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Item type:Publication, Access status: with files , Re-revision risk of modular and monobloc revision stems after revision hip arthroplasty(2025-06-01); ; ; Aims Modular revision stem fracture is a rare but difficult complication after hip arthroplasty revision. The purpose of this German Arthroplasty Registry (EPRD)-based study was to investigate whether the overall re-revision rate and the re-revision reasons of modular revision stems compared with monobloc stems are different. Methods A total of 291 re-revisions occurring within five years after implantation of a revision stem (n = 2,039) documented in the EPRD were analyzed using Kaplan-Meier survival analysis and Cox regression. Stem type (modular: n = 1,026, monobloc: n = 1,013) and revision reason were investigated as independent variables, while BMI, sex, age, hospitals’ annual revision volume, and Elixhauser score were treated as confounding variables. Cases with an infection at index surgery were analyzed separately. Results Re-revision risk after five years was similar for either stem type (modular: 18.7% (95% CI 15.9 to 21.9); monobloc: 15.6% (95% CI 13.2 to 18.4); p = 0.200). One stem fracture of a modular revision stem was reported. The main reasons for re-revision were infection (modular/monobloc: 50%/60% of all revisions; p = 0.200), dislocation (19.8%/9.6%; p = 0.045), and loosening (12.2%/ 11.4%; p > 0.999). An Elixhauser score of 4 and above was associated with a higher hazard ratio (HR) for re-revision for either stem type (modular/monobloc: HR 2.01; p = 0.026/HR 2.44; p = 0.004), as well as a BMI category above 25/40 (modular/monobloc: HR 1.73 to 3.25; all p < 0.025/HR 3.61; p < 0.001). An infected index surgery increased the re-revision risk after one year to 26.0% (95% CI 22.2% to 30.3%) compared with 8.3% for noninfected cases (95% CI 7.0% to 9.8%) (p < 0.001) independent of stem type. Conclusion A high BMI increases the HR for revision for either stem design but not due to mechanical implant failure. Infection at the index operation increases re-revision risk significantly, and is also the dominant reason for re-revision independent of stem type.Publicationtype: Journal Article16 18 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Access status: without files , Re-revision risk of modular and monobloc revision stems after revision total hip arthroplasty(British Editorial Society of Bone and Joint Surgery, 2024-08-19); ; ; Michel, M.Implant fracture of modular revision stems is a major complication after total hip arthroplasty revision (rTHA). Studies looking at specific modular designs report fracture rates of 0.3% to 0.66% whereas fractures of monobloc designs are only reported anecdotally. It is unclear whether the overall re-revision rate of modular designs is higher and if, whether stem fractures or other revision reasons are responsible for this elevation. All revisions within 5 years after implantation of a revision stems (n0=13,900; n5=2506) were analysed using Cox regression with design (modular: n=17, monobloc: n=27), BMI, Sex and Elixhauser Score as independent variables. One stage and two stage revisions were analysed separately (1-stage: modular n= 7,102; monobloc n= 4,542; 2-stage: 1,551 / 704). The revision volume of the hospitals was also considered (low: <20 revisions, medium: 21–50 revisions, high: >50 revisions). For the 1-stage revisions, the re-revision risk after 4 years was 14,3% [13.2%, 15.5%] for monobloc and 17.4% [16.40%, 18.40%] for modular stems (p< 0.001). Stem fracture was the reason for re-revision in 2.4% of the modular (fracture rate 0.42%) and 0.6% of the monobloc revisions. The difference in re-revision rates between the designs was mainly due to differences in dislocation and stem loosening. For the 2-stage revisions, the revision risks for either design were similar (21.7% [18,5%, 25.4%] vs. 23.0% [20.8%, 25.4%]; p=0.05). Patient characteristics influenced the comparison between the two designs in the 1-stage group but very little in the 2-stage group. Modular revision stem fractures only contribute very minor to re-revision risk. In 2-stage revisions, no difference in overall re-revision rates between designs was observed. This might indicate that the differences observed for 1-stage procedures are due to differences between the patient cohorts, not reflected by the parameters available or surgeon choice.Publicationtype: Conference Paper16