Is There a Benefit to Modularity for Femoral Revisions When Using a Splined, Tapered Titanium Stem?

Autor: Cohn MR; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL., Tetreault MW; Capital Region Orthopaedics and Department of Orthopaedics, Albany Medical Center, Albany, NY., Li J; Department of Orthopaedic Surgery, University of California San Francisco-Fresno, Fresno, CA., Kunze KN; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL., Nahhas CR; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL., Michalski JF; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL., Levine BR; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL., Nam D; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2020 Jun; Vol. 35 (6S), pp. S278-S283. Date of Electronic Publication: 2020 Jan 07.
DOI: 10.1016/j.arth.2019.12.041
Abstrakt: Background: Proposed benefits of modularity for femoral revisions in total hip arthroplasty (THA) include more precise biomechanical restoration and improved stability, but this has not been proven with use of a splined, tapered design. This study's purpose is to compare (1) complication rates, (2) functional outcomes, and (3) radiographic measures of subsidence, offset, and leg length discrepancy with the use of modular vs monoblock splined, tapered titanium stems in revision THA.
Methods: We retrospectively reviewed 145 femoral revisions with minimum 2-year follow-up (mean, 5.12 years; range, 2-17.3 years). Patients receiving a modular (67) or monoblock (78) splined, tapered titanium stem for femoral revision were included.
Results: There were no statistically significant differences in rates of reoperation (22.3% vs 17.9%; P = .66), intraoperative fracture (9.0% vs 3.8%; P = .30), postoperative fracture (3.0% vs 1.3%; P = .47), dislocation (11.9% vs 5.1%; P = .23), or aseptic loosening (4.5% vs 6.4%; P = .73) between the modular and monoblock cohorts, respectively. There were similar results regarding subsidence >5 mm (10.4% vs 12.8%; P = .22), LLD >1 cm (35.8% vs 38.5%; P = .74), restoration of hip offset (-5.88 ± 10.1 mm vs -5.07 ± 12.1 mm; P = .67), and Harris Hip Score (70.7 ± 17.9 vs 73.9 ± 19.7; P = .36) between groups. Multivariate regression showed no differences in complications (P = .44) or reoperations (P = .20) between groups.
Conclusion: Modular and monoblock splined, tapered titanium stems demonstrated comparable complication rates, functional outcomes, and radiographic parameters for femoral revisions. However, a limited number of patients with grade IIIB or IV femoral bone loss received a monoblock stem. Future investigations are required to determine whether modularity is beneficial for more complex femoral defects.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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