Which Factors Can Lead to Subsidence of a Non-Modular Tapered Stem after Revision Hip Arthroplasty?

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Aim of the study — to evaluate our own experience of the use of non-modular tapered stems in revision hip arthroplasty to determine the incidence and causes of repeated revisions, functional outcomes, and factors associated with subsidence of non-modular tapered stems.

Methods. We retrospectively analyzed the results of using 78 non-modular tapered stems. The average follow-up period was 5.1 years.

Results. There were repeated revisions accompanied by the removal of non-modular tapered stems in 14 (17.9%) cases. Significant subsidence was observed in 5 (6.4%) cases. Bicortical contact less than 2.0 cm (p = 0.017) was a risk factor for subsidence of non-modular tapered stems. The risk of having a bicortical contact of less than 2 cm was higher in patients with type IV femoral defect (p = 0.048). An improvement in functional parameters was found. Patients with significant subsidence of non-modular tapered stems had worse functional outcomes compared to patients without significant subsidence.

Conclusions. The use of non-modular tapered stems in revision hip arthroplasty shows good results in terms of repeated revision rates and functional outcomes. Periprosthetic infection and aseptic loosening were the most frequent causes of repeated revisions with removal of non-modular tapered stems. All patients with significant subsidence of non-modular tapered stems underwent repeated revision due to aseptic loosening. Bicortical contact less than 2.0 cm was a risk factor for significant subsidence of non-modular tapered stems. The risk of bicortical contact less than 2.0 cm was higher in patients with type IV femoral defects. Therefore, it is recommended to use non-modular tapered stems with caution or consider other hip reconstruction options in this type of defect.

作者简介

Rashid Tikhilov

Vreden National Medical Research Center of Traumatology and Orthopedics

编辑信件的主要联系方式.
Email: rtikhilov@gmail.com
ORCID iD: 0000-0003-0733-2414

Dr. Sci. (Med.), Professor

俄罗斯联邦, St. Petersburg

Alisagib Dzhavadov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: alisagib.dzhavadov@mail.ru
ORCID iD: 0000-0002-6745-4707

Dr. Sci. (Med.), Professor

俄罗斯联邦, St. Petersburg

Artur Kopcov

Tetyukhin Urals Clinical Treatment and Rehabilitation Center

Email: avkoptsov@gmail.com
ORCID iD: 0000-0002-4353-4710
俄罗斯联邦, Nizhny Tagil

Pavel Filonov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: drpavelfilonov@gmail.com
ORCID iD: 0000-0001-7758-0128
俄罗斯联邦, St. Petersburg

Saida Kurbanova

Pavlov First Saint Petersburg State Medical University

Email: angelina6791@list.ru
ORCID iD: 0009-0004-5825-5548

Студент

俄罗斯联邦, St. Petersburg

Igor Shubnyakov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: shubnyakov@mail.ru
ORCID iD: 0000-0003-0218-3106
俄罗斯联邦, St. Petersburg

参考

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2. Fig. 1. X-ray images of the left hip of a 64-year-old patient after revision surgery: a — on day 1; b — in 9 months: 24.3 mm subsidence of the stem is observed

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3. Fig. 2. X-ray images of the right hip of a 50-year-old patient on day 1 after revision surgery: a — lines indicate the contact between the femoral component and the cortical layer of the femur on the medial and lateral sides; b — the length of the bicortical contact was defined as the total length of the direct contact between the cortical plate and the contour of the prosthesis without a radiolucent line (arrows 1 and 2)

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4. Fig. 3. The functional status according to the Oxford Hip Score: a — preoperative (x), postoperative (y); b — patients with significant stem subsidence (x), patients without significant stem subsidence (y)

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