Abstract
The ZMR® porous stem is a modular cylindrical porous-coated femoral stem for revision THA. The objective of this study was to evaluate the clinical and radiographic outcomes of this stem at midterm followup. We prospectively reviewed 69 patients (72 femoral revisions) treated with the stem. The indication for revision was aseptic loosening in 61 (85%), periprosthetic fractures in five (7%), infection in three (4%), dislocation in two (3%), and fractured stem in one (1%). Minimum followup was 60 months (mean, 85 months; range, 60–114 months). The survival rate with revision for any reason as an end point was 93.8%. Mean preoperative Harris hip score was 39 points, and mean Harris hip score at last followup was 72 points. Four (5.5%) stems required rerevision, two (2.8%) for loosening, one (1.4%) for fracture at the modular junction, and one (1.4%) for infection. Subsidence occurred in eight (11%) patients, in the range of 5 to 25 mm. Two (2.89%) of the stems that subsided were symptomatic and progressive. The ZMR® porous stem is a versatile system that offers a reliable fixation and an off-the-shelf solution for a multitude of femoral reconstruction challenges.
Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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References
Barrack RL. Orthopaedic crossfire: stem modularity is unnecessary in revision total hip arthroplasty: in the affirmative. J Arthroplasty. 2003;18(3 suppl 1):98–100.
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 4.8 years. J Bone Joint Surg Am. 2001;83:1023–1031.
Böhm P, Bischel O. The use of tapered stems for femoral revision surgery. Clin Orthop Relat Res. 2004;420:148–159.
Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD Jr, Ranawat CS. Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982: a two to five-year follow-up. J Bone Joint Surg Am. 1985;67:1074–1085.
Cameron HU. The long-term success of modular proximal fixation stems in revision total hip arthroplasty. J Arthroplasty. 2002;17(4 suppl 1):138–141.
Cameron HU. Orthopaedic crossfire: stem modularity is unnecessary in revision total hip arthroplasty: in opposition. J Arthroplasty. 2003;18(3 suppl 1):101–103.
Dalury DF, Gonzales RA, Adams MJ. Minimum 5-year results in 96 consecutive hips treated with a tapered titanium stem system. J Arthroplasty. 2008 Dec 3. [Epub ahead of print].
Engh CA Jr, Hopper RH Jr, Engh CA Sr. Distal ingrowth components. Clin Orthop Relat Res. 2004;420:135–141.
Garbuz DS, Toms A, Masri BA, Duncan CP. Improved outcome in femoral revision arthroplasty with tapered fluted modular titanium stems. Clin Orthop Relat Res. 2006;453:199–202.
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.
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 result evaluation. J Bone Joint Surg Am. 1969;51:737–755.
Hungerford DS, Jones LC. The rationale of cementless revision of cemented arthroplasty failures. Clin Orthop Relat Res. 1988;235:12–24.
Kang MN, Huddleston JI, Hwang K, Imrie S, Goodman SB. Early outcome of a modular femoral component in revision total hip arthroplasty. J Arthroplasty. 2008;23:220–225.
Köster G, Walde TA, Willert HG. Five- to 10-year results using a noncemented modular revision stem without bone grafting. J Arthroplasty. 2008;23:964–970.
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.
Kwong LM, Miller AJ, Lubinus P. A modular distal fixation option for proximal bone loss in revision total hip arthroplasty: a 2- to 6-year follow-up study. J Arthroplasty. 2003;18(3 suppl 1):94–97.
Leopold SS, Rosenberg AG. Current status of impaction allografting for revision of a femoral component. Instr Course Lect. 2000;49:111–118.
Malkani AL, Settecerri JJ, Sim FH, Chao EY, Wallrichs SL. Long-term results of proximal femoral replacement for non-neoplastic disorders. J Bone Joint Surg Br. 1995;77:351–356.
McAuley JP, Engh CA Jr. Femoral fixation in the face of considerable bone loss: cylindrical and extensively coated femoral components. Clin Orthop Relat Res. 2004;429:215–221.
McCarthy JC, Lee JA. Complex revision total hip arthroplasty with modular stems at a mean of 14 years. Clin Orthop Relat Res. 2007;465:166–169.
Moreland JR, Moreno MA. Cementless femoral revision arthroplasty of the hip: minimum 5 years followup. Clin Orthop Relat Res. 2001;393:194–201.
Mroczkowski ML, Hertzler JS, Humphrey SM, Johnson T, Blanchard CR. Effect of impact assembly on the fretting corrosion of modular hip tapers. J Orthop Res. 2006;24:271–279.
Mulroy WF, Harris WH. Revision total hip arthroplasty with use of so-called second-generation cementing techniques for aseptic loosening of the femoral component: a fifteen-year-average follow-up study. J Bone Joint Surg Am. 1996;78:325–330.
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.
Rodriguez JA, Fada R, Murphy SB, Rasquinha VJ, Ranawat CS. Two-year to five-year follow-up of femoral defects in femoral revision treated with the Link MP modular stem. J Arthroplasty. 2008 Oct 31. [Epub ahead of print].
Safir O, Kellett CF, Flint M, Backstein D, Gross AE. Revision of the deficient proximal femur with a proximal femoral allograft. Clin Orthop Relat Res. 2009;467:206–212.
Saleh KJ, Holtzman J, Gafni A, Saleh L, Davis A, Resig S, Gross AE. Reliability and intraoperative validity of preoperative assessment of standardized plain radiographs in predicting bone loss at revision hip surgery. J Bone Joint Surg Am. 2001;83:1040–1046.
Sporer SM, Paprosky WG. Revision total hip arthroplasty: the limits of fully coated stems. Clin Orthop Relat Res. 2003;417:203–209.
Sporer SM, Paprosky WG. Femoral fixation in the face of considerable bone loss: the use of modular stems. Clin Orthop Relat Res. 2004;429:227–231.
Wagner H, Wagner M. Cone prosthesis for the hip joint. Arch Orthop Trauma Surg. 2000;120:88–95.
Acknowledgments
We thank Matthew MacDonald for help in data collection and calculation of hip scores and David Razao for help in data collection.
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One of the authors (AEG) serves as a consultant for Zimmer, Inc, Warsaw, IN.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
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Lakstein, D., Backstein, D., Safir, O. et al. Revision Total Hip Arthroplasty with a Porous-coated Modular Stem: 5 to 10 Years Followup. Clin Orthop Relat Res 468, 1310–1315 (2010). https://doi.org/10.1007/s11999-009-0937-0
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DOI: https://doi.org/10.1007/s11999-009-0937-0