Early Results of Femoral Reconstruction with a Tapered, Cementless, Modular Stem

Jihad M. Al-Ajlouni

Abstract


Objective: The orthopedic surgeon is faced with various challenging problems on the femoral side while performing a revision total hip arthroplasty. Some of these challenges may arise acutely or even intra operatively with limited resources. The aim of this study is to evaluate clinical and radiological outcomes with a single revision modular system used for various indications, and to determine whether such a system achieved initial fixation, femoral offset restoration, stability, and leg length equalization.

Methods: We prospectively followed 33 patients with 36 implants for various indications. Functional assessment was achieved using the Harris hip score (HHS). Hip stability, Leg length discrepancy, stem fixation, and offset restoration were evaluated radiographically. Follow up ranged from 24-87 months.

Results: HHS increased from a preoperative mean of 22.1 to a mean of 71.6 postoperatively. The total number of patients who had dislocation is 5 (13.9%). Three stems were re-revised (9%). Subsidence of the femoral component was less than 5mm in 30 patients (83%). Leg length discrepancy was corrected to within 5mm in 53% of patients, Offset restoration was achieved in 39% of patients. No fractures at the body to stem junction were seen at latest follow up.

Conclusions: Modular femoral stems are useful to address hip stability, leg length equalization, offset restoration, and distal fixation when revising a failed femoral component in the presence of significant proximal femur bone loss. These stems provide good clinical outcome in a simple, uniform, reproducible way.

Keywords


Revision total hip replacement, Modular femoral stem, Cementless fixation, Femoral bone loss, Leg length discrepancy after total hip replacement

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