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Comparative Study
. 2020 Jun 29;21(1):411.
doi: 10.1186/s12891-020-03461-5.

Comparison of cylindrical and tapered stem designs for femoral revision hip arthroplasty

Yu Zhang  1 , Ye Zhang  1 , Jian-Ning Sun  1 , Zi-Jian Hua  2 , Xiang-Yang Chen  3 , Shuo Feng  4
Affiliations
Comparative Study

Comparison of cylindrical and tapered stem designs for femoral revision hip arthroplasty

Yu Zhang et al. BMC Musculoskelet Disord. .

Abstract

Background: Both cylindrical and tapered stems are commonly used in revision total hip arthroplasty. However, whether the geometry of prosthesis stem has an effect on patient prognosis is unclear. We assume that the tapered stem results in better clinical outcome than the cylindrical stem.

Methods: A multicenter review of 120 femoral revisions with Paprosky I, II, and III defects using cobalt chrome cylindrical stem (54 hips) or titanium tapered stem (66 hips) was performed with an average follow-up of 6 years. Demographic data were comparable between groups.

Results: No significant group differences were found in surgery time, bleeding volume, postoperative Harris Hip Score, level of overall satisfaction, and 8-year cumulative survival. However, intraoperative fractures occurred significantly less in the tapered group (4.5%) than in the cylindrical group (14.8%), and stem subsidence was significantly less in the tapered group (2.17 mm) than in the cylindrical group (4.17 mm). A higher ratio of bone repair and lower bone loss were observed in the tapered group compared with the cylindrical group. The postoperative thigh pain rate was higher in the cylindrical group (12.9%) than in the tapered group (4.5%).

Conclusion: Both cylindrical stem and tapered stem can achieve satisfactory mid-term clinical results in revision total hip arthroplasty. The tapered stem has better bone restoration of proximal femur, lower incidence of intraoperative fractures, and lower postoperative thigh pain rate compared with the cylindrical stem.

Keywords: Complications; Cylindrical stem; Femoral revisions; Hip arthroplasty; Tapered stem.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of the preoperative and postoperative Harris score and VAS score between the two groups
Fig. 2
Fig. 2
Comparison of the prosthesis subsidence between the two groups at the last follow-up (P < 0.05)
Fig. 3
Fig. 3
Kaplan-Meier survival analysis with the endpoint defined as any reoperation because of septic or aseptic complications
Fig. 4
Fig. 4
Preoperative and postoperative radiographs of cylindrical stem with intraoperative fractures
Fig. 5
Fig. 5
Preoperative and postoperative radiographs of tapered stem with intraoperative fractures
Fig. 6
Fig. 6
Postoperative radiographs of cylindrical stem with osteolysis around cup and re-revision with cup exchange
See this image and copyright information in PMC

References

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