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Revision Hip Arthroplasty Using a Modular, Cementless Femoral Stem: Long-Term Follow-Up
Rosa S Valtanen1, Katherine L Hwang1, Derek F Amanatullah1
1Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
Insights
Long-term data for revision total hip arthroplasty (THA) is scarce. This study shows cementless modular stems are safe and effective for revision THA, with improved patient outcomes at 14 years.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Increasing primary total hip arthroplasty (THA) cases necessitate more revision surgeries.
- Limited long-term follow-up data exists for revision THA procedures.
Purpose of the Study:
- To evaluate the long-term clinical success and safety of cementless modular stems in revision total hip arthroplasty (THA).
- To assess patient-reported outcomes at a minimum of 14-year follow-up after revision THA.
Main Methods:
- Retrospective review of patients undergoing revision THA with a cementless modular stem.
- Collection of demographic, clinical, and radiographic data.
- Comparison of pre- and post-operative patient-reported outcome scores at minimum 14-year follow-up.
Main Results:
- Eighty-four patients (89 hips) with a median age of 69 underwent revision THA.
- Aseptic loosening was the primary indication (84.2%), followed by infection (12.4%) and fracture (3.4%).
- Significant improvements in UCLA activity, VR-12 physical, HOOS, and Harris Hip scores were observed at long-term follow-up.
Conclusions:
- Cementless modular revision stems demonstrate long-term clinical success.
- These stems are a safe and reliable option for complex revision hip arthroplasty operations.
- Challenges in long-term follow-up include patient factors and mortality.
Background:
As the number of primary total hip arthroplasty (THA) cases increase, so does the demand for revision operations. However, long-term follow-up data for revision THA is lacking.
Methods:
A retrospective review was completed of patients who underwent revision THA at a single institution between January 2002 and October 2007 using a cementless modular stem. Patient demographic, clinical, and radiographic data was collected. Preoperative and postoperative patient-reported outcome scores were compared at a minimum of fourteen-year follow-up.
Results:
Eighty-four patients (89 hips) with a median age of 69 years (range, 28 to 88) at operation were included. Indications for revision included aseptic loosening (84.2%), infection (12.4%), and periprosthetic fracture (3.4%). Twenty-two hips sustained at least 1 complication: intraoperative fracture (7.9%), dislocation (6.7%), prosthetic joint infection (4.5%), deep venous thrombosis (3.4%), and late periprosthetic fracture (2.2%). There were no modular junction complications. Eight patients underwent reoperations; only three involved the stem. Thirty-eight patients (45%) were deceased prior to final follow-up without known reoperations. Twenty-seven patients (32%) were lost to follow-up. Twenty-one patients (23%) were alive at minimum fourteen-year follow-up. Complete patient-reported outcomes were available for nineteen patients (range, 14 to 18.5 years of follow-up). Significant improvement was seen in UCLA activity, VR-12 physical, hip disability and osteoarthritis outcome score, joint replacement., and Harris Hip score pain and function scores.
Conclusion:
Challenges of long-term follow-up include patient migration, an unwillingness to travel for re-examination, medical comorbidities, advanced age, and death. The cementless modular revision stem demonstrated long-term clinical success and remains a safe and reliable option for complex revision operations.
