Bicortical Contact Predicts Subsidence of Modular Tapered Stems in Revision Total Hip Arthroplasty

We describe the intraoperative parameters that affect stem subsidence rates in tapered modular femoral stems for revision total hip arthroplasty (THA). We also determine the effect of the stem bicortical contact on subsidence rates and whether there is a minimum threshold bicortical contact that must be achieved to avoid the complication of subsidence.

This is a retrospective cohort study consisting of 109 hips in 105 patients (53 males and 52 females) at a minimum of 2 years of follow-up. All revisions were carried out for Paprosky type 3A and 3B femoral deficits. Clinical outcomes included the indication for revision, aseptic re-revision surgery, specifications of the stem inserted, and specifications of the femoral head and acetabular components implanted. Radiographic outcome measures included subsidence (mm) and bicortical contact (mm).

Using multivariate regression analysis, 3 parameters were associated with an increased rate of stem subsidence. A reduced bicortical contact distance ( P < .001) and a stem length of ≤155 mm ( P < .001) were both associated with higher subsidence rates. We also demonstrated a novel threshold of 20-mm bicortical contact which must be achieved to significantly reduce subsidence rates in these modular femoral stems for revision THA.

Subsidence rates of modular tapered femoral stems for revision THA can be significantly reduced by increasing the initial bicortical contact of the stem within the diaphysis and the overall length of the femoral stem >155 mm. We describe a minimum threshold bicortical contact distance of 20 mm that should ideally be exceeded to significantly reduce the risk of stem subsidence within the femoral canal.