Restricted accessResearch articleFirst published online 2022-7
Clinical,functional and radiographic outcomes after revision total hip arthroplasty with tapered fluted modular or non-modular stems: a systematic review
The aim of the study was to systematically evaluate clinical outcomes of tapered fluted stems, either monoblock or modular, in revision total hip arthroplasty.
Methods:
PubMed, EMBASE and Web of Science and Cochrane databases were systematically searched by 2 researchers. Clinical studies reporting primarily on survival and re-revision rates, and secondarily on subsidence, dislocation, intraoperative fractures, periprosthetic fractures and infection were included. 2 investigators assessed the quality of the studies.
Results:
46 studies were included in this review, reporting on 4601 stem revisions. The pooled re-revision rate was 5.1% and long-term survival ranged from 75% to 98.5%. No differences were observed between monoblock and modular stems regarding re-revision rate, dislocation rate, periprosthetic fracture rate or infection rates. Monoblock stems exhibited more subsidence and modular stems displayed more intraoperative fractures.
Conclusions:
Satisfactory results can be obtained with the use of tapered fluted end-bearing stems. Monoblock stems offer the same clinical results as modular stems.
NemesSGordonMRogmarkC, et al. Projections of total hip replacement in Sweden from 2013 to 2030. Acta Orthop2014; 85: 238–243.
2.
Maradit KremersHLarsonDRCrowsonCS, et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am2015; 97: 1386–1397.
3.
KurtzSMOngKLLauE, et al. Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg Am2014; 96: 624–630.
4.
National Joint Registry for England, Wales, Northern Ireland and The Isle of Man. 15th Annual Report2018, https://reports.njrcentre.org.Uk/downloads (2018, accessed 1 September 2019).
5.
WagnerH.A revision prosthesis for the hip jointOrthopade1989; 18: 438–453.
6.
OvesenOEmmeluthCHofbauerC, et al. Revision total hip arthroplasty using a modular tapered stem with distal fixation: good short-term results in 125 revisions. J Arthroplasty2010; 25: 348–354.
7.
RestrepoCMashadiMParviziJ, et al. Modular femoral stems for revision total hip arthroplasty. Clin Orthop Relat Res2011; 469: 476–482.
8.
BoothAClarkeMGhersiD, et al. An international registry of systematic review protocols. Lancet2011; 377: 108–109.
9.
StroupDFBerlinJAMortonSC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA2000; 283: 2008–2012.
10.
HigginsJPGreenS. Cochrane handbook for systematic reviews of interventions, Version 5.1.0. The Cochrane Collaboration, 2011.
11.
MoherDLiberatiATetzlaffJ, et al. Preferred reporting items for systematic reviews and meta analyses: the PRISMA statement. PLoS Med2009; 6: e1000097.
12.
von ElmEAltmanDGEggerM, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet2007; 370: 1453–1457.
WallaceBDahabrehITrikalinosT, et al. Closing the gap between methodologists and end-users: R as a computational back-end. J Stat Softw2012; 49: 1–15.
16.
HuangYZhouYShaoH, et al. What is the difference between modular and nonmodular tapered fluted titanium stems in revision total hip arthroplasty. J Arthroplasty2017; 32: 3108–3113.
17.
AbdelMPCottinoULarsonDR, et al. Modular fluted tapered stems in aseptic revision total hip arthroplasty. J Bone Joint Surg Am2017; 99: 873–881.
18.
AmanatullahDFHowardJLSimanH, et al. Revision total hip arthroplasty in patients with extensive proximal femoral bone loss using a fluted tapered modular femoral component. Bone Joint J2015; 97: 312–317.
19.
ArtiacoSBoggioFTitoloP, et al. Clinical experience in femoral revision with the modular Profemur R stem. Hip Int2011; 21: 39–42.
20.
BaktırAKaraaslanFGencerK, et al. Femoral revision using the wagner sl revision stem: a single-surgeon experience featuring 11-19 years of follow-up. J Arthroplasty2015; 30: 827–834.
21.
Revision Total Hip Arthroplasty Study Group. A comparison of modular tapered versus modular cylindrical stems for complex femoral revisions. J Arthroplasty2013; 28(Suppl. 8): 71–73.
22.
BöhmPBischelO.The use of tapered stems for femoral revision surgery. Clin Orthop Relat Res2004; 420: 148–159.
23.
BrownNMTetreaultMCiprianoCA, et al. Modular tapered implants for severe femoral bone loss in THA: reliable osseointegration but frequent complications. Clin Orthop Relat Res2015; 473: 555–560.
