Revision total hip arthroplasty: the limits of fully coated stems.
Femoral revision with a 7-inch or 8-inch fully porous-coated stem may not provide reliable long-term results in patients with moderate bone loss. The purpose of this study was to evaluate the limits of fully porous-coated stems and to create a treatment algorithm for femoral deficiencies. Fifty-one patients with either a 10-inch or 9-inch calcar fully porous-coated stem, 10 patients with impaction bone grafting, and 10 patients with a modular tapered stem were evaluated at an average 4.2 years postoperatively. The mechanical failure rate among the 9-inch and 10-inch fully porous-coated stems was 0% in Type III B defects with femoral canals less than 19 mm (15 patients), 18% in Type IIIB defects with femoral canals greater than 19 mm (2 of 11 patients) and 37.5% in Type IV defects (three of eight patients). There were no mechanical failures observed among the bone packing or modular tapered stems. Patients with Type IIIB defects and a femoral canal less than 19 mm can be treated successfully with either a 10-inch or 9-inch calcar fully porous-coated stem. However, patients with Type IIIB defect and an endosteal canal greater than 19 mm or a Type IV defect require alternative methods of reconstruction such as a modular tapered stem or a bone packing procedure.
Sporer
Scott M
SM
Department of Orthopaedic Surgery, Rush Presbyterian-St. Luke's Medical Center, Chicago, IL, USA. ssporer@hotmail.com
Paprosky
Wayne G
WG
D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001847:Bone Diseases / Q000145:classification / Q000209:etiology / Q000601:surgery; D005270:Femur Head; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies