Related Experiment Video
Updated: May 23, 2026
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Monoblock and Modular Tapered Fluted Stems Versus Proximal Femoral Replacement in Revision Total Hip Arthroplasty: A
Jessica H Leipman1, Alan D Lam1, Jennifer Bido1
1Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
Introduction:
Periprosthetic bone loss is often challenging in revision total hip arthroplasty (THA). This study compared survivorship of monoblock, modular, and proximal femoral replacements (PFR) across various stages of femoral bone loss.
Methods:
This was a retrospective cohort study of 350 patients who underwent revision THA at a single institution. Patients either received a monoblock stem (n = 108, 30.9%), a modular stem (n = 198, 56.6%), or a PFR (n = 44, 12.6%) during revision THA. Pre-revision radiographs were reviewed to determine the Paprosky classification of femoral bone loss (Grade I, II, IIIA, IIIB, or IV). The primary outcome was implant survivorship free of re-revision between stem types in patients who had femoral bone loss.
Results:
There were 115, 162, and 73 cases classified as Paprosky I, II, and III+ (including grades IIIA, IIIB, and IV), respectively. In total, 55 (15.7%) required re-revision and 15 (4.29%) required reoperation. The most common indication for re-revision was periprosthetic joint infection. Monoblock and modular stems classified as Grade I or II showed comparable four-year survivorship free of re-revision to those classified as Grade III+ (87.4% [95% CI (confidence interval) 83.5 to 91.5] versus 83.3% [95% CI 72.0 to 96.4]; P = 0.540). When comparing implants in patients who had Grade II+ femoral bone loss (n = 235), PFRs demonstrated significantly lower four-year survivorship (69.8% [95% CI 57.3 to 84.9]) compared to monoblock (84.5% [95% CI 75.7 to 94.3]) and modular stems (85.8% [95% CI 80.1 to 91.9]; P = 0.030).
Conclusion:
Monoblock and modular stems demonstrated comparable mid-term survivorship across varying degrees of bone loss, including severe Paprosky III+ defects. PFRs had lower survivorship than non-PFR stems above Grade II. In select cases with advanced femoral bone loss, modular and monoblock stems can be a viable alternative to PFR in revision THA.
