Medium-term outcomes of the S-ROM modular femoral stem in revision hip replacement.

INTRODUCTION: The objective of this study was to analyse results achieved with the S-ROM modular stem in revision surgery. MATERIALS AND METHODS: A retrospective observational study was conducted from 2007 to 2015 including 51 patients who had a follow-up of ≥ 2 years and complete medical history. The mean age was 66.5 years old (34-87). The main reason for revision was aseptic loosening (38 cases, 74.5%), followed by infection (10, 19.6%), instability (2, 3.9%) and an adverse reaction associated with a metal-on-metal hip implant (1, 2%). Using the Paprosky classification, there were 22 cases of type I (43.1%), 27 of type II (52.9%) and 2 of type IIIA (4%). At the end of the follow-up, radiological parameters were assessed using Engh's criteria. Pre- and postoperative clinical status was assessed using the Harris Hip Score, a visual analogue scale and the Merle D'Aubigné score. RESULTS: The mean follow-up period was 5.7 years (2-10). The mean Harris Hip Score improved from 45.5 points (22-65) to 85.8 (55-100) (p < 0.001), and the final mean Merle D'Aubigné scores were 5.2, 4.6 and 5.6 for pain, ability to walk and mobility, respectively. Osseointegration was confirmed in all except one patient with fibrous non-union. No aseptic loosening has been recorded. Postoperative complications were deep infection in four cases (7.8%) and dislocation in three (5.9%). CONCLUSION: This study indicates good medium-term outcomes using a modular hip replacement system with porous-coated proximal sleeves in revision surgery in patients with Paprosky type I and II defects.

Functional and radiological outcome of periprosthetic femoral fractures after hip arthroplasty.

BACKGROUND: The aim of this study was to determine the functional and radiological results of the treatment of periprosthetic femoral fractures. MATERIALS AND METHODS: A review was performed of all periprosthetic femur fractures after a total hip arthroplasty (THA) or hemiarthroplasty (HA) treated at our institution from 1995 to 2011. Functional outcome was assessed in terms of the Harris Hip Score and ambulatory status. Radiological findings were classified using Beals and Tower's criteria. RESULTS: A total of 59 periprosthetic fractures were identified in 58 patients. The mean age of patients was 79 years old and the mean follow-up time was 33.6 months. Local risk factors were identified in 71% of the patients, principally osteoporosis (59%), followed by osteolysis (24%) and loosening of the stem (19%). In the multivariable analysis, the presence of local risk factors was associated with worsening of patients' ambulatory status. According to the Vancouver classification, there were 8 type A, 46 type B and 5 type C fractures. Of the type B fractures 24 were B1, 14 were B2 and 8 were B3. Fracture union was achieved in 54 fractures, with a mean union time of 6 months. Applying Beals and Tower's criteria, radiological results were excellent in 20 patients (34%), good in 22 (37%), and poor in 17 (29%). None of the patients improved their ability to walk after these fractures and 31 patients (52%) did not regain their prefracture walking status. The mean Harris Hip Score postoperatively was 67.9. There were major or minor complications in 33 patients (56%) and 11 patients (19%) required further operations. CONCLUSION: Although this study shows good radiological results following methods of treatment in accordance with the Vancouver classification, there was marked functional deterioration in many patients and a high rate of complications. Local risk factors were associated with poorer ambulatory status.