Clinical Orthopaedics and Related Research®

, Volume 467, Issue 8, pp 2032–2040 | Cite as

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

Original Article

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.

Notes

Acknowledgments

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

References

  1. 1.
    Amstutz HC, Ma SM, Jinnah RH, Mai L. Revision of aseptic loose total hip arthroplasties. Clin Orthop Relat Res. 2004;420:2–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Barnett E, Nordin BE. The radiological diagnosis of osteoporosis: a new approach. Clin Radiol. 1960;11:166–174.PubMedCrossRefGoogle Scholar
  3. 3.
    Barrack RL, Folgueras AJ. Revision total hip arthroplasty: the femoral component. J Am Acad Orthop Surg. 1995;3:79–85.PubMedGoogle Scholar
  4. 4.
    Berry DJ. Femoral revision: distal fixation with fluted, tapered grit-blasted stems. J Arthroplasty. 2002;17(suppl 1):142–146.PubMedCrossRefGoogle Scholar
  5. 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.PubMedGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 7.
    Böhm P, Bischel O. The use of tapered stems for femoral revision surgery. Clin Orthop Relat Res. 2004;420:148–159.PubMedCrossRefGoogle Scholar
  8. 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.PubMedGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 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.PubMedGoogle Scholar
  11. 11.
    Della Valle CJ, Paprosky WG. The femur in revision total hip arthroplasty evaluation and classification. Clin Orthop Relat Res. 2004;420:55–62.PubMedCrossRefGoogle Scholar
  12. 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.PubMedGoogle Scholar
  13. 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.PubMedGoogle Scholar
  14. 14.
    Engh CA Jr, Hopper RH Jr, Engh CA Sr. Distal ingrowth components. Clin Orthop Relat Res. 2004;420:135–141.PubMedCrossRefGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. 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.PubMedGoogle Scholar
  17. 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.PubMedGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 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.PubMedGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedGoogle Scholar
  22. 22.
    Hungerford DS, Jones LC. The rationale of cementless revision of cemented arthroplasty failures. Clin Orthop Relat Res. 1988;235:12–24.PubMedGoogle Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 24.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.CrossRefGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. 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.PubMedGoogle Scholar
  27. 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.PubMedGoogle Scholar
  28. 28.
    Kim YH. Cementless revision hip arthroplasty using strut allografts and primary cementless proximal porous-coated prosthesis. J Arthroplasty. 2004;19:573–581.PubMedCrossRefGoogle Scholar
  29. 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.PubMedGoogle Scholar
  30. 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.PubMedCrossRefGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 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.PubMedCrossRefGoogle Scholar
  33. 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.PubMedCrossRefGoogle Scholar
  34. 34.
    Lawrence JM, Engh CA, Macalino GE. Revision total hip arthroplasty: long-term results without cement. Orthop Clin North Am. 1993;24:635–644.PubMedGoogle Scholar
  35. 35.
    Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007;38:651–654.PubMedCrossRefGoogle Scholar
  36. 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.CrossRefGoogle Scholar
  37. 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.PubMedCrossRefGoogle Scholar
  38. 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.PubMedCrossRefGoogle Scholar
  39. 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.PubMedGoogle Scholar
  40. 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.PubMedGoogle Scholar
  41. 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.PubMedCrossRefGoogle Scholar
  42. 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.PubMedCrossRefGoogle Scholar
  43. 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.PubMedGoogle Scholar
  44. 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.PubMedCrossRefGoogle Scholar
  45. 45.
    Rubash HE, Harris WH. Revision of nonseptic, loose, cemented femoral components using modern cementing techniques. J Arthroplasty. 1988;3:241–248.PubMedCrossRefGoogle Scholar
  46. 46.
    Schuh A, Holzwarth U, Zeiler G. [Titanium modular revision prosthesis stem in revision hip prosthesis] [in German]. Orthopade. 2004;33:63–67.PubMedCrossRefGoogle Scholar
  47. 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.PubMedCrossRefGoogle Scholar
  48. 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.PubMedCrossRefGoogle Scholar
  49. 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.PubMedGoogle Scholar
  50. 50.
    Wagner H. [Revision prosthesis for the hip joint in severe bone loss] [in German]. Orthopade. 1987;16:295–300.Google Scholar
  51. 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.PubMedCrossRefGoogle Scholar
  52. 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.PubMedCrossRefGoogle Scholar
  53. 53.
    Woolson ST, Delaney TJ. Failure of a proximally porous-coated femoral prosthesis in revision total hip arthroplasty. J Arthroplasty. 1995;10:S22–S28.PubMedCrossRefGoogle Scholar
  54. 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.PubMedGoogle Scholar
  55. 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.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2009

Authors and Affiliations

  1. 1.Orthopedic DepartmentGeneral Hospital “Agios Andreas”PatrasGreece

Personalised recommendations