24.
Gutiérrez Del AlamoJGarcia-CimbreloECastellanosV, et al. Radiographic bone regeneration and clinical outcome with the Wagner SL revision stem: a 5-year to 12-year follow-up study. J Arthroplasty2007; 22: 515–524.
25.
FinkBUrbanskyKSchusterP.Mid-term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement. Bone Joint J2014; 96–B: 889–895.
26.
GrünigRMorscherEOchsnerPE.Three-to 7-year results with the uncemented SL femoral revision prosthesis. Arch Orthop Trauma Surg1997; 116: 187–197.
27.
HobergMKonradsCEngelienJ, et al. Outcome of a modular tapered uncemented titanium femoral stem in revision hip arthroplasty. Int Orthop2015; 39: 1709–1713.
28.
IsacsonJStarkAWallenstenR.The Wagner revision prosthesis consistently restores femoral bone structure. Int Orthop2000; 24: 139–142.
29.
JangHGLeeKJMinBW, et al. Mid-term results of revision total hip arthroplasty using modular cementless femoral stems. Hip Pelvis2015; 27: 135–140.
30.
KlauserWBangertYLubinusP, et al. Medium-term follow-up of a modular tapered noncemented titanium stem in revision total hip arthroplasty: a single-surgeon experience. J Arthroplasty2013; 28: 84–89.
31.
KolstadKAdalberthGMallminH, et al. The Wagner revision stem for severe osteolysis. 31 hips followed for 1.5-5 years. Acta Orthop Scand1996; 67: 541–544.
32.
KösterGWaldeTAWillertHG.Five- to 10-year results using a noncemented modular revision stem without bone grafting. J Arthroplasty2008; 23: 964–670.
33.
KwongLMMillerAJLubinusP.A modular distal fixation option for proximal bone loss in revision total hip arthroplasty: a 2- to 6-year follow-up study. J Arthroplasty2003; 18(Suppl. 1): 94–97.
34.
LaksteinDKosashviliYBacksteinD, et al. Revision total hip arthroplasty with a modular tapered stem. Hip Int2010; 20: 136–142.
35.
LyuSR.Use of Wagner cementless self-locking stems for massive bone loss in hip arthroplasty. J Orthop Surg (Hong Kong)2003; 11: 43–47.
36.
MantelosGKoulouvarisPKotsovolosH, et al. Consistent new bone formation in 95 revisions: average 9-year follow-up. Orthopedics2008; 31: 654.
37.
McInnisDPHorneGDevanePA. Femoral revision with a fluted, tapered, modular stem seventy patients followed for a mean of 3.9 years. J Arthroplasty2006; 21: 372–380.
38.
MunroJTGarbuzDSMasriBA, et al. Role and results of tapered fluted modular titanium stems in revision total hip arthroplasty. J Bone Joint Surg Br2012; 94(Suppl. A): 58–60.
39.
MurrayRCHorneJG.Medium-term outcome of titanium uncemented stems in revision total hip arthroplasty. J Orthop Surg (Hong Kong)2011; 19: 164–168.
40.
MurphySBRodriguezJ.Revision total hip arthroplasty with proximal bone loss. J Arthroplasty2004; 19(Suppl. 1): 115–119.
41.
PalumboBTMorrisonKLBaumgartenAS, et al. Results of revision total hip arthroplasty with modular, titanium-tapered femoral stems in severe proximal metaphyseal and diaphyseal bone loss. J Arthroplasty2013; 28: 690–694.
42.
ParkMSLeeJHParkJH, et al. A distal fluted, proximal modular femoral prosthesis in revision hip arthroplasty. J Arthroplasty2010; 25: 932–938.
43.
PatelPDKlikaAKMurrayTG, et al. Influence of technique with distally fixed modular stems in revision total hip arthroplasty. J Arthroplasty2010; 25: 926–931.
44.
PattynCMulliezAVerdonkR, et al. Revision hip arthroplasty using a cementless modular tapered stem. Int Orthop2012; 36: 35–41.
45.
RegisDSandriABonettiL, et al. Femoral revision with the Wagner tapered stem: a ten- to 15-year follow-up study. J Bone Joint Surg Br2011; 93: 1320–1326.
46.
RichardsCJDuncanCPMasriBA, et al. Femoral revision hip arthroplasty: a comparison of two stem designs. Clin Orthop Relat Res2010; 468: 491–496.
