Five-year results of a monolithic tapered, fluted titanium femoral component in complex primary and revision total hip arthroplasty.

Abstract

Total hip arthroplasty (THA) in the setting of proximal femoral defects and poor bone stock often necessitates distal fixation using specialized implants, such as monolithic tapered, fluted titanium stems (TFTSs), to ensure adequate stability. This study evaluates the mid-term outcomes of TFTS in both primary and revision THA. This was a multi-institutional retrospective review of patients who received monolithic TFTS between July 2016 and June 2020 during either complex primary THA or revision THA. Outcomes included pre-, intra- and postoperative characteristics, as well as five-year all-cause, septic and aseptic revisions, and Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) at different postoperative timepoints. A total of 115 patients with a mean follow-up of 6.3 years (SD 1.2) were included. Femoral component survivorship free from aseptic revisions was 99.1% (95% CI 97.3 to 100) at 5.1 years after TFTS. Aseptic revision occurred in a single patient (0.9%) due to periprosthetic acetabular fracture that necessitated femoral component removal for exposure 60.6 months following TFTS. Survivorship from septic revisions was 93.2% (95% CI 91.5 to 99.9) at 5.3 years. Septic revisions included debridement, irrigation and exchange of modular components (n = 3, 2.6%), and two-stage revision arthroplasties (n = 4, 3.5%) at a mean of 27.7 months after surgery (1.5 to 63.9). All-cause survivorship from any revision was 92.4% (95% CI 90.5 to 100) at 5.3 years after TFTS. HOOS, JR scores improved from preoperative to five-year follow-up (46.1 (SD 20.8) to 83.8 (SD 19.0), respectively). The TFTS demonstrates excellent mid-term survivorship (99.1% at five years) and significant clinical improvement in complex primary and revision THA. These outcomes suggest that the TFTS can be considered a valuable option in this challenging patient population.