Cementless femoral stems are currently used in revision total hip arthroplasty (THA) with the surgeon choosing between various fixation modes. The outcomes are good in the medium term; however, some failures have been attributed to technical errors during implantation. When the decision has been made to use a press-fit implant, the impact of the surgeon’s technique on the functional outcomes have not been explored in-depth. This led us to carry out a retrospective study on a large population of total hip arthroplasty patients which aims were achieved press-fit to (1) determine the impact of the type of primary fixation (with and without press-fit) on the functional outcomes; (2) specify the effect of stem length on the functional scores when diaphyseal press-fit is achieved and (3) analyse the main reasons why a true press-fit effect was not achieved (three-point fixation).
There is a relationship between the primary fixation method by press-fit of a revision femoral stem and the functional outcomes.
Patients and methods
We performed a retrospective analysis of a continuous cohort of 244 THA revision cases with a mean follow-up of 6.1 ± 3.5 years (range, 2–18). The femoral area in which close contact was achieved (shared interface between the bone and implant) was used to define various types of press-fit fixation. The functional outcomes were determined using the Harris Hip Score (HHS) and the Merle d’AubignéPostel score (MAP score) out of 12 points (pain and walking items).
The post-operative HHS averaged 90.83 ± 7.51 for proximal press-fit and 80.14 ± 14.93 with no press-fit (p = 0.01). The MAP averaged 10.83 ± 1.03 for proximal press-fit and 9.75 ± 2.09 with no press-fit (p = 0.09). The MAP score was worse for long diaphyseal press-fit than for short press-fit (p = 0.02). Use of a long stem with an endofemoral route or an overly small femoral window in patients with a curved femur is the main reason that three-point fixation occurred instead of press-fit.
While press-fit is an effective concept, it is a demanding one that requires the surgeon to choose the correct surgical strategy for the patient’s anatomy. A meticulous surgical technique is required to achieve proximal press-fit or at a minimum, short diaphyseal press-fit.
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We are grateful to Daniel F.A. de Menezes and Mathias Goldschild for their advice on this study, Anne Ingels for the statistical analysis and Joanne Archambault for the English translation.
Conflict of interest
FC certifies that he has or may receive payments or benefits from a commercial entity (Zimmer Educational).
SP certifies that he has or may receive payments or benefits from a commercial entity (Tornier Corin).
LD and LC have nothing to declare.
PLB certifies that he has or may receive payments or benefits from a commercial entity (Zimmer GmbH) that may be perceived as a potential conflict of interest.
Ethical board review statement
Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
Location of the work
This work was performed at CHU Montpellier.
Level of Evidence: Level IV, therapeutic study
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Cite this article
Canovas, F., Putman, S., Dagneaux, L. et al. Cementless revision femoral stems application of press-fit principles and clinical outcomes. International Orthopaedics (SICOT) 43, 2261–2267 (2019). https://doi.org/10.1007/s00264-018-4265-4
- Press-fit stem
- Fixation zone
- Functional results