Medium- and long-term effectiveness of hip revision with SL-PLUS MIA stem in patients with Paprosky type <b>Ⅰ</b>-<b>Ⅲ</b> femoral bone defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

Nuerailijiang·Yushan ¹ ,  LI Yicheng ¹ , GUO Xiaobin ¹ , Wuhuzi·Wulamu ¹ , ZHAO Xujun ² , XU Zhiyong ² ,  ZHANG Xiaogang ¹ , CAO Li ¹

1. Department of Orthopaedics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China;
2. Department of Orthopedics, People’s Hospital of Shache County, Kashi Xinjiang, 844799, P. R. China;

Corresponding author：

LI Yicheng, Email: 455518943@qq.com; ZHANG Xiaogang, Email: zxgjohn1972@sina.com

Keywords：

Hip revision; SL-PLUS MIA stem; femoral bone defect; medium- and long-term effectiveness

DOI：

10.7507/1002-1892.202403053

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Objective To investigate the medium- and long-term effectiveness of hip revision with SL-PLUS MIA stem in patients with Paprosky typeⅠ-Ⅲ femoral bone defect. Methods Between June 2012 and December 2018, 44 patients with Paprosky typeⅠ-Ⅲ femoral bone defect received hip revision using SL-PLUS MIA stem. There were 28 males and 16 females, with an average age of 57.7 years (range, 31-76 years). Indications for revision comprised aseptic loosening (27 cases) and periprosthetic joint infection (17 cases). The Harris hip scores were 54 (48, 60) and 43 (37, 52) in patients with aseptic loosening and periprosthetic joint infection, respectively. The preoperative femoral bone defects were identified as Paprosky type Ⅰ in 32 cases, type Ⅱ in 9 cases, type ⅢA in 2 cases, and type ⅢB in 1 case. Operation time and intraoperative blood transfusion volume were recorded. During follow-up after operation, the hip joint function were evaluated by Harris hip score and X-ray films, the femoral stem survival was analyzed, and the surgical related complications were recorded. Results The operation time of infected patients was 95-215 minutes, with an average of 125.0 minutes. The intraoperative blood transfusion volume was 400-1 800 mL, with an average of 790.0 mL. The operation time of patients with aseptic loosening was 70-200 minutes, with an average of 121.0 minutes. The intraoperative blood transfusion volume was 400-1 400 mL, with an average of 721.7 mL. All patients were followed up 5.3-10.0 years (mean, 7.4 years). At last follow-up, the Harris hip scores were 88 (85, 90) and 85 (80, 88) in patients with aseptic loosening and periprosthetic joint infection, respectively, both of which were significantly higher than those before operation (P<0.05). Radiological examination results showed that the distal end of the newly implanted femoral stem did not cross the distal end of the original prosthesis in 25 cases, and all femoral stems obtained bone fixation. Two cases experienced femoral stem subsidence and 1 case had a translucent line on the lateral side of the proximal femoral stem. When aseptic loosening was defined as the end event, the 10-year survival rate of the SL-PLUS MIA stem was 100%. When treatment failure due to any reason was defined as the end event, the survival time of the prosthesis was (111.70±3.66) months, and the 7-year survival rate was 95.5%. The 7-year survival rates were 94.1% and 96.3% in patients with aseptic loosening and periprosthetic joint infection, respectively. The incidence of postoperative complications was 9.1% (4/44), among which the prosthesis related complications were 4.5% (2/44), 1 case of dislocation and 1 case of infection recurrence. Conclusion Hip revision with SL-PLUS MIA stem has the advantages of simple operation and few postoperative complications in the patients with Paprosky type Ⅰ-Ⅲ femoral bone defect, and the medium- and long-term effectiveness is reliable.

Citation： Nuerailijiang·Yushan, LI Yicheng, GUO Xiaobin, Wuhuzi·Wulamu, ZHAO Xujun, XU Zhiyong, ZHANG Xiaogang, CAO Li. Medium- and long-term effectiveness of hip revision with SL-PLUS MIA stem in patients with Paprosky type Ⅰ-Ⅲ femoral bone defect. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(7): 842-848. doi: 10.7507/1002-1892.202403053 Copy

