Minimal 11-year follow-up of extensively porous-coated stems in femoral revision total hip arthroplasty,☆☆

https://doi.org/10.1054/arth.2002.32461Get rights and content

Abstract

Between 1984 and 1989, 188 consecutive femoral revision surgeries were performed. Eighteen patients died or were lost to follow-up, and the remaining 170 patients were followed for 11 to 16 years (mean, 14.2 years). Radiographic evidence of a bone ingrown stem was present in 82% of the hips, stable fibrous fixation was present in 14% of the hips, and 4% of the hips were unstable. Six stems were revised to a larger, fully coated cementless implant. Proximal femoral osteolysis was seen in 23% of femora but was limited to Gruen zones 1 and 7. No diaphyseal osteolysis was seen. The overall mechanical failure rate in this series was 4.1%. Failure of fixation correlated highly with extent of bone loss present at the time of surgery. On the basis of the radiographic and clinical results at a mean follow-up of 14.2 years, we recommend the use of extensively coated femoral stems in revision hip arthroplasty. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Defect classification system

The classification system devised by the senior author (W.G.P.) assists the surgeon in planning a femoral revision and predicting the probability of bone ingrowth [2]. The system is divided into 4 categories, based on the extent and location of femoral bone loss, ranging from minimal type I defects to type IV defects, involving extensive femoral metadiaphyseal damage with thin cortices and widened canals (Table 1) [4].

. Defect classification system

Type of DefectDescription of FemurRecommended

Materials and methods

Between 1984 and 1989, 188 consecutive cementless femoral revision surgeries were performed at this institution using extensively porous-coated femoral components (DePuy/Johnson & Johnson, Warsaw, IN). Eighteen patients (18 hips) died or were lost to follow-up. The remaining 170 patients had a mean 14.2-year follow-up (range, 11–16 years). Mean patient age was 61.2 years. The reasons for revision surgery were aseptic loosening (82%), septic loosening (8%), periprosthetic fractures (6%), and

Results

At minimal mean 14.2-year follow-up, 139 hips (82%) had radiographic evidence of bone ingrowth, 24 hips (14%) appeared to have stable fibrous fixation, and 7 hips (4%) were unstable. Six stems had been revised to larger, fully coated cementless implants. Stem subsidence occurred in 27 hips (16%). Unstable stems subsided an average of 7.1 mm (range, 4–10 mm). All radiographically stable stems showed no progression of stem subsidence after 2 years.

Proximal femoral osteolysis was seen in 23% of

Discussion

The current research found that stable biologic fixation of femoral components can be maintained in >95% of cases at 11 to 16 years after revision surgery. Despite observing stress shielding and osteolysis in some patients, we did not observe any cases in which this became a clinical problem or compromised femoral fixation. The femora classified as type IIIB had a lower rate of stable biologic fixation (21% failure rate) with a fully coated cementless stem. Impaction grafting has been found to

Acknowledgements

We thank Peggy Arp for her assistance and support during the preparation of this manuscript.

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No benefits or funds were received in support of this study.

☆☆

Reprint requests: Wayne G. Paprosky, MD, FACS, Central Dupage Hospital, 25 North Winfield Road, Winfield, IL 60190.

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