Clinical and radiographic evaluation of long-stem femoral components following revision total hip arthroplasty.
Fifty-four consecutive, long-stem revision hip arthroplasties were performed in 53 patients. In order to evaluate periprosthetic femoral changes, all cases utilizing cement, requiring bone-grafts for prosthetic stability, or with a follow-up period of less than 2 years were omitted. Thus, 32 long-stem revision hip arthroplasties in 32 patients were reviewed. Twenty-three Porous Coated Anatomic (Howmedica, Rutherford, NJ) and nine Bi-Metric (Biomet, Warsaw, IN) stems were implanted, with an average follow-up period of 3.6 years (range, 2-6 years). Prosthetic canal fill averaged 94% proximally and 80% distally. Intraoperative complications included three femoral shaft fractures. Harris hip scores averaged 47.8 points, before surgery and 87.6 points at the final follow-up evaluation, with 81% of patients the pain-free. Only three cases of subsidence and one case of osteolysis were noted. By 1 year, proximal osteopenia (off-load) (P = .005), bony condensation about the porous surface (spot weld) (P = .01), and pedestal formation (P = .004) were observed. The presence of distal cortical hypertrophy, (P = .02) spot weld (P = .001), and pedestal formation (P = .05) correlated significantly with off-load. Pedestal formation and distal cortical hypertrophy were commonly found together (P = .001). Despite significant periprosthetic remodeling, adequate fixation and satisfactory early clinical scores were achieved in this setting. Contrary to similar reviews using extensive bone-grafts, acceptable pain-free clinical results were obtained with these components.
Center for Hip and Knee Surgery, Mooresville, Indiana.
J B
JB
Meding
M A
MA
Ritter
E M
EM
Keating
P M
PM
Faris
D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006622:Hip Prosthesis / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome