Outcomes of Modular Stem for the Treatment of Periprosthetic Femoral Fracture: a Systematic Review of the Literature

Overview

Journal Ann Jt

Publisher AME Publishing Company

Date 2024 Mar 26

PMID 38529241

Authors

Giorgio Cacciola

Lorenzo Braconi

Francesco Bosco

Fortunato Giustra

Luigi Sabatini

Marcello Capella

Federico De Meo

Pietro Cavaliere

Giuseppe Solarino

Affiliations

Soon will be listed here.

Abstract

Background: Periprosthetic femoral fractures (PFFs) are a frequent complication after total hip arthroplasty (THA). Both modular and non-modular tapered fluted titanium (TFT) stems could be used in total hip revisions (THRs). Nevertheless, the most appropriate femoral stem type is still under debate. The current systematic review aims to analyze the survival rate and all causes of stem revision, the overall complication rate and reason for reoperation, and patient reported outcome measures (PROMs) in THR for PFF using the modular tapered titanium stems (MTTS).

Methods: A comprehensive search in four databases, PubMed, Scopus, Embase, and the Cochrane Database of Systematic Reviews databases, was performed, and following the PRISMA guidelines, a systematic review was conducted. Strict inclusion and exclusion criteria were applied, starting from 1,259 studies. The risk of bias was analyzed according to the MINORS tool system. Descriptive statistical analysis was performed for all data extracted.

Results: Eighteen clinical studies were included in the qualitative analysis for a total of 775 patients enrolled. A mean MINORS criteria score of 9.8 [8-12] was reported. The overall survival of MTTS for PFF treatment was 95.4%, with an overall reintervention rate of 10.3% at an average follow-up of 4.5 years. Despite the use of modular components, postoperative hip instability remains the most frequent complication and cause of reintervention in these patients. In addition, a mean postoperative Harris Hip Score (HHS) of 78.1 was reported, which was considered acceptable given the high mean age of 74.1 years at the time of the revision.

Conclusions: Several therapeutic approaches and a wide variety of implants have been described in the literature for PFF management; however, no one solution has proven superior to others in the PFF treatment. MTTS has become a commonly used treatment option for Vancouver B2 and B3 fractures because they provide good clinical and radiological results with a reasonable survival rate. However, the complication rate of MTTS is still high.

Citing Articles

A Modified Wagner Stem Design Increases the Primary Stability in Cementless Revision Hip Arthroplasty.

Boettcher J, Sellenschloh K, Huber G, Ondruschka B, Morlock M Arthroplast Today. 2025; 32:101622.

PMID: 39991631 PMC: 11847092. DOI: 10.1016/j.artd.2025.101622.

References

Garbuz D, Toms A, Masri B, Duncan C . Improved outcome in femoral revision arthroplasty with tapered fluted modular titanium stems. Clin Orthop Relat Res. 2007; 453:199-202. DOI: 10.1097/01.blo.0000238875.86519.cf. View

Malchau H, Herberts P, Eisler T, Garellick G, Soderman P . The Swedish Total Hip Replacement Register. J Bone Joint Surg Am. 2002; 84-A Suppl 2:2-20. DOI: 10.2106/00004623-200200002-00002. View

Mahomed N, Arndt D, McGrory B, Harris W . The Harris hip score: comparison of patient self-report with surgeon assessment. J Arthroplasty. 2001; 16(5):575-80. DOI: 10.1054/arth.2001.23716. View

Amenabar T, Rahman W, Avhad V, Vera R, Gross A, Kuzyk P . Vancouver type B2 and B3 periprosthetic fractures treated with revision total hip arthroplasty. Int Orthop. 2015; 39(10):1927-32. DOI: 10.1007/s00264-015-2957-6. View

Rodriguez J, Berliner Z, Williams C, Robinson J, Hepinstall M, Cooper H . Management of Vancouver Type-B2 and B3 Periprosthetic Femoral Fractures: Restoring Femoral Length via Preoperative Planning and Surgical Execution Using a Cementless, Tapered, Fluted Stem. JBJS Essent Surg Tech. 2018; 7(3):e27. PMC: 6132713. DOI: 10.2106/JBJS.ST.17.00007. View

Garbuz D, Masri B, Duncan C . Periprosthetic fractures of the femur: principles of prevention and management. Instr Course Lect. 1998; 47:237-42. View

