Promising results of revision total hip arthroplasty using a hexagonal, modular, tapered stem in cases of aseptic loosening.

Background: Modular stems are widely used in revision total hip arthroplasty (THA) with aseptic loosening being a common reason for revision. Despite the good results reported on the use of modular stem designs, there are only few studies focusing on aseptic revisions and few studies on a hexagonal stem design. The goal of this study is to determine stem survival, clinical and functional outcome along with possible risk factors for implant failure in aseptic revision THA.
Methods: We retrospectively identified 53 patients with aseptic THA revision using a modular hexagonal stem with a minimum follow-up of two years. Femoral bone loss, radiographic and clinical outcomes as well as function measured using the Harris Hip Score (HHS) was assessed. Patients' previous medical history was analyzed for comorbidities and the body mass index. Stem survival was calculated using the Kaplan-Meier method. Possible risk factors for implant failure were analyzed using the log-rank test. The median age at revision was 69 (IQR 62-73) with a median follow up of 74 months.
Results: Implant survival rates amounted to 90.4% at 3 and 5 years. The median HHS improved by 47 points (34 (IQR 22-47) vs 81 (IQR 59-90) p<0.001). There was a reduced implant survival after 5 years when the revision stem was used following a previous cemented stem (83.4% vs 100%, p = 0.04).
Conclusion: A modular, hexagonal stem can be successfully used in aseptic revision THA with remarkable functional results and excellent survivorship. Revision of a cemented stem using this implant might result in reduced survival which must be considered when planning treatment.
Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Prof. Georg Gosheger, Dr. Burkhard Möllenbeck, Dr. Thomas Ackmann and Dr. Tom Schmidt- Bräkling declare not to have any competing interests regarding this publication. Dr. Jan Schwarze, Dr. Christoph Theil and Prof. Ralf Dieckmann declare to have one financial competing interest: Travel grants and honoraria for speaking or participation at meetings have been paid by implantcast GmbH (Buxtehude Germany). This does not alter our adherence to PLOS ONE policies on sharing data and materials.