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Clinical and radiographic outcomes of primary total hip arthroplasty with the revelation hip system using density mapping

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

The Revelation Hip System is a cementless stem with a lateral flare concept. Stable fixation is achieved by fitting the stem to the medullary cavity of the proximal lateral femoral cortex. Patients who have undergone total hip arthroplasty using the Revelation Hip System show good postoperative clinical and radiographic outcomes. However, to the best of our knowledge, no study has reported the relationship between stem fitting and clinical or radiological outcomes after the surgery. In the present study, we investigated the relationship between stem fitting and clinical or radiological outcomes after total hip arthroplasty (THA) using the Revelation Hip System. In this study, 28 hips of 26 patients who were treated with the Revelation Hip System for osteoarthritis, osteonecrosis of the femoral head, rheumatoid arthritis, and rapidly destructive coxarthropathy and were followed up for > 5 y were enrolled. These patients were divided into two groups, including the rest fit group (11 hips, group R) and the control group (17 hips, group C), according to the results of the density mapping analysis. In group R, the lateral side of the stem fits on the medullary cavity of the proximal lateral femoral cortex, while in group C, the lateral side of the stem did not fit. Radiographic results showed no significant differences between the groups in terms of stem alignment, subsidence, and stress shielding around the cup. The incidence of stress shielding around the stem in zone 7 was not significant but tended to be higher in group R than in group C (p = 0.052). Clinical outcomes showed no significant differences between group R and group C in terms of the Harris hip score, the Japanese Orthopaedic Association (JOA) score, and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) total score. However, pain complaints that were assessed by patient-reported outcomes using the 36-Item Short Form Health Survey (SF-36) bodily pain and vitality subscales and the JHEQ pain subscale were significantly higher in group R than in group C at the final follow-up. These results suggest that some patients had pain complaint even if the stems were inserted as per the concept after THA with the Revelation Hip System.

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Funding

Grant: The present study was supported in part by a Grant-in-Aid for Scientific Research (19K18471) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan

    Hiroaki Sakai, Nobuyuki Watanabe, Gen Kuroyanagi, Muneyoshi Fukuoka, Takuya Usami & Hideki Murakami

  2. Department of Orthopaedic Surgery, Tosei General Hospital, Seto, Japan

    Hiroaki Sakai, Nobuyuki Watanabe & Muneyoshi Fukuoka

  3. Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Gen Kuroyanagi & Yoshino Ueki

Authors
  1. Hiroaki Sakai
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  2. Nobuyuki Watanabe
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  3. Gen Kuroyanagi
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  4. Muneyoshi Fukuoka
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  5. Takuya Usami
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  6. Yoshino Ueki
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  7. Hideki Murakami
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Contributions

H.S. and N.W. designed the study. N.W. performed the surgery. H.S., N.W., G.K. and M.F. analyzed the data. H.S., N.W. and G.K. drafted the manuscript. M.F., T.U., Y.U. and H.M. critically reviewed the manuscript. All authors have read and approved the final manuscript before submission.

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Correspondence to Gen Kuroyanagi.

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The authors declare that they have no conflict of interest.

Ethical Approval

This project was considered and approved by the Tosei General Hospital Research Ethics Committee.

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Sakai, H., Watanabe, N., Kuroyanagi, G. et al. Clinical and radiographic outcomes of primary total hip arthroplasty with the revelation hip system using density mapping. Eur J Orthop Surg Traumatol 33, 435–440 (2023). https://doi.org/10.1007/s00590-022-03210-5

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  • DOI: https://doi.org/10.1007/s00590-022-03210-5

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