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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Cementless Femoral Component in Revision Hip Arthroplasty: A Registry Comparative Study Between Primary and Revision
Francesco Castagnini1, Barbara Bordini, Monica Cosentino
1From the Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (Castagnini and Diquattro), the Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (Bordini and Cosentino), the Head of Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Bologna and DIBINEM, Università di Bologna, Bologna, Italy (Faldini), and the Head of Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna and DIBINEM, Università di Bologna, Bologna, Italy (Traina).
Introduction:
Femoral component choice in revision hip arthroplasty is debated. An arthroplasty registry study was designed to compare the survival rates of revision hip arthroplasties performed for femoral component failure using noncemented primary stems or noncemented revision stems, aiming to assess (1) the survival rates of primary and revision stems and (2) the survival rates of primary and revision stems, in single-taper and modular versions.
Methods:
In a regional arthroplasty registry, 5,186 revision surgeries of femoral component using noncemented stems performed on residing patients were identified: 1,127 primary stems (21.7%) and 4,069 (78.3%) revision stems. Implants were additionally categorized according to modularity. The cohorts differed for demographic and implant-related features.
Results:
Primary stems achieved less than 10-year survival rates than revision stems (85.9% vs. 92.3%; P < 0.0001). Primary stems achieved lower 10-year survival rates with specific end points, aseptic loosening ( P = 0.0005), and periprosthetic fracture ( P < 0.0001) but not primary instability ( P = 0.011). The survival rates of the four cohorts stratified for modularity demonstrated different 10-year survival rates (single-taper primary stems: 84.1%; modular primary stems: 87.9%; single-taper revision stems: 94.5%; modular revision stems: 91.2%; P < 0.0001). In revision surgeries due to aseptic loosening, primary stems achieved lower survival rates, especially in women aged more than 65 years ( P = 0.021). Single-taper primary stems achieved lower performances than single-taper revision stems ( P < 0.001).
Discussion:
Primary stems should be carefully adopted in femoral component revision surgeries, especially in women aged 65 years or older. Single-taper primary stems carried a notable rate of failures at 10 years in comparison to single-taper revision stems.
Level Of Evidence:
III, therapeutic study.
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