Hernandez-Vaquero D, Fernandez-Lombardia J, de los Rios J, Perez-Coto I, Iglesias-Fernandez S . Treatment of periprosthetic femoral fractures with modular stems. Int Orthop. 2015; 39(10):1933-8. DOI: 10.1007/s00264-015-2958-5. View

Cacciola G, Mancino F, De Meo F, Bruschetta A, Martino I, Cavaliere P . Current Reconstruction Options in Periprosthetic Fractures Around the Knee. Geriatr Orthop Surg Rehabil. 2021; 12:21514593211023996. PMC: 8404675. DOI: 10.1177/21514593211023996. View

Parry J, Hernandez N, Berry D, Abdel M, Yuan B . Risk Factors for Subsidence of Modular Fluted Tapered Stems Used During Revision Total Hip Arthroplasty for Periprosthetic Hip Fractures. J Arthroplasty. 2018; 33(9):2967-2970. DOI: 10.1016/j.arth.2018.05.006. View

10.

Abdel M, Watts C, Houdek M, Lewallen D, Berry D . Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Joint J. 2016; 98-B(4):461-7. DOI: 10.1302/0301-620X.98B4.37201. View

11.

Park C, Lim S, Park Y . Modular Stems: Advantages and Current Role in Primary Total Hip Arthroplasty. Hip Pelvis. 2018; 30(3):147-155. PMC: 6123508. DOI: 10.5371/hp.2018.30.3.147. View

12.

Bohm P, Bischel O . The use of tapered stems for femoral revision surgery. Clin Orthop Relat Res. 2004; (420):148-59. View

13.

Santiago L I, Gerardo A, Fernando V, Leonel P, Ignacio P, Pablo M . Midterm results and complications rates in vancouver type B2 and B3 periprosthetic femoral fractures treated with modular fluted tapered stems. J Orthop. 2021; 28:1-4. PMC: 8523868. DOI: 10.1016/j.jor.2021.10.006. View

14.

Fink B, Grossmann A, Singer J . Hip revision arthroplasty in periprosthetic fractures of vancouver type B2 and B3. J Orthop Trauma. 2011; 26(4):206-11. DOI: 10.1097/BOT.0b013e318220a94f. View

15.

Mancino F, Di Matteo V, Mocini F, Cacciola G, Malerba G, Perisano C . Survivorship and clinical outcomes of proximal femoral replacement in non-neoplastic primary and revision total hip arthroplasty: a systematic review. BMC Musculoskelet Disord. 2021; 22(Suppl 2):933. PMC: 8576938. DOI: 10.1186/s12891-021-04711-w. View

16.

Park J, Kim H, Kim K, Lee Y, Ha Y, Koo K . A 10- to 12-year follow-up study of delta ceramic-on-ceramic total hip arthroplasty. Arch Orthop Trauma Surg. 2023; 143(8):5385-5394. DOI: 10.1007/s00402-022-04758-x. View

17.

Curley A, Padmanabhan S, Prabhavalkar O, Perez-Padilla P, Maldonado D, Domb B . Durable Outcomes After Hip Labral Reconstruction at Minimum 5-Year Follow-Up: A Systematic Review. Arthroscopy. 2023; 39(7):1702-1713. DOI: 10.1016/j.arthro.2023.02.015. View

18.

Schreiner A, Steidle C, Schmidutz F, Gonser C, Hemmann P, Stockle U . Hip Revision Arthroplasty of Periprosthetic Fractures Vancouver B2 and B3 with a Modular Revision Stem: Short-Term Results and Review of Literature. Z Orthop Unfall. 2020; 160(1):40-48. DOI: 10.1055/a-1209-4002. View

19.

Bruschetta D, Anastasi G, Andronaco V, Cascio F, Rizzo G, Di Mauro D . Human calf muscles changes after strength training as revealed by diffusion tensor imaging. J Sports Med Phys Fitness. 2018; 59(5):853-860. DOI: 10.23736/S0022-4707.18.08759-5. View

20.

Ries M . Intraoperative modular stem lengthening to treat periprosthetic femur fracture. J Arthroplasty. 1996; 11(2):204-5. DOI: 10.1016/s0883-5403(05)80019-1. View