Fixation of a modular curved revision stem with a taper of 2° in the femur

  • Bernd FinkEmail author
  • Uli Buntenbroich
  • Damian Oremek
Hip Arthroplasty



Modular revision stems with a short distal component can prevent the bypassing of the femoral isthmus and hereby theoretically have advantages concerning risk of periprosthetic fractures, breakage of the junction and a technically easier revision procedure.

Materials and methods

Radiological evaluation of 202 stem revision operations with the modular curved revision stem “Revitan Curved” with a 2° taper was carried out after a mean follow-up period of 7.44 ± 2.09 years (3–13 years) to investigate whether short-stem combinations are effective in Paprosky 2 and 3A defects with respect to rate of subsidence and loosening.


Sixty of 62 endofemoral (96.8%) and 137 of 140 transfemoral implantations (97.9%) involved the short, 140 mm distal component. Significant subsidence was seen in 3.3% of cases following endofemoral implantation and in 2.1% of cases following transfemoral implantation. Neither aseptic loosening nor periprosthetic fracture were observed.


The use of combinations of short modular components leads to reproducibly good outcomes in femoral revision with respect to subsidence and loosening.


Revision arthroplasty Tapered stem Fixation Modular revision stem 



There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that one of the authors is a consultant of ZimmerBiomet, but no author was supported for this paper.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Böhm P, Bischel O (2004) The use of tapered stems for femoral revision surgery. Clin Orthop Relat Res 420:148–159CrossRefGoogle Scholar
  2. 2.
    Artiaco S, Boggio F, Titolo P, Zoccola K, Bianchi R, Bellomo F (2011) Clinical experience in femoral revision with the modular Profemur R stem. Hip Int 21:39–42CrossRefGoogle Scholar
  3. 3.
    Pattyn C, Mulliez A, Verdonk R, Audenaert E (2012) Revision hip arthroplasty using a cementless modular tapered stem. Int Orthop 36:35–41CrossRefGoogle Scholar
  4. 4.
    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 24:134–138CrossRefGoogle Scholar
  5. 5.
    Fink B, Urbansky K, Schuster (2014) Mid term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement. Bone Jt J 96-B(7):889–895CrossRefGoogle Scholar
  6. 6.
    van Houwelingen AP, Duncan CP, Masri BA, Greidanus NV, Garbuz DS (2013) High survival of modular tapered stems for proximal femoral bone defects at 5 to 10 years follow-up. Clin Orthop Relat Res 471:454–462CrossRefGoogle Scholar
  7. 7.
    Köster G, Wald TA, Willert HG (2008) Five- to 10-year results using a noncemented modular revision stem without bone grafting. J Arthroplasty 23:964–970CrossRefGoogle Scholar
  8. 8.
    Kwong LM, Miller AJ, Lubinus P (2003) A modular distal fixation option for proximal bone loss in revision total hip arthroplasty. A 2- to 6-year follow-up study. J Arthroplasty 18:94–97CrossRefGoogle Scholar
  9. 9.
    Fink B (2016) Letter to the Editor: Is there a benefit to modularity in “simpler” femoral revisions? Clin Orthop Relat Res 474:2538–2539CrossRefGoogle Scholar
  10. 10.
    Fink B (2018) What can the surgeon do to reduce the risk of junction breakage of modular revison stems. Arthroplasty Today 4:306–309CrossRefGoogle Scholar
  11. 11.
    Fink B, Hahn M, Fuerst M, Thybaut L, Delling G (2005) Principle of fixation of the cementless modular revision stem Revitan. Unfallchirurg 108:1029–1037CrossRefGoogle Scholar
  12. 12.
    Fink B, Oremek D (2016) The transfemoral approach for removal of well-fixed femoral stems in two-stage septic hip revision. J Arthroplasty 31:1065–1071CrossRefGoogle Scholar
  13. 13.
    Fink B, Grossman A, Schubring S, Schulz MS, Fuerst M (2008) Short-term results of hip revisions with a curved cementless modular stem in association with the surgical approach. Archiv Orthop Trauma Surg 129:65–73CrossRefGoogle Scholar
  14. 14.
    Fink B, Grossmann A, Fuerst M (2010) Distal interlocking screws with a modular revision stem for revision total hip arthroplasty in severe bone defects. J Arthroplasty 2010;25:759–765CrossRefGoogle Scholar
  15. 15.
    McInnis DP, Horne G, Dvane PA (2006) Femoral revision with a fluted, tapered, modular stem. Seventy patients followed for a mean of 3.9 years. J Arthroplasty 21:372–380CrossRefGoogle Scholar
  16. 16.
    Fink B, Grossmann A (2007) Modified transfemoral approach to revision arthroplasty with uncemented modular revision stems. Oper Orthop Traumatol 19:32–55CrossRefGoogle Scholar
  17. 17.
    Fink B, Grossmann A, Schubring S, Schulz MS, Fuerst M (2007) A modified transfemoral approach using modular cementless revision stems. Clin Orthop Relat Res 462:105–114CrossRefGoogle Scholar
  18. 18.
    Nunn D, Freeman MAR, Hil PF, Evans SJW (1989) The measurement of migration of the acetabular component of hip prostheses. J Bone Jt Surg Br 71-B:629–631CrossRefGoogle Scholar
  19. 19.
    Paprosky WG, Lawrence J, Cameron H (1990) Femoral defect classification. Clinical application. Orthop Rev 19(Suppl):9–15Google Scholar
  20. 20.
    Paprosky WG, Greidanus NV, Antoniou J (1999) Minimum 10-year results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res 369:230–242CrossRefGoogle Scholar
  21. 21.
    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 Jt Surg 67-A:1074–1085Google Scholar
  22. 22.
    De Menezes DFA, Le Béguec P, Sieber H-P, Goldschild M (2012) Stem and osteotomy length are critical for success of the transfemoral approach and cementless stem revision. Clin Orthop Relat Res 470:883–888CrossRefGoogle Scholar
  23. 23.
    Russell RD, Pierce W, Huo MH (2016) Tapered vs cylindrical stem fixation in a model of femoral bone deficiency in revision total hip arthroplasty. J Arthroplasty 31:1352–1355CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinic of Joint Replacement, General and Rheumatic OrthopaedicsOrthopaedic Clinic Markgröningen gGmbHMarkgröningenGermany
  2. 2.Orthopaedic ClinicUniversity-Hospital Hamburg-EppendorfHamburgGermany

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