1.	Bohm P, Bischel O. The use of tapered stems for femoral revision surgery. Clin Orthop Relat Res, 2004, (420): 148-159.
2.	Chatelet JC, Ait-Si-Selmi T, Machenaud A, et al. Mid-term clinical and radiographic outcomes of a long cementless monobloc stem for revision total hip arthroplasty. J Arthroplasty, 2021, 36(1): 261-267.
3.	Hasegawa M, Tone S, Naito Y, et al. Minimum ten-year results in revision total hip arthroplasty using titanium fully porous long stem. Int Orthop, 2021, 45(7): 1727-1733.
4.	Lee KJ, Kim BS, Kim KT, et al. Three-dimensional morphologic features of Asian atypical femur and clinical implications of cephalomedullary nail fixation: Computational measurement at actual size. Injury, 2022, 53(12): 4090-4098.
5.	Vives P, Plaquet JL, Leclair A, et al. Revision of interlocking rod for loosening of THP. Concept-preliminary results. Acta Orthop Belg, 1992, 58(1): 28-35.
6.	Pinaroli A, Lavoie F, Cartillier JC, et al. Conservative femoral stem revision: Avoiding therapeutic escalation. J Arthroplasty, 2009, 24(3): 365-373.
7.	Kavanagh BF, Ilstrup DM, Fitzgerald Jr RH. Revision total hip arthroplasty. J Bone Joint Surg (Am), 1985, 67(4): 517-526.
8.	Swarts E, Bucher TA, Phillips M, et al. Does the ingrowth surface make a difference? A retrieval study of 423 cementless acetabular components. J Arthroplasty, 2015, 30(4): 706-712.
9.	Tanaka A, Kaku N, Tabata T, et al. Comparison of early femoral bone remodeling and functional outcome after total hip arthroplasty using the SL-PLUS MIA stem with and without hydroxyapatite coating. Musculoskelet Surg, 2020, 104(3): 313-320.
10.	Paprosky WG, Burnett RS. Assessment and classification of bone stock deficiency in revision total hip arthroplasty. Am J Orthop (Belle Mead NJ), 2002, 31(8): 459-464.
11.	Ji B, Li G, Zhang X, et al. Midterm survival of a varus-valgus constrained implant following one-stage revision for periprosthetic joint infection: a single-center study. J Knee Surg, 2023, 36(3): 284-291.
12.	Ji B, Li G, Zhang X, et al. Effective single-stage revision using intra-articular antibiotic infusion after multiple failed surgery for periprosthetic joint infection: a mean seven years’ follow-up. Bone Joint J, 2022, 104-B(7): 867-874.
13.	Engh CA Jr, Hopper RH Jr, Engh CA Sr. Distal ingrowth components. Clin Orthop Relat Res, 2004(420): 135-141.
14.	Zhang Y, Zhang Y, Sun SN, et al. Comparison of cylindrical and tapered stem designs for femoral revision hip arthroplasty. BMC Musculoskelet Disord, 2020, 21(1): 411. doi: 10.1186/s12891-020-03461-5.
15.	Hazlehurst KB, Chang JW, Stanford M. A numerical investigation into the influence of the properties of cobalt chrome cellular structures on the load transfer to the periprosthetic femur following total hip arthroplasty. Med Eng Phys, 2014, 36(4): 458-466.
16.	Sumner DR. Long-term implant fixation and stress-shielding in total hip replacement. J Biomech, 2015, 48(5): 797-800.
17.	Burnett RS, Rosenberg AG, Barrack RL. Revision total hip arthroplasty: principles, planning, and decision making//Barrack RL, Rosenberg AG. Master techniques in orthopaedic surgery: the hip. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006: 297-319.
18.	Tetreault MW, Shukla SK, Yi PH, et al. Are short fully coated stems adequate for “simple” femoral revisions? Clin Orthop Relat Res, 2014, 472(2): 577-583.
19.	Valle CJ, Paprosky WG. Classification and an algorithmic approach to the reconstruction of femoral deficiency in revision total hip arthroplasty. J Bone Joint Surg (Am), 2003: 85-A Suppl 4: 1-6.
20.	Russell RD, Pierce W, Huo MH. Tapered vs cylindrical stem fixation in a model of femoral bone deficiency in revision total hip arthroplasty. J Arthroplasty, 2016, 31(6): 1352-1355.
21.	Saunders PRJ, Shaw DA, Sidharthan SK, et al. Survivorship and radiological analysis of a monoblock, hydroxyapatite-coated titanium stem in revision hip arthroplasty. J Arthroplasty, 2020, 35(6): 1678-1685.
22.	王健, 肖军, 赵亮, 等. 非骨水泥锥形方柄在股骨近端骨缺损翻修重建中的应用. 中华骨科杂志, 2016, 36(23): 1517-1523.
23.	Khanuja HS, Issa K, Naziri Q, et al. Results of a tapered proximally-coated primary cementless stem for revision hip surgery. J Arthroplasty, 2014, 29(1): 225-228.
24.	Uriarte I, Moreta J, Cortés L, et al. Revision hip arthroplasty with a rectangular tapered cementless stem: a retrospective study of the SLR-Plus stem at a mean follow-up of 4.1 years. Eur J Orthop Surg Traumatol, 2020, 30(2): 281-289.
25.	Wang J, Dai WL, Lin ZM, et al. Revision total hip arthroplasty in patients with femoral bone loss using tapered rectangular femoral stem: a minimum 10 years’ follow-up. Hip Int, 2020, 30(5): 622-628.
26.	Stimac JD, Boles J, Parkes N, et al. Revision total hip arthroplasty with modular femoral stems. J Arthroplasty, 2014, 29(11): 2167-2170.
27.	Garbuz DS, Masri BA, Duncan CP, et al. The Frank Stinchfield Award: dislocation in revision THA: do large heads (36 and 40 mm) result in reduced dislocation rates in a randomized clinical trial? Clin Orthop Relat Res, 2012, 470(2): 351-356.
28.	Guo LL, Yang YJ, An B, et al. Risk factors for dislocation after revision total hip arthroplasty: A systematic review and meta-analysis. Int J Surg, 2017, 38: 123-129.
29.	Wetters NG, Murray TG, Moric M, et al. Risk factors for dislocation after revision total hip arthroplasty. Clin Orthop Relat Res, 2013, 471(2): 410-416.
30.	Wallace CN, Chang JS, Kayani B, et al. Long-term results of revision total hip arthroplasty using a modern extensiiiely porous-coated femoral stem. J Arthroplasty, 2020, 35(12): 3697-3702.
31.	Cavagnaro L, Formica M, Basso M, et al. Femoral revision with primary cementless stems: a systematic review of the literature. Musculoskelet Surg, 2018, 102(1): 1-9.
32.	Romagnoli S, Marullo M, Corbella M, et al. Conical primary cementless stem in revision hip arthroplasty: 94 consecutive implantations at a mean follow-up of 12.7 years. J Arthroplasty, 2021, 36(3): 1080-1086.
33.	Kang JS, Na Y, Ko BS, et al. Clinical outcomes and survival rate of cementless modular distal fixation femoral stem for revision hip arthroplasty: A minimum 6-year follow-up. J Orthop Surg (Hong Kong), 2018, 26(3): 2309499018812241. doi: 10.1177/2309499018812241.
34.	Paprosky WG, Greidanus NV, Antoniou J. Minimum 10- year-results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res, 1999, (369): 230-242.

1. Bohm P, Bischel O. The use of tapered stems for femoral revision surgery. Clin Orthop Relat Res, 2004, (420): 148-159.
2. Chatelet JC, Ait-Si-Selmi T, Machenaud A, et al. Mid-term clinical and radiographic outcomes of a long cementless monobloc stem for revision total hip arthroplasty. J Arthroplasty, 2021, 36(1): 261-267.
3. Hasegawa M, Tone S, Naito Y, et al. Minimum ten-year results in revision total hip arthroplasty using titanium fully porous long stem. Int Orthop, 2021, 45(7): 1727-1733.
4. Lee KJ, Kim BS, Kim KT, et al. Three-dimensional morphologic features of Asian atypical femur and clinical implications of cephalomedullary nail fixation: Computational measurement at actual size. Injury, 2022, 53(12): 4090-4098.
5. Vives P, Plaquet JL, Leclair A, et al. Revision of interlocking rod for loosening of THP. Concept-preliminary results. Acta Orthop Belg, 1992, 58(1): 28-35.
6. Pinaroli A, Lavoie F, Cartillier JC, et al. Conservative femoral stem revision: Avoiding therapeutic escalation. J Arthroplasty, 2009, 24(3): 365-373.
7. Kavanagh BF, Ilstrup DM, Fitzgerald Jr RH. Revision total hip arthroplasty. J Bone Joint Surg (Am), 1985, 67(4): 517-526.
8. Swarts E, Bucher TA, Phillips M, et al. Does the ingrowth surface make a difference? A retrieval study of 423 cementless acetabular components. J Arthroplasty, 2015, 30(4): 706-712.
9. Tanaka A, Kaku N, Tabata T, et al. Comparison of early femoral bone remodeling and functional outcome after total hip arthroplasty using the SL-PLUS MIA stem with and without hydroxyapatite coating. Musculoskelet Surg, 2020, 104(3): 313-320.
10. Paprosky WG, Burnett RS. Assessment and classification of bone stock deficiency in revision total hip arthroplasty. Am J Orthop (Belle Mead NJ), 2002, 31(8): 459-464.
11. Ji B, Li G, Zhang X, et al. Midterm survival of a varus-valgus constrained implant following one-stage revision for periprosthetic joint infection: a single-center study. J Knee Surg, 2023, 36(3): 284-291.
12. Ji B, Li G, Zhang X, et al. Effective single-stage revision using intra-articular antibiotic infusion after multiple failed surgery for periprosthetic joint infection: a mean seven years’ follow-up. Bone Joint J, 2022, 104-B(7): 867-874.
13. Engh CA Jr, Hopper RH Jr, Engh CA Sr. Distal ingrowth components. Clin Orthop Relat Res, 2004(420): 135-141.
14. Zhang Y, Zhang Y, Sun SN, et al. Comparison of cylindrical and tapered stem designs for femoral revision hip arthroplasty. BMC Musculoskelet Disord, 2020, 21(1): 411. doi: 10.1186/s12891-020-03461-5.
15. Hazlehurst KB, Chang JW, Stanford M. A numerical investigation into the influence of the properties of cobalt chrome cellular structures on the load transfer to the periprosthetic femur following total hip arthroplasty. Med Eng Phys, 2014, 36(4): 458-466.
16. Sumner DR. Long-term implant fixation and stress-shielding in total hip replacement. J Biomech, 2015, 48(5): 797-800.
17. Burnett RS, Rosenberg AG, Barrack RL. Revision total hip arthroplasty: principles, planning, and decision making//Barrack RL, Rosenberg AG. Master techniques in orthopaedic surgery: the hip. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2006: 297-319.
18. Tetreault MW, Shukla SK, Yi PH, et al. Are short fully coated stems adequate for “simple” femoral revisions? Clin Orthop Relat Res, 2014, 472(2): 577-583.
19. Valle CJ, Paprosky WG. Classification and an algorithmic approach to the reconstruction of femoral deficiency in revision total hip arthroplasty. J Bone Joint Surg (Am), 2003: 85-A Suppl 4: 1-6.
20. Russell RD, Pierce W, Huo MH. Tapered vs cylindrical stem fixation in a model of femoral bone deficiency in revision total hip arthroplasty. J Arthroplasty, 2016, 31(6): 1352-1355.
21. Saunders PRJ, Shaw DA, Sidharthan SK, et al. Survivorship and radiological analysis of a monoblock, hydroxyapatite-coated titanium stem in revision hip arthroplasty. J Arthroplasty, 2020, 35(6): 1678-1685.
22. 王健, 肖军, 赵亮, 等. 非骨水泥锥形方柄在股骨近端骨缺损翻修重建中的应用. 中华骨科杂志, 2016, 36(23): 1517-1523.
23. Khanuja HS, Issa K, Naziri Q, et al. Results of a tapered proximally-coated primary cementless stem for revision hip surgery. J Arthroplasty, 2014, 29(1): 225-228.
24. Uriarte I, Moreta J, Cortés L, et al. Revision hip arthroplasty with a rectangular tapered cementless stem: a retrospective study of the SLR-Plus stem at a mean follow-up of 4.1 years. Eur J Orthop Surg Traumatol, 2020, 30(2): 281-289.
25. Wang J, Dai WL, Lin ZM, et al. Revision total hip arthroplasty in patients with femoral bone loss using tapered rectangular femoral stem: a minimum 10 years’ follow-up. Hip Int, 2020, 30(5): 622-628.
26. Stimac JD, Boles J, Parkes N, et al. Revision total hip arthroplasty with modular femoral stems. J Arthroplasty, 2014, 29(11): 2167-2170.
27. Garbuz DS, Masri BA, Duncan CP, et al. The Frank Stinchfield Award: dislocation in revision THA: do large heads (36 and 40 mm) result in reduced dislocation rates in a randomized clinical trial? Clin Orthop Relat Res, 2012, 470(2): 351-356.
28. Guo LL, Yang YJ, An B, et al. Risk factors for dislocation after revision total hip arthroplasty: A systematic review and meta-analysis. Int J Surg, 2017, 38: 123-129.
29. Wetters NG, Murray TG, Moric M, et al. Risk factors for dislocation after revision total hip arthroplasty. Clin Orthop Relat Res, 2013, 471(2): 410-416.
30. Wallace CN, Chang JS, Kayani B, et al. Long-term results of revision total hip arthroplasty using a modern extensiiiely porous-coated femoral stem. J Arthroplasty, 2020, 35(12): 3697-3702.
31. Cavagnaro L, Formica M, Basso M, et al. Femoral revision with primary cementless stems: a systematic review of the literature. Musculoskelet Surg, 2018, 102(1): 1-9.
32. Romagnoli S, Marullo M, Corbella M, et al. Conical primary cementless stem in revision hip arthroplasty: 94 consecutive implantations at a mean follow-up of 12.7 years. J Arthroplasty, 2021, 36(3): 1080-1086.
33. Kang JS, Na Y, Ko BS, et al. Clinical outcomes and survival rate of cementless modular distal fixation femoral stem for revision hip arthroplasty: A minimum 6-year follow-up. J Orthop Surg (Hong Kong), 2018, 26(3): 2309499018812241. doi: 10.1177/2309499018812241.
34. Paprosky WG, Greidanus NV, Antoniou J. Minimum 10- year-results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res, 1999, (369): 230-242.

Chinese Journal of Reparative and Reconstructive Surgery

Medium- and long-term effectiveness of hip revision with SL-PLUS MIA stem in patients with Paprosky type Ⅰ-Ⅲ femoral bone defect

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