Hip Pelvis.  2013 Dec;25(4):260-266. 10.5371/hp.2013.25.4.260.

Revision Hip Arthroplasty with a Cementless Femoral Stem

• Chung YY
• Lim CH
• Kim CY
• Kim JS

• KMID: 1808133
• DOI: http://doi.org/10.5371/hp.2013.25.4.260

Abstract

PURPOSE
To evaluate the clinical and radiographic results of patients who received revision total hip arthroplasty using cementless femoral stems.
MATERIALS AND METHODS
This study included 26 patients who underwent revision total hip arthroplasty using a cementless femoral stems in our hospital, between Jan 2000 and May 2010, and were able to be evaluated in the final follow-up. The mean age was 63.8 years at the time of the revision surgery, and the follow up period was an average of 45 months. The causes of revision were aseptic loosening in 11 cases, periprosthetic fracture in 6 cases, femoral osteolysis in 6 cases, and infection in 3 cases. The radiologic results were evaluated in term of subsidence, loosening, and the stress shielding. The clinical results were evaluated by the Harris hip score and thigh pain.
RESULTS
Harris hip score improved from 41.2 points preoperatively to 85.8 points at the final follow-up. There were 5 cases that complained of thigh pain at the last follow-up. Subsidence of femoral stem of more than 10 mm was observed in 3 cases. Stress shielding was noticed in 6 hips. The 3 grafted strut allografts were completely fused with the host bone. Complications included 2 cases of intraoperative periprosthetic fracture and 3 cases of dislocation.
CONCLUSION
We obtained favorable clinical and radiologic outcomes in revision total hip arthroplasty using a cementless femoral stems. However, thigh pain and stress shielding resulted from the diameter of femoral stem being too large.

Keyword

Revision hip arthroplasty; Cementless femoral stems

MeSH Terms

Allografts
Arthroplasty*
Arthroplasty, Replacement, Hip
Dislocations
Follow-Up Studies
Hip*
Humans
Osteolysis
Periprosthetic Fractures
Thigh
Transplants

Figure

• 

  Fig. 1 (A) 83-year-old female with a loosened cemented femoral stem with bone defect. (B) The hip was revised using a Wagner (Zimmer, Europe) stem, 190 mm in length, with onlay strut allografting for bone defect. (C) Lateral view after revision hip arthroplasty. (D) 60-momths after revision surgery, the grafting bone fused with host bone and remodeled.

• 

  Fig. 2 (A) Preoperative radiograph showed loosening of a cemented femoral stem. The bone defect was classified as Paprosky type IIIB. (B) Revision was done with the largest in diameter cementless femoral stem was inserted with incomplete scratch fitting in the distal diaphysis. (C) Loosening of femoral stem with progressive subsidence was seen on follow-up radiographs.

• 

  Fig. 3 (A) Immediate postoperative radiograph of 72-year-old female with revision arthroplasty with a fully extensive coated femoral stem 16 mm in diameter due to infection. (B) Follow-up radiograph showed a Grade IV stress shielding.

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