gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Femoral hip revision arthroplasty using a modular hexagonal uncemented stem in femoral Paprosky type 3 defects – clinical and radiographic results of 51 cases

Meeting Abstract

  • presenting/speaker Valentin Acker - Evangelisches Waldkrankenhaus Spandau, Berlin, Germany
  • Arne Ebeling - Evangelisches Waldkrankenhaus Spandau, Berlin, Germany
  • Johannes Reichert - Evangelisches Waldkrankenhaus Spandau, Berlin, Germany
  • Eberhard von Rottkay - Evangelisches Waldkrankenhaus Spandau, Berlin, Germany
  • Ulrich Nöth - Evangelisches Waldkrankenhaus Spandau, Berlin, Germany
  • Lars Rackwitz - Evangelisches Waldkrankenhaus Spandau, Berlin, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN26-1072

doi: 10.3205/17dkou055, urn:nbn:de:0183-17dkou0550

Veröffentlicht: 23. Oktober 2017

© 2017 Acker et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: The immanent meta- and diaphyseal bone loss in femoral Paprosky type III defects may counteract fixation of the stem in hip revision surgery. We investigated the mid-term outcome of the Modular Universal Tumor and Revision System (MUTARS) RS stem, a modular, uncemented, hexagonal hydroxyapatite-coated stem, in patients undergoing total hip revision surgery.

Methods: Fifty-one patients that received a one- or two stage total hip revision surgery in between 2007 and 2015 with femoral Paprosky type IIIA/B were followed up retrospectively. The cause for hip revision surgery was periprosthetic infection (52,9%), aseptic loosening (35,2%), periprosthetic fracture (5,8%) or mechanical stem failure (5,8%). At follow up we assessed the clinical, functional (Harris Hip Score, WOMAC score) and radiographic outcome. Standard radiographs were digitally analyzed for stem integration, axial migration and signs of radiolucency according to Gruen.

Results: Mean follow up was 4.1 years (min 1 - max 9 years) postoperative. Mean patient age at the time of hip revision surgery was 71,1 years (min 55 - 84 years) and 75,2 years at follow up (min 62 - max 86 years). The average HHS was 76,2 (±14.1). Standard radiographs revealed good bony integration of the RS stem in 48 patients (94%) without any sign of axial migration, tilting or radiolucencies. Axial stem migration of more than 5 mm was obvious in 2 cases (3,9%) without any clinical sign of loosening and were rated as secondary stabilized. One patient showed radiolucent lines around the proximal, metaphyseal body (Gruen zone 1 + 7) but without stem subsidence or clinical signs of loosening. The overall revision rate during the follow up period was 11.7%. Two patients (3.9%) suffered from recurrent hip dislocation which was solved by an exchange of the head and liner, two patients (3.9%) had to be revised because of a periprosthetic fracture that required osteosynthethis, and another two patients underwent revision surgery due to an early postoperative wound infection.

Conclusion: Using the modular, uncemented, HA-coated RS stem to address femoral Paprosky type III defects in revision hip surgery we observed no stem failure due to aseptic loosening in this retrospective mid-term study. Whereas, the overall revision and complication rate compares to data from other publications. Besides dislocation and periprosthetic joint infection, stem subsidence due to insufficient initial meta-/diaphyseal press fit-fixation is known to be one of the main burdens in the use of uncemented stems in hip revision arthroplasty. These results are promising, however the need for a more extensive follow up, a larger patient cohort and prospective clinical trials is inevitable.