Treatment of Large Femoral Bone Defects - 15-Year Experiences with the Cementless Bicontact Revision Stem with Distal Interlocking

Abstract

Aim: With the steady growth in the number of hip arthroplasty revision operations, the concept and long-term results of the Bicontact revision stem with distal interlocking for the treatment of extensive femoral bone defects were investigated in this prospective study. Method: The first 156 stem revision operations performed between January 1992 and December 2002 were evaluated. The indication for operation was aseptic loosening in 133, stem fracture in 14, recurrent dislocation in 2 and reimplantation following Girdlestone removal of a septic prosthesis in 7. The cup component was revised at the same time in 74 cases. Results: Higher-grade femoral bone defects were found intraoperatively in 66 %. The average age of the patients was 71.4 (34 - 88) years at operation and 76.9 (44 - 94) years at the last follow-up. The average period until follow-up, re-revision or loss to follow-up was 5.54 (0.1 - 14.9) years. The clinical and radiological follow-up rate (with reference to the total number of patients) was 35 % (55 von 156), and 51 % (55 of 107) with reference to patients still living. The median Harris Hip Score was 63.7 points. In the observation period, 12 stems were exchanged for a cemented standard stem, 5 stems were removed because of infection and 2 stems were revised because of periprosthetic fracture. The calculated survival rate for the stems after 14.9 years was 85.9 %. Conclusion: The 15-year results confirm the biomechanical concept of the Bicontact revision stem with optional distal interlocking for the treatment of extensive bone defects in stem revision surgery.

Key words

total hip arthroplasty - Bicontact revision stem - long‐term results - femoral bone defect - cementless