47.
RodriguezJADeshmukhAJRobinsonJ, et al. Reproducible fixation with a tapered, fluted, modular, titanium stem in revision hip arthroplasty at 8-15 years follow-up. J Arthroplasty2014; 29(Suppl. 9): 214–218.
48.
SandifordNAGarbuzDSMasriBA, et al. Nonmodular tapered fluted titanium stems osseointegrate reliably at short term in revision THAs. Clin Orthop Relat Res2017; 475: 186–192.
49.
SchuhAWerberSHolzwarthU, et al. Cementless modular hip revision arthroplasty using the MRP Titan revision stem: outcome of 79 hips after an average of 4 years’ follow-up. Arch Orthop Trauma Surg2004; 124: 306–309.
50.
SinghSPBhalodiyaHP.Results of Wagner SL revision stem with impaction bone grafting in revision total hip arthroplasty. Indian J Orthop2013; 47: 357–363.
51.
SkyttäETEskelinenARemesV.Successful femoral reconstruction with a fluted and tapered modular distal fixation stem in revision total hip arthroplasty. Scand J Surg2012; 101: 222–226.
52.
ŠponerPKučeraTUrbanK, et al. Osteointegration of an uncemented modular revision stem implanted during revision hip surgery. Acta Medica (Hradec Kralove)2014; 57: 105–111.
53.
StimacJDBolesJParkesN, et al. Revision total hip arthroplasty with modular femoral stems. J Arthroplasty2014; 29: 2167–2170.
54.
TamvakopoulosGSServantCTClarkG, et al. Medium-term follow-up series using a modular distal fixation prosthesis to address proximal femoral bone deficiency in revision total hip arthroplasty. A 5- to 9-year follow-up study. Hip Int2007; 17: 143–149.
55.
Van HouwelingenAPDuncanCPMasriBA, et al. High survival of modular tapered stems for proximal femoral bone defects at 5 to 10 years followup. Clin Orthop Relat Res2013; 471: 454–462.
56.
WangLDaiZWenT, et al. Three to seven-year follow-up of a tapered modular femoral prosthesis in revision total hip arthroplasty. Arch Orthop Trauma Surg2013; 133: 275–281.
57.
WeberMHempfingAOrlerR, et al. Femoral revision using the Wagner stem: results at 2-9 years. Int Orthop2002; 26: 36–39.
58.
WeissRJBeckmanMOEnocsonA, et al. Minimum 5-year follow-up of a cementless, modular, tapered stem in hip revision arthroplasty. J Arthroplasty2011; 26: 16–23.
59.
WirtzDCGraviusSAscherlR, et al. Uncemented femoral revision arthroplasty using a modular tapered, fluted titanium stem: 5- to 16-year results of 163 cases. Acta Orthop2014; 85: 562–569.
60.
KirkKLPotterBKLehmanRAJr, et al. Effect of distal stem geometry on interface motion in uncemented revision total hip prostheses. Am J Orthop (Belle Mead NJ)2007; 36: 545–549.
61.
OrnsteinELinderLRanstamJ, et al. Femoral impaction bone grafting with the Exeter stem - the Swedish experience: survivorship analysis of 1305 revisions performed between 1989 and 2002. J Bone Joint Surg Br2009; 91: 441–446.
62.
WraightePJHowardPW. Femoral impaction bone allografting with an exeter cemented collarless, polished, tapered stem in revision hip replacement: a mean follow-up of 10.5 years. J Bone Joint Surg Br2008; 90: 1000–1004.
63.
SinghJASchleckCHarmsenC, et al. Clinically important improvement thresholds for Harris Hip Score and its ability to predict revision risk after primary total hip arthroplasty. BMC Musculoskelet Disord2016; 17: 256.
64.
EfeTSchmittJ.Analyses of prosthesis stem failures in noncemented modular hip revision prostheses. J Arthroplasty2011; 26: 665–667.
65.
FinkB.What can the surgeon do to reduce the risk of junction breakage in modular revision stems?Arthroplast Today2018; 4: 306–309.
66.
TriantafyllopoulosGKElpersMEBurketJC, et al. Otto Aufranc award: large heads do not increase damage at the head-neck taper of metal-on- polyethylene total hip arthroplasties. Clin Orthop Relat Res2016; 474: 330–338.
67.
McAlisterIPAbdelMP.Elevated serum titanium level as a marker for failure in a titanium modular fluted tapered stem. Orthopedics2016; 39: 768–770.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
