Skip to main content
SpringerLink
Log in

Long-term survivorship of a monoblock long cementless stem in revision total hip arthroplasty

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to assess the clinical outcomes, complications, and survival of a long cementless titanium femoral stem in revision total hip arthroplasty (THA) at a minimum five year follow-up.

Methods

Between 2000 and 2010, 114 patients (116 hips), with a mean age of 68 ± 12 years, underwent revision THA using a KAR® stem (DePuy, Leeds, UK). The main reasons for revision were aseptic loosening (82%), periprosthetic joint infections (PJI) (11%), and periprosthetic fractures (6%). Mean follow-up was ten ± three years (range, 5–16). Harris Hip Score (HHS), Oxford Hip Score (OHS), and Postel-Merle d’Aubigné (PMA) score were recorded. Radiographic analysis assessed stem osseointegration and subsidence. Survival was analyzed using the Kaplan-Meier (KM) method and cumulative incidence function (CIF).

Results

Post-operative HHS was 83 ± 15 (range, 35–99) and OHS was 37 ± 8 (range, 8–48). PMA score significantly increased from 12 ± 2 (range, 5–18) pre-operatively to 14.6 ± 2 (range, 9–18) post-operatively (p = 0.0004). The radiographic Engh score was 15 ± 8 (range, 7–22). Stem subsidence was observed in two cases (3%). At ten years, five stems had been revised, three for infections and two for periprosthetic fractures. Using the KM method, ten year survival free of stem revision for aseptic loosening was 100%, free of revision for any reason 95%, and free of any re-operation 81%.

Conclusions

The present study reported satisfactory outcomes and survival of a long tapered unlocked cementless femoral stem in revision THA at a minimum follow-up of five years.

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. 6

Similar content being viewed by others

References

  1. Haynes JA, Stambough JB, Sassoon AA et al (2015) Contemporary surgical indications and referral trends in revision total hip arthroplasty: a 10-year review. J Arthroplast 31:622–625

    Article  Google Scholar 

  2. Pinaroli A, Lavoie F, Cartillier JC et al (2009) Conservative femoral stem revision: avoiding therapeutic escalation. J Arthroplast 24:365–373

    Article  Google Scholar 

  3. Hartman CW, Garvin KL (2012) Femoral fixation in revision total hip arthroplasty. Instr Course Lect 61:313–325

    PubMed  Google Scholar 

  4. Smith MA, Deakin AH, Allen D et al (2016) Midterm outcomes of revision total hip arthroplasty using a modular revision hip system. J Arthroplast 31:446–450

    Article  Google Scholar 

  5. Hoberg M, Konrads C, Engelien J et al (2015) Outcome of a modular tapered uncemented titanium femoral stem in revision hip arthroplasty. Int Orthop 39:1709–1713

    Article  Google Scholar 

  6. Kim YH, Park JW, Kim JS et al (2015) High survivorship with cementless stems and cortical strut allografts for large femoral bone defects in revision THA. Clin Orthop Relat Res 473:2990–3000

    Article  Google Scholar 

  7. Thomsen PB, Jensen NJ, Kampmann J et al (2013) Revision hip arthroplasty with an extensively porous-coated stem - excellent long-term results also in severe femoral bone stock loss. Hip Int 23:352–358

    Article  Google Scholar 

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

    Article  Google Scholar 

  9. Engh CA, Massin P, Suthers KE (1990) Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res 107–128

  10. Biau DJ, Latouche A, Porcher R (2007) Competing events influence estimated survival probability: when is Kaplan-Meier analysis appropriate? Clin Orthop Relat Res 462:229–233

    Article  Google Scholar 

  11. Solomon LB, Costi K, Kosuge D et al (2015) Revision total hip arthroplasty using cemented collarless double-taper femoral components at a mean follow-up of 13 years (8 to 20): an update. Bone Joint J 97-B:1038–1045

    Article  CAS  Google Scholar 

  12. Carrera L, Haddad S, Minguell J et al (2015) Mid-term outcomes and complications with cementless distal locking hip revision stem with hydroxyapatite coating for proximal bone defects and fractures. J Arthroplast 30:1035–1040

    Article  Google Scholar 

  13. Ferreira A, Aslanian T, Dalin T et al (2017) Ceramic bearings with bilayer coating in cementless total hip arthroplasty. A safe solution A retrospective study of one hundred and twenty six cases with more than ten years’ follow-up. Int Orthop 41:893–899

    Article  Google Scholar 

  14. Schmolders J, Amvrazis G, Pennekamp PH et al (2017) Thirteen year follow-up of a cementless femoral stem and a threaded acetabular cup in patients younger than fifty years of age. Int Orthop 41:39–45

    Article  Google Scholar 

  15. Imbuldeniya AM, Walter WK, Zicat BA et al (2014) The S-ROM hydroxyapatite proximally-coated modular femoral stem in revision hip replacement: results of 397 hips at a minimum ten-year follow-up. Bone Joint J 96:730–736

