title: Bone remodeling after a mean of 10 years in diaphyseal cortical defects repaired with femoral revision using bypass fixation of extensively porous-coated stems with high stiffness.
abstract: BACKGROUND
  Femoral component revisions with extensively porous-coated stems have shown promising clinical results, although there are still concerns over stress-shielding.
  
  
  METHODS
  We retrospectively reviewed data for 18 patients undergoing femoral component revisions with extensively porous-coated stems with high stiffness. The average length of follow-up was 10 years (range 6-13.7 years).
  
  
  RESULTS
  Radiographic evidence of a bone-ingrown stem was present in 94 % of the hips, and stable fibrous fixation was present in only one hip, but no hips were considered unstable. There was mild stress-shielding in 15 hips, moderate stress-shielding in one hip, and severe stress-shielding in two hips. In one of the latter two hips, stress-shielding was progressive even 8 years after revision surgery. In 12 (92 %) of the 13 hips in which bypass fixation for diaphyseal cortical defects was used, there was good remodeling.
  
  
  CONCLUSIONS
  We suggest that femoral component revision using extensive porous-coated stems is a useful option that may allow for healing of diaphyseal cortical defects.
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahokugun, Ishikawa, 920-0293, Japan, 66406kf@kanazawa-med.ac.jp.
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Fukui
authors.forename: Ayumi
authors.initials: A
authors.lastname: Kaneuji
authors.forename: Tanzo
authors.initials: T
authors.lastname: Sugimori
authors.forename: Toru
authors.initials: T
authors.lastname: Ichiseki
authors.forename: Tadami
authors.initials: T
authors.lastname: Matsumoto
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001847:Bone Diseases / Q000503:physiopathology / Q000601:surgery*; D016723:Bone Remodeling / Q000502:physiology*; D020099:Coated Materials, Biocompatible; D018483:Diaphyses / Q000601:surgery*; D005260:Female; D005269:Femur / Q000601:surgery*; D062785:Hemiarthroplasty / Q000009:adverse effects; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000503:physiopathology / Q000601:surgery; D016062:Porosity; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D020099:Coated Materials, Biocompatible