Mid term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement.

Mid term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement.

The bone & joint journal (2014-07-06)

B Fink, K Urbansky, P Schuster

ABSTRACT

We report our experience of revision total hip replacement (THR) using the Revitan curved modular titanium fluted revision stem in patients with a full spectrum of proximal femoral defects. A total of 112 patients (116 revisions) with a mean age of 73.4 years (39 to 90) were included in the study. The mean follow-up was 7.5 years (5.3 to 9.1). A total of 12 patients (12 hips) died but their data were included in the survival analysis, and four patients (4 hips) were lost to follow-up. The clinical outcome, proximal bone regeneration and subsidence were assessed for 101 hips. The mean Harris Hip Score was 88.2 (45.8 to 100) after five years and there was an increase of the mean Barnett and Nordin-Score, a measure of the proximal bone regeneration, of 20.8 (-3.1 to 52.7). Five stems had to be revised (4.3%), three (2.9%) showed subsidence, five (4.3%) a dislocation and two of 85 aseptic revisions (2.3%) a periprosthetic infection. At the latest follow-up, the survival with revision of the stem as the endpoint was 95.7% (95% confidence interval 91.9% to 99.4%) and with aseptic loosening as the endpoint, was 100%. Peri-prosthetic fractures were not observed. We report excellent results with respect to subsidence, the risk of fracture, and loosening after femoral revision using a modular curved revision stem with distal cone-in-cone fixation. A successful outcome depends on careful pre-operative planning and the use of a transfemoral approach when the anatomy is distorted or a fracture is imminent, or residual cement or a partially-secured existing stem cannot be removed. The shortest appropriate stem should, in our opinion, be used and secured with > 3 cm fixation at the femoral isthmus, and distal interlocking screws should be used for additional stability when this goal cannot be realised.

MATERIALS

Product Number

Brand

Product Description

460400

Sigma-Aldrich

Titanium, wire, diam. 0.25 mm, 99.7% trace metals basis

369489

Sigma-Aldrich

Titanium, foil, thickness 2.0 mm, 99.7% trace metals basis

GF29584187

Titanium, tube, 500mm, outside diameter 2.03mm, inside diameter 1.55mm, wall thickness 0.24mm, annealed, 99.6+%

GF87716997

Titanium, rod, 100mm, diameter 16mm, as drawn, 99.99+%

GF54978249

Titanium, rod, 200mm, diameter 4mm, annealed, 99.6+%

GF34106363

Titanium, rod, 1000mm, diameter 1.5mm, annealed, 99.6+%

GF62676759

Titanium, rod, 200mm, diameter 2mm, as drawn, 99.99+%

GF05925281

Titanium, microfoil, disks, 10mm, thinness 0.1μm, specific density 42.8μg/cm², permanent mylar 3.5μm support, 99.6+%

GF17705516

Titanium, rod, 200mm, diameter 3.0mm, annealed, 99.6+%

GF12929744

Titanium, microfoil, disks, 25mm, thinness 0.25μm, specific density 112.6μg/cm², permanent mylar 3.5μm support, 99.6+%

GF64061760

Titanium, rod, 1000mm, diameter 16mm, annealed, 99.6+%

GF54883581

Titanium, rod, 1000mm, diameter 3.0mm, annealed, 99.6+%

GF76772391

Titanium, rod, 100mm, diameter 10mm, annealed, 99.6+%

GF52551222

Titanium, microfoil, disks, 10mm, thinness 0.25μm, specific density 112.6μg/cm², permanent mylar 3.5μm support, 99.6+%

GF61322699

Titanium, rod, 100mm, diameter 2mm, annealed, 99.6+%

GF13959939

Titanium, microfoil, disks, 10mm, thinness 0.5μm, specific density 225.4μg/cm², permanent mylar 3.5μm support, 99.6+%

GF06082286

Titanium, microfoil, disks, 10mm, thinness 1.0μm, specific density 429μg/cm², permanent mylar 3.5μm support, 99.6+%

GF62977540

Titanium, tube, 200mm, outside diameter 2.03mm, inside diameter 1.63mm, wall thickness 0.2mm, annealed, 99.6+%

GF32801251

Titanium, tube, 1000mm, outside diameter 1.05mm, inside diameter 0.75mm, wall thickness 0.15mm, annealed, 99.6+%

GF58567067

Titanium, rod, 100mm, diameter 5mm, annealed, 99.6+%

GF03838282

Titanium, rod, 500mm, diameter 1.5mm, annealed, 99.6+%

GF16031843

Titanium, mesh, 100x100mm, nominal aperture 0.19mm, wire diameter 0.23mm, 60x60 wires/inch, open area 20%, twill weave

GF23916618

Titanium, microfoil, disks, 25mm, thinness 0.5μm, specific density 225.4μg/cm², permanent mylar 3.5μm support, 99.6+%

GF66991179

Titanium, rod, 100mm, diameter 2mm, as drawn, 99.99+%

GF31127712

Titanium, rod, 10mm, diameter 50mm, 99.99+%

GF65336700

Titanium, rod, 200mm, diameter 2mm, annealed, 99.6+%

GF04311638

Titanium, rod, 100mm, diameter 6mm, annealed, 99.6+%

GF10374678

Titanium, rod, 500mm, diameter 5mm, annealed, 99.6+%

GF72503827

Titanium, tube, 100mm, outside diameter 2.03mm, inside diameter 1.63mm, wall thickness 0.2mm, annealed, 99.6+%

GF72212813

Titanium, tube, 200mm, outside diameter 25.4mm, inside diameter 23.62mm, wall thickness 0.89mm, annealed, 99.6+%