Femoral revision hip arthroplasty: a comparison of two stem designs

For various reasons the tapered, fluted, modular titanium (TFMT) stem has become our component of choice over cylindrical, nonmodular cobalt chrome (CNCC) components for THA revision. We therefore asked whether the TFMT femoral components better achieved three important goals of revision arthroplasty than CNCC stems: (1) improving quality of life; (2) avoiding complications; and (3) preserving or restoring femoral bone stock. We compared patients undergoing femoral component revision hip arthroplasty with either a CNCC (N = 105) component or a TFMT (N = 95) component to determine if the increased use of TFMT components is justified. We retrospectively reviewed all patients undergoing revision total hip arthroplasty between January 2000 and March 2006. All eligible patients completed outcome questionnaires (WOMAC, SF-12, Oxford-12, UCLA Activity Score, and Satisfaction Scores). Radiographs were evaluated for loosening and preservation or restoration of the proximal femur host bone. The TFMT and CNCC cohorts were comparable with respect to age, gender, diagnosis, and comorbidities. The TFMT cohort had worse preoperative bone defects (65% Paprosky 3B and 4). The TFMT cohort had higher outcome scores (WOMAC pain, WOMAC stiffness, Oxford-12, and Satisfaction), fewer intraoperative fractures, and better restoration of the proximal femur host bone. Our data suggest the TFMT stem provided improved clinical outcomes (improved quality of life, decreased complications, and preservation of bone stock) than the CNCC stem.

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.