References

• 1 Bettin D, Katthagen B D. [The German Society of Orthopedics and Traumatology classification of bone defects in total hip endoprostheses revision operations] Die DGOT-Klassifikation von Knochendefekten bei Hüft-Totalendoprothesen - Revisionsoperationen.  Z Orthop. 1997;  135 281-284
• 2 Böhm P, Bischel O. Femoral revision with the Wagner SL revision stem: Evaluation of one hundred and twenty-nine revisions followed for a mean of 4,8 years.  J Bone Joint Surg [Am]. 2001;  83 1023-1031
• 3 Brooker A F, Bowerman J W, Robinson R A, Riley Jr L H. Ectopic ossification following total hip replacement. Incidence and a method of classification.  J Bone Joint Surg [Am]. 1973;  55 1629-32
• 4 Callaghan J J, Salvati E A, Pellicci P M, Wilson P D, Ranawat C S. Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982. A two to five-year follow-up.  J Bone Joint Surg [Am]. 1985;  67 1074-1085
• 5 Cameron H U. The two- to six-year results with a proximally modular noncemented total hip replacement used in hip revisions.  Clin Orthop. 1994;  298 47-53
• 6 Cameron H U. Modular shafts in hip prosthesis revision surgery.  Orthopäde. 2001;  30 287-293
• 7 Chandler H P, Ayres D K, Tan R C, Anderson L C, Varma A K. Revision total hip replacement using the S‐Rom femoral component.  Clin Orthop. 1995;  319 130-140
• 8 Collier J P, Mayor M B, Williams I R, Surprenant V A, Suprenant H P, Currier B H. The tradeoffs associated with modular hip prostheses.  Clin Orthop. 1995;  311 91-101
• 9 Crawford S A, Siney P D, Wroblewski B M. Revision of failed total hip arthroplasty with a proximal femoral modular cemented stem.  J Bone Joint Surg [Br]. 2000;  82 684-688
• 10 Christie M J, DeBoer D K, Tingstad E M, Capps M, Brinson M F, Trick L W. Clinical experience with a modular noncemented femoral component in revision total hip arthroplasty: 4- to 7-year results.  J Arthroplasty. 2000;  15 840-848
• 11 Dobbs H S. Survivorship of total hip replacement.  J Bone Joint Surg [Br]. 1998;  62 168-173
• 12 Dohmae Y, Bechthold J E, Sherman R E, Puno R M, Gustilo R B. Reduction in cement-bone interface shear strength between primary and revision arthroplasty.  Clin Orthop. 1988;  36 214-220
• 13 Eingartner C, Volkmann R, Ochs U, Egetemeyer D, Weise K. Intramedullary stabilisation of periprosthetic fractures of the femur taking special account of bone defects.  Oper Orthop Traumatol. 2006;  18 341-363
• 14 Gilbert J L, Buckley C A, Jacobs J J. In vivo corrosion of modular hip prosthesis components in mixed and similar metal combinations. The effect of crevice, stress, motion, and alloy coupling.  J Biomed Mater Res. 1993;  27 1533-1544
• 15 Gruen T A, McNeice G M, Amstutz H C. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening.  Clin Orthop Relat Res. 1979;  141 17-27
• 16 Haddad F S, Masri B A, Garbuz D S, Duncan C P. Femoral bone loss in total hip arthroplasty: classification and preoperative planning.  J Bone Joint Surg [Am]. 1999;  81 1483-1489
• 17 Harris W H. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation.  J Bone Joint Surg [Am]. 1969;  51 737-755
• 18 Malchau U, Herberts P, Ahnfelt L. Prognosis of total hip replacement in Sweden. Follow-up of 92.675 operations performed 1978 - 1990.  Acta Orthop Scand. 1993;  64 497-506
• 19 Malkani A L, Settecerri J J, Sim F H, Chao E Y, Wallrichs S L. Long-term results of proximal femoral replacement for non-neoplastic disorders.  J Bone Joint Surg [Br]. 1995;  77 351-356
• 20 Martin J W, Sugiyma H, Kaiser A D, Van Hoech J, Whiteside L A. An analysis of screw fixation of the femoral component in cementless hip arthroplasty.  J Arthroplasty. 1990;  5 15-20
• 21 McKellop H A, Sarmiento A, Brien W, Park S H. Interface corrosion of a modular head total hip prosthesis.  J Arthroplasty. 1992;  7 291-294
• 22 Murray D W, Carr A J, Bulstrode C J. Survival analysis of joint replacements.  J Bone Joint Surg [Br]. 1993;  75 697-704
• 23 Pak J U, Paprosky W G, Jablonsky W S, Lawrence J M. Femoral strut allografts in cementless revision total hip arthroplasty.  Clin Orthop. 1993;  295 172-178
• 24 Puhl W, Kessler S. Which factors influence the long term outcome of total hip replacement?. Rieker C, Oberholzer S, Urs W World tribology Forum in Arthroplasty. Bern, Göttingen; Huber 2001: pp.35-47
• 25 Roberson J R. Proximal femoral bone loss after total hip arthroplasty.  Orthop Clin North Am. 1992;  23 291-302
• 26 Rothman K J. Estimation of confidence limits for the cumulative probability of survival in life table analysis.  J Chron Dis. 1978;  31 557-560
• 27 Schramm M, Wirtz D C, Holzwarth U, Pitto R P. The Morse taper junction in modular revision hip replacement - a biomechanical and retrieval analysis.  Biomed Tech. 2000;  45 105-109
• 28 Volkmann R, Bretschneider C, Eingartner C, Weller S. Revision arthroplasty - femoral aspect: the concept to solve high grade defects.  Int Orthop. 2003;  27(Suppl 1) 24-28
• 29 Wagner H. [A revision prosthesis for the hip joint] Revisionsprothese für das Hüftgelenk.  Orthopäde. 1989;  18 438-453
• 30 Wirtz D C, Niethard F U. [Etiology, diagnosis and therapy of aseptic hip prosthesis loosening - a status assessment] Ursachen, Diagnostik und Therapie der aseptischen Hüftendoprothesenlockerung - eine Standortbestimmung.  Z Orthop. 1997;  135 270-280
• 31 Wirtz D C, Heller K D, Holzwarth U, Siebert C, Pitto R P, Zeiler G, Blencke B A, Forst R. A modular femoral implant for uncemented stem revision.  Int Orthop. 2000;  24 134-138