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Published on: February 27, 2018
Comparison of Cylindrical and Tapered Stem Designs for Femoral Revision Hip Arthroplasty
José María Hernández-Mateo1, Javier Orozco-Martínez1, José Antonio Matas-Díaz1
1Department of Orthopaedic Surgery, General University Hospital Gregorio Marañón, 28007 Madrid, Spain.
Insights
Monoblock fluted conical tapered stems (FCTS) and cylindrical fully-coated cobalt-chromium stems (CCS) show similar long-term survival in femoral revisions. However, FCTS may be favored due to lower rates of thigh pain and stress shielding associated with CCS.
Area of Science:
- Orthopedic surgery
- Biomaterials engineering
- Implant design and biomechanics
Background:
- Cylindrical fully-coated cobalt-chromium stems (CCS) are established for femoral revisions.
- Monoblock fluted conical tapered stems (FCTS) are emerging as a popular alternative.
- Long-term comparative data between CCS and FCTS in femoral revisions are limited.
Purpose of the Study:
- To compare the long-term clinical and radiographic outcomes of CCS versus FCTS in femoral revision surgery.
- To identify potential differences in complication rates, implant survival, and patient-reported pain between the two stem designs.
Main Methods:
- Retrospective comparative study of 38 CCS and 40 FCTS femoral revision implants.
- Data collection included demographic, clinical, and radiographic parameters.
- Analysis focused on complications, reoperations, pain, radiolucencies, subsidence, stress shielding, and overall survival at 120 months.
Main Results:
- FCTS were more frequently used in cases with higher bone defect grades (IIIA+).
- CCS group showed significantly higher rates of clinical thigh pain (p=0.006), proximal radiolucencies, subsidence, and stress shielding.
- Overall survival at 120 months was comparable (84.2% CCS vs. 85% FCTS; p=0.520), with similar aseptic loosening survival rates.
Conclusions:
- Both CCS and FCTS demonstrate excellent long-term survival in femoral revisions.
- FCTS may offer advantages over CCS by reducing the incidence of thigh pain, radiolucencies, and stress shielding.
- The choice of stem design may be influenced by bone defect severity and the desire to minimize specific implant-related complications.
Abstract:
Background: Cylindrical fully-coated cobalt-chromium stems (CCS) have been widely used in femoral revisions. However, monoblock fluted conical tapered stems (FCTS) are growing in popularity. The present study seeks to determine whether there are any long-term differences between the two designs. Material and methods: A retrospective study of 38 CCS versus 40 FCTS was carried out. Demographic data, clinical variables and radiographic parameters were recorded. Results: Demographic data were comparable. A greater proportion of septic revisions, periprosthetic fractures and previous osteosynthesis failures was observed with FCTS versus CCS (p = 0.012). A greater use of FCTS was recorded in cases with bone defects of type IIIA and higher (p = 0.025). There were no significant differences in terms of in-hospital complications (p = 0.815), postoperative surgical complications or need for reoperation (p = 0.156). The CCS group presented a higher percentage of clinical thigh pain at the end of follow-up (p = 0.006). Additionally, a greater presence of radiolucencies was observed with CCS, especially in proximal zones (1, 7, 10 and 14). More subsidence, tip cortical hypertrophy and stress shielding were recorded in the CCS group. The overall survival at 120 months was 84.2% in the CCS group and 85% in the FCTS group (p = 0.520). When analyzing isolated aseptic loosening as the cause of failure, the survival rate was 94.7% in the CCS group and 95% in the FCTS group (p = 0.506). Conclusions: Both FCTS and CCS with diaphyseal anchorage afford excellent long-term survival rates, with no differences between the two designs. However, a higher incidence of stress shielding, radiolucencies and thigh pain with CCS seems to favor the use of FCTS.
