Mean 8.1-Year Follow-Up of a Monoblock, Splined Tapered Femoral Stem in Revision Hip Arthroplasty.

Abstract

Revision total hip arthroplasty (rTHA) presents challenges in cases of poor bone stock and proximal femoral defects. A monoblock, splined, tapered stem provides distal fixation without modularity for these complex cases. This study aimed to assess mid- to long-term clinical outcomes, complication rates, and implant survival. Outcomes of rTHA using a monoblock, splined, tapered femoral stem from a single surgeon were reviewed. At minimum 4-year follow-up, there were 184 cases identified with 107 included in this analysis (mean 8.1 ± 2.8 years). Preoperative and postoperative modified Harris Hip Scores, radiographic subsidence, limb length discrepancy, complications, and reoperations were analyzed. Patients undergoing primary total hip arthroplasty with less than four years of follow-up or without necessary radiographic imaging were excluded (n = 77). Aseptic loosening (n = 35) and septic loosening (n = 48) were the primary indicators for rTHA. The mean modified Harris Hip Score improved from 40.4 ± 16.3 preoperatively to 73.9 ± 18.8 at the final follow-up (P < 0.001). There were 24 re-revisions, including seven irrigation and debridement procedures, nine for fracture fixation, two septic revisions, and six aseptic revisions. Logistic regression showed no significant predictors of rerevisions. Mean subsidence and limb length discrepancy were -2.5 ± 3.6 mm and -0.2 ± 4.1 mm, respectively. At final follow-up, the Kaplan-Meier estimated survival was 78.5% (95% confidence interval 71.1 to 85.9) for all-cause reoperations and 93.4% (95% confidence interval 88.5 to 98.3) for implant survivorship of the acetabular and femoral components. Revision rates and outcomes after rTHA using a monoblock, splined, tapered femoral stem were acceptable at mid- to long-term evaluation, with 93.4% survivorship of the stem at a mean of 8.1 year follow-up.