Medium-term follow-up of a modular tapered noncemented titanium stem in revision total hip arthroplasty: a single-surgeon experience.

We report a single-surgeon experience with a noncemented modular revision shaft (Modular Prosthesis; LINK, Hamburg, Germany) with clinical and radiographic results of 63 patients after 10 years. The Harris Hip Score improved from 51 to 84 points. Intraoperative complications included 11 fractures. Four patients had postoperative femoral fractures. Further shaft revisions were necessary: 1 subsidence, 1 late fracture, 1 late deep infection. Sixty-eight percent of cases showed revision defects as graded 3° by Mallory; 95 % did not show signs of loosening or subsidence; 38 patients showed adequate bone remodeling in the shaft and proximal femur; 21 patients showed excellent recovery of preoperative osteolytic areas, and 5 patients did not show signs of remodeling. The Modular Prosthesis stem shows adequate fixation and tendency toward satisfactory bone remodeling after 10 years.

Patterns of osseointegration and remodeling in femoral revision with bone loss using modular, tapered, fluted, titanium stems.

Radiographic signs of osseointegration with the use of fluted, tapered, modular, titanium stems in revision hip arthroplasty with bone loss have not been previously categorized. Serial radiographs of 64 consecutive hips with mean follow-up of 6.2 years were retrospectively reviewed. Bone loss was classified as per Paprosky classification, osseointegration was assessed according to a modified system of Engh et al, and Harris Hip Score was used to document pain and function. Seventy-four percent of the hips had type 3 or 4 bone loss. All stems were radiographically osseointegrated. Early minor subsidence was seen in 6.2% of the hips; definite bony regeneration, 73% of the hips; and stress shielding, 26% of the hips. These osseointegration patterns were different from those described for extensively porous-coated cobalt-chromium stems and had a bearing on the evaluation of fixation of these stems.