC, Ma SM, Jinnah RH, Mai L. Revision of aseptic loose total hip arthroplasties. Clin Orthop Relat Res. 2004;420:2–9.

    Article  PubMed  Google Scholar 

  2. Barnett E, Nordin BE. The radiological diagnosis of osteoporosis: a new approach. Clin Radiol. 1960;11:166–174.

    Article  PubMed  CAS  Google Scholar 

  3. Barrack RL, Folgueras AJ. Revision total hip arthroplasty: the femoral component. J Am Acad Orthop Surg. 1995;3:79–85.

    PubMed  Google Scholar 

  4. Berry DJ. Femoral revision: distal fixation with fluted, tapered grit-blasted stems. J Arthroplasty. 2002;17(suppl 1):142–146.

    Article  PubMed  Google Scholar 

  5. Berry DJ, Harmsen WS, Ilstrup D, Lewallen DG, Cabanela ME. Survivorship of uncemented proximally porous-coated femoral components. Clin Orthop Relat Res. 1995;319:168–177.

    PubMed  Google Scholar 

  6. Böhm P, Bischel O. Femoral revision with the Wagner SL revision stem: evaluation of one hundred and twenty-nine revisions followed for a mean of 48 years. J Bone Joint Surg Am. 2001;83:1023–1031.

    Article  PubMed  Google Scholar 

  7. Böhm P, Bischel O. The use of tapered stems for femoral revision surgery. Clin Orthop Relat Res. 2004;420:148–159.

    Article  PubMed  Google Scholar 

  8. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–1632.

    PubMed  CAS  Google Scholar 

  9. Busija L, Osborne RH, Nilsdotter A, Buchbinder R, Roos EM. Magnitude and meaningfulness of change in SF-36 scores in four types of orthopedic surgery. Health Qual Life Outcomes. 2008;6:55.

    Article  PubMed  Google Scholar 

  10. D’Antonio J, McCarthy JC, Bargar WL, Borden LS, Cappelo WN, Collis DK, Steinberg ME, Wedge JH. Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1993;296:133–139.

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  12. Dohmae Y, Bechtold JE, Sherman RE, Puno RM, Gustilo RB. Reduction in cement-bone interface shear strength between primary and revision arthroplasty. Clin Orthop Relat Res. 1988;236:214–220.

    PubMed  Google Scholar 

  13. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement: the factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987;69:45–55.

    PubMed  CAS  Google Scholar 

  14. Engh CA Jr, Hopper RH Jr, Engh CA Sr. Distal ingrowth components. Clin Orthop Relat Res. 2004;420:135–141.

    Article  PubMed  Google Scholar 

  15. Estok DM, Harris WH. Long-term results of cemented femoral revision surgery using second-generation techniques: an average 11.7-year follow-up evaluation. Clin Orthop Relat Res. 1994;299:190–202.

    PubMed  Google Scholar 

  16. Gorab RS, Covino BM, Borden LS. The rationale for cementless revision total hip replacement with contemporary technology. Orthop Clin North Am. 1993;24:627–633.

    PubMed  CAS  Google Scholar 

  17. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.

    PubMed  Google Scholar 

  18. Grünig R, Morscher E, Ochsner PE. Three- to 7-year results with the uncemented SL femoral revision prosthesis. Arch Orthop Trauma Surg. 1997;116:187–197.

    Article  PubMed  Google Scholar 

  19. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end result study using a new method of results evaluation. J Bone Joint Surg Am. 1969;51:737–755.

    PubMed  CAS  Google Scholar 

  20. Head WC, Malinin TI, Emerson RH Jr, Mallory TH. Restoration of bone stock in revision surgery of the femur. Int Orthop. 2000;24:9–14.

    Article  PubMed  CAS  Google Scholar 

  21. Hedley AK, Gruen TA, Ruoff DP. Revision of failed total hip arthroplasties with uncemented porous-coated anatomic components. Clin Orthop Relat Res. 1988;235:75–90.

    PubMed  Google Scholar 

  22. Hungerford DS, Jones LC. The rationale of cementless revision of cemented arthroplasty failures. Clin Orthop Relat Res. 1988;235:12–24.

    PubMed  Google Scholar 

  23. Hungerford MW, Hungerford DS, Khanuja HS, Pietryak BP, Jones LC. Survivorship of femoral revision hip arthroplasty in patients with osteonecrosis. J Bone Joint Surg Am. 2006;88(suppl 3):126–130.

    Article  PubMed  Google Scholar 

  24. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.

    Article  Google Scholar 

  25. Katz RP, Callaghan JJ, Sullivan PM, Johnston RC. Long-term results of revision total hip arthroplasty with improved cementing technique. J Bone Joint Surg Br. 1997;79:322–326.

    Article  PubMed  CAS  Google Scholar 

  26. Kavanagh BF, Fitzgerald RH Jr. Multiple revisions for failed total hip arthroplasty not associated with infection. J Bone Joint Surg Am. 1987;69:1144–1149.

    PubMed  CAS  Google Scholar 

  27. Kershaw CJ, Atkins RM, Dodd CA, Bulstrode CJ. Revision total hip arthroplasty for aseptic failure: a review of 276 cases. J Bone Joint Surg Br. 1991;73:564–568.

    PubMed  CAS  Google Scholar 

  28. Kim YH. Cementless revision hip arthroplasty using strut allografts and primary cementless proximal porous-coated prosthesis. J Arthroplasty. 2004;19:573–581.

    Article  PubMed  Google Scholar 

  29. Kolstad K, Adalberth G, Mallmin H, Milbrink J, Sahlstedt B. The Wagner revision stem for severe osteolysis: 31 hips followed for 1.5–5 years. Acta Orthop Scand. 1996;67:541–544.

    PubMed  CAS  Google Scholar 

  30. Korovessis P, Baikousis A, Stamatakis M. First experience with the use of compression cerclage Gundolf in orthopaedic and trauma surgery: a preliminary report. Arch Orthop Trauma Surg. 1998;117:448–452.

    Article  PubMed  CAS  Google Scholar 

  31. Korovessis P, Petsinis G, Repanti M, Repantis T. Metallosis after contemporary metal-on-metal total hip arthroplasty: five to nine-year follow-up. J Bone Joint Surg Am. 2006;88:1183–1191.

    Article  PubMed  CAS  Google Scholar 

  32. Krishnamurthy AB, Macdonald SJ, Paprosky WG. 5- to 13-year follow-up study on cementless femoral components in revision surgery. J Arthroplasty. 1997;12:839–847.

    Article  PubMed  CAS  Google Scholar 

  33. Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87:1487–1497.

    Article  PubMed  Google Scholar 

  34. Lawrence JM, Engh CA, Macalino GE. Revision total hip arthroplasty: long-term results without cement. Orthop Clin North Am. 1993;24:635–644.

    PubMed  CAS  Google Scholar 

  35. Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007;38:651–654.

    Article  PubMed  Google Scholar 

  36. Loehr JF, Schutz U, Zund T, Drobny T, Munzinger U. [Intermediate term outcome of a hip prosthesis revision system] [in German]. Orthopäde. 2001;30:304–309.

    Article  Google Scholar 

  37. Malhotra R, Dua A, Kiran EK, Bhan S. Femoral revision using long hydroxyapatite-coated interlocking stem. Arch Orthop Trauma Surg. 2008;128:355–362.

    Article  PubMed  CAS  Google Scholar 

  38. Malkani AL, Lewallen DG, Cabanela ME, Wallrichs SL. Femoral component revision using an uncemented, proximally coated, long-stem prosthesis. J Arthroplasty. 1996;11:411–418.

    Article  PubMed  CAS  Google Scholar 

  39. Maurer SG, Baitner AC, Di Cesare PE. Reconstruction of the failed femoral component and proximal femoral bone loss in revision hip surgery. J Am Acad Orthop Surg. 2000;8:354–363.

    PubMed  CAS  Google Scholar 

  40. Meek D, Garbuz D, Masri B, Greidanus N, Dunkan C. Intraoperative fracture of the femur in revision total hip arthroplasty with a diaphyseal fitting stem. J Bone Joint Surg Am. 2004;86:480–485.

    PubMed  Google Scholar 

  41. Mulliken BD, Rorabeck CH, Bourne RB. Uncemented revision total hip arthroplasty: a 4-to-6-year review. Clin Orthop Relat Res. 1996;325:156–162.

    Article  PubMed  Google Scholar 

  42. Paprosky WG, Greidanus NV, Antoniou J. Minimum 10-year-results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res. 1999;369:230–242.

    Article  PubMed  Google Scholar 

  43. Pellicci PM, Wilson PD Jr, Sledge CB, Salvati EA, Ranawat CS, Poss R, Callaghan JJ. Long-term results of revision total hip replacement: a follow-up report. J Bone Joint Surg Am. 1985;67:513–516.

    PubMed  CAS  Google Scholar 

  44. Retpen JB, Varmarken JE, Rock ND, Jensen JS. Unsatisfactory results after repeated revision of hip arthroplasty 61 cases followed for 5 (1–10) years. Acta Orthop Scand. 1992;63:120–127.

    Article  PubMed  CAS  Google Scholar 

  45. Rubash HE, Harris WH. Revision of nonseptic, loose, cemented femoral components using modern cementing techniques. J Arthroplasty. 1988;3:241–248.

    Article  PubMed  CAS  Google Scholar 

  46. Schuh A, Holzwarth U, Zeiler G. [Titanium modular revision prosthesis stem in revision hip prosthesis] [in German]. Orthopade. 2004;33:63–67.

    Article  PubMed  CAS  Google Scholar 

  47. Sotereanos N, Sewecke J, Raukar GJ, DeMeo PJ, Bargiotas K, Wohlrab D. Revision total hip arthroplasty with a custom cementless stem with distal cross-locking screws: early results in femora with large proximal segmental deficiencies. J Bone Joint Surg Am. 2006;88:1079–1084.

    Article  PubMed  Google Scholar 

  48. Van Kleunen JP, Anbari KK, Vu D, Garino JP. Impaction allografting for massive femoral defects in revision hip arthroplasty using collared textured stems. J Arthroplasty. 2006;21:362–371.

    Article  PubMed  Google Scholar 

  49. Volkmann R, Bretschneider C, Eingartner C, Weller S. Revision arthroplasty—femoral aspect: the concept to solve high grade defects. Int Orthop. 2003;27(suppl 1):S24–S28.

    PubMed  Google Scholar 

  50. Wagner H. [Revision prosthesis for the hip joint in severe bone loss] [in German]. Orthopade. 1987;16:295–300.

    Google Scholar 

  51. Walter WL, Walter WK, Zicat B. Clinical and radiographic assessment of a modular cementless ingrowth femoral stem system for revision hip arthroplasty. J Arthroplasty. 2006;21:172–178.

    Article  PubMed  Google Scholar 

  52. Weber M, Hempfing A, Orler R, Ganz R. Femoral revision using the Wagner stem: results at 2–9 years. Int Orthop. 2002;26:36–39.

    Article  PubMed  CAS  Google Scholar 

  53. Woolson ST, Delaney TJ. Failure of a proximally porous-coated femoral prosthesis in revision total hip arthroplasty. J Arthroplasty. 1995;10:S22–S28.

    Article  PubMed  Google Scholar 

  54. Zicat B, Engh CA, Gokcen E. Patterns of osteolysis around total hip components inserted with and without cement. J Bone Joint Surg Am. 1995;77:432–439.

    PubMed  CAS  Google Scholar 

  55. Zweymuller KA, Schwarzinger UM, Steindl MS. Radiolucent lines and osteolysis along tapered straight cementless titanium hip stems: a comparison of 6-year and 10-year follow-up results in 95 patients. Acta Orthop. 2006;77:871–876.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Panagiotis Iliopoulos, MD, PhD, for evaluating the hip radiographs and Petter Fennema for statistical and survivorship analysis.

Author information

Authors and Affiliations

  1. Orthopedic Department, General Hospital “Agios Andreas”, 1, Tsertidou Street, 26335, Patras, Greece

    Panagiotis Korovessis MD, PhD & Thomas Repantis MD

Authors
  1. Panagiotis Korovessis MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas Repantis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Panagiotis Korovessis MD, PhD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This paper is a part of the thesis of the resident Thomas Repantis, that is in progress at the University of Patras, Medical School, Greece.

About this article

Cite this article

Korovessis, P., Repantis, T. High Medium-term Survival of Zweymüller SLR-Plus® Stem Used in Femoral Revision. Clin Orthop Relat Res 467, 2032–2040 (2009). https://doi.org/10.1007/s11999-009-0760-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-009-0760-7

Keywords

Search

Navigation