15-year experience with tapered fluted modular titanium stems in revision hip arthroplasty and complex femoral reconstruction: a long-term survivorship analysis in a tertiary care centre

Introduction: Over the past 2decades, tapered fluted modular titanium stems have gained wide acceptance due to their intraoperative versatility and encouraging early- to mid-term outcomes. This study aims to analyse the clinical and radiographic outcomes, complications, and survivorship of tapered fluted modular titanium stems in revision THA and complex femoral reconstruction with long-term follow-up. Materials and methods: A retrospective study was conducted on patients who underwent revision hip surgery or complex reconstruction using a non-cemented modular tapered fluted stem at a single institution between 2009 and 2016. A total of 47 patients (48 hips) were included. Clinical evaluation was performed using the Harris Hip Score (HHS). Radiographic parameters were used to assess implant stability, osteointegration, subsidence, and stress shielding. Complications were recorded, and implant survivorship was analysed using the Kaplan-Meier method. Results: The mean age was 70 (range 37–95) years, with a mean follow-up of 9 (range 6–15) years. All patients showed functional and pain improvement after surgery, with an average increase of 38 points in the HHS ( p 5 mm) of 4%. Stress shielding was present in 8% of cases. A total of 6 reoperations were recorded: 3 (6%) due to recurrent dislocation, 2 (4%) due to septic loosening, and 1 (2%) due to aseptic loosening. Overall implant survivorship was 87.5% for any reoperation, 91.7% for any stem revision, and 100% for stem revision due to mechanical failure of the femoral component. Conclusions: The modular tapered fluted stem proved to be a reliable and durable option in revision total hip arthroplasty and complex femoral reconstruction, with high rates of osteointegration and long-term stability. Its design allows for effective distal fixation and bone reconstruction in patients with severe femoral defects.