    Article  Google Scholar 

  16. Mertl P, Philippot R, Rosset P et al (2011) Distal locking stem for revision femoral loosening and peri-prosthetic fractures. Int Orthop 35:275–282

    Article  Google Scholar 

  17. Canovas F, Putman S, Girard J et al (2018) Global radiological score for femoral cementless revision stem. Int Orthop 42:1007–1013

    Article  Google Scholar 

  18. Roche O, Girard J, Canovas F et al (2016) Assessment of fixation in cementless femoral revision of total hip arthroplasty: comparison of the Engh score versus radiolucent line measurement. Int Orthop 40:907–912

    Article  Google Scholar 

  19. Sanli I, Arts JJ, Geurts J (2015) Clinical and radiologic outcomes of a fully hydroxyapatite-coated femoral revision stem: excessive stress shielding incidence and its consequences. J Arthroplast 31:209–214

    Article  Google Scholar 

  20. Makani A, Kim TW, Kamath AF et al (2014) Outcomes of long tapered hydroxyapatite-coated stems in revision total hip arthroplasty. J Arthroplast 29:827–830

    Article  Google Scholar 

  21. Demey G, Fary C, Lustig S et al (2011) Does a collar improve the immediate stability of uncemented femoral hip stems in total hip arthroplasty? A bilateral comparative cadaver study. J Arthroplast 26:1549–1555

    Article  Google Scholar 

  22. Khatod M, Cafri G, Inacio MC et al (2015) Revision total hip arthoplasty: factors associated with re-revision surgery. J Bone Joint Surg Am 97:359–366

    Article  Google Scholar 

  23. Springer BD, Fehring TK, Griffin WL et al (2009) Why revision total hip arthroplasty fails. Clin Orthop Relat Res 467:166–173

    Article  Google Scholar 

  24. Ponzio DY, Shahi A, Park AG et al (2015) Intraoperative proximal femoral fracture in primary cementless total hip arthroplasty. J Arthroplast 30:1418–1422

    Article  Google Scholar 

  25. Viste A, Desmarchelier R, Fessy MH (2017) Dual mobility cups in revision total hip arthroplasty. Int Orthop 41:535–542

    Article  Google Scholar 

  26. Mohaddes M, Cnudde P, Rolfson O et al (2017) Use of dual-mobility cup in revision hip arthroplasty reduces the risk for further dislocation: analysis of seven hundred and ninety one first-time revisions performed due to dislocation, reported to the Swedish Hip Arthroplasty Register. Int Orthop 41:583–588

    Article  Google Scholar 

  27. Tetreault MW, Shukla SK, Yi PH et al (2014) Are short fully coated stems adequate for “simple” femoral revisions? Clin Orthop Relat Res 472:577–583

    Article  Google Scholar 

  28. Hultmark P, Karrholm J, Stromberg C et al (2000) Cemented first-time revisions of the femoral component: prospective 7 to 13 years’ follow-up using second-generation and third-generation technique. J Arthroplast 15:551–561

    Article  CAS  Google Scholar 

  29. Vidalain JP (2011) Twenty-year results of the cementless Corail stem. Int Orthop 35:189–194

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Chirurgie Orthopédique et Traumatologique, 165 Chemin du Grand Revoyet, 69495, Pierre Benite Cedex, France

    Yannick Herry, Anthony Viste, Romain Desmarchelier & Michel-Henri Fessy

  2. Université de Lyon, 69622, Lyon, France

    Anthony Viste, Romain Desmarchelier & Michel-Henri Fessy

  3. Université Claude Bernard Lyon1, 43 boulevard du 11 novembre, 69100, Villeurbanne, France

    Anthony Viste, Romain Desmarchelier & Michel-Henri Fessy

  4. IFSTTAR, UMRT_ 9406, Laboratoire de Biomécanique et Mécanique des Chocs, 25 Avenue Mitterrand, 69500, Bron, France

    Anthony Viste, Romain Desmarchelier & Michel-Henri Fessy

  5. ReSurg SA, 35 Chmin de la Vuarpillière, 1260, Nyon, Switzerland

    Hugo Bothorel

Authors
  1. Yannick Herry
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony Viste
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hugo Bothorel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Romain Desmarchelier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michel-Henri Fessy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anthony Viste.

Ethics declarations

Conflict of interest

MHF perceives royalties from DePuy and Serf, not related to the current study. AV, HB, RD, and YH have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Herry, Y., Viste, A., Bothorel, H. et al. Long-term survivorship of a monoblock long cementless stem in revision total hip arthroplasty. International Orthopaedics (SICOT) 43, 2279–2284 (2019). https://doi.org/10.1007/s00264-018-4186-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-018-4186-2

Keywords

Search

Navigation