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Fracture risk of tapered modular revision stems: a failure analysis.

ABSTRACT: Fractures of well-ingrown femoral components are a rare and often challenging complication after revision total hip arthroplasty. Prior series have documented catastrophic failure at the modular junction of revision femoral components. However, to the authors' knowledge, there has been only 1 report of a mid-stem fracture of a modular tapered revision stem. The present article reports 2 cases of fatigue fractures (14 months and 10 years after implantation) of a tapered modular revision stem. It presents the results of the fracture surface analysis, discusses the etiology of failure, and presents the authors' recommendations on how to best avoid this complication.

SUBMITTER: Rueckl K

PROVIDER: S-EPMC6123177 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Fracture risk of tapered modular revision stems: a failure analysis.

Rueckl Kilian K Sculco Peter K PK Berliner Jonathan J Cross Michael B MB Koch Chelsea C Boettner Friedrich F

Arthroplasty today 20171221 3

Fractures of well-ingrown femoral components are a rare and often challenging complication after revision total hip arthroplasty. Prior series have documented catastrophic failure at the modular junction of revision femoral components. However, to the authors' knowledge, there has been only 1 report of a mid-stem fracture of a modular tapered revision stem. The present article reports 2 cases of fatigue fractures (14 months and 10 years after implantation) of a tapered modular revision stem. It ...[more]

PMID: 30186909

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Project description:BackgroundBoth modular and monoblock tapered fluted titanium (TFT) stems are increasingly being used for revision total hip arthroplasty (rTHA). However, the differences between the two designs in clinical outcomes and complications are not yet clear. Here, we intend to compare the efficacy and safety of modular versus monoblock TFT stems in rTHA.MethodsPubMed, Embase, Web of Science, and Cochrane Library databases were searched to include studies comparing modular and monoblock implants in rTHA. Data on the survivorship of stems, postoperative hip function, and complications were extracted following inclusion criteria. Inverse variance and Mantel-Haenszel methods in Review Manager (version 5.3 from Cochrane Collaboration) were used to evaluate differences between the two groups.ResultsTen studies with a total of 2188 hips (1430 modular and 758 monoblock stems) were finally included. The main reason for the revision was aseptic loosening. Paprosky type III was the most common type in both groups. Both stems showed similar re-revision rates (modular vs monoblock: 10.3% vs 9.5%, P = 0.80) and Harris Hip Scores (WMD = 0.43, P = 0.46) for hip function. The intraoperative fracture rate was 11.6% and 5.0% (P = 0.0004) for modular and monoblock stems, respectively. The rate of subsidence > 10 mm was significantly higher in the monoblock group (4.5% vs 1.0%, P = 0.003). The application of extended trochanteric osteotomy was more popular in monoblock stems (22.7% vs 17.5%, P = 0.003). The incidence of postoperative complications such as periprosthetic femoral fracture and dislocation was similar between both stems.ConclusionsNo significant difference was found between modular and monoblock tapered stems as regards postoperative hip function, re-revision rates, and complications. Severe subsidence was more frequent in monoblock stems while modular ones were at higher risk of intraoperative fracture.Level of evidenceLevel III, systematic review of randomized control and non-randomized studies.Trial registrationWe registered our study in the international prospective register of systematic reviews (PROSPERO) (CRD42020213642).

Dataset Information

Fracture risk of tapered modular revision stems: a failure analysis.

Publications

Fracture risk of tapered modular revision stems: a failure analysis.

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