Results of noncemented revision.
The results of revision of total hip replacements with noncemented fixation are dependent on implant design, postoperative treatment, and the technique selected in relationship to the bone quality and quantity.  When proximal femoral bone ingrowth fixation is desired an implant must have a double wedge design, which permits a high percentage contact between the host bone and the porous coating of the implant.  Bone graft in either the femur or acetabulum should be used at a minimum.  Every attempt to obtain host bone contact to porous coating should be done.  When a bone graft is used to replace the proximal femur or when an acetabular bone graft covers more than 50% of the cup, the implant should be cemented into the bone graft. Bone structure affects the outcome of noncemented revisions more than the thickness of the bone.  Even thin and weak femoral bone has dynamic remodeling capability.  The structure influences result more according to the ability to contact the host bone to the porous coating.  When this can be done, the bone will heal to the porous coating.  Postoperatively, 40% of our patients are treated with a cast to protect bone grafts and weak bones that are important for stability of the implant.  We believe that conservative postoperative rehabilitation for noncemented revision arthroplasty significantly improves the healing for the bone to the implant.
Kerlan-Jobe Orthopaedic Clinic, Inglewood, CA 90301.
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D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D006622:Hip Prosthesis / Q000009:adverse effects* / Q000379:methods / Q000534:rehabilitation; D006801:Humans; D011182:Postoperative Care; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation