title: Revision total hip arthroplasty using cemented collarless double-taper femoral components at a mean follow-up of 13 years (8 to 20): an update.
abstract: The outcome of 219 revision total hip arthroplasties (THAs) in 98 male and 121 female patients, using 137 long length and 82 standard length cemented collarless double-taper femoral stems in 211 patients, with a mean age of 72 years (30 to 90) and mean follow-up of six years (two to 18) have been described previously. We have extended the follow-up to a mean of 13 years (8 to 20) in this cohort of patients in which the pre-operative bone deficiency Paprosky grading was IIIA or worse in 79% and 73% of femurs with long and standard stems, respectively. For the long stem revision group, survival to re-revision for aseptic loosening at 14 years was 97% (95% confidence interval (CI) 91 to 100) and in patients aged > 70 years, survival was 100%. Two patients (two revisions) were lost to follow-up and 86 patients with 88 revisions had died. Worst-case analysis for survival to re-revision for aseptic loosening at 14 years was 95% (95% CI 89 to 100) and 99% (95% CI 96 to 100) for patients aged > 70 years. One additional long stem was classified as loose radiographically but not revised. For the standard stem revision group, survival to re-revision for aseptic loosening at 14 years was 91% (95% CI 83 to 99). No patients were lost to follow-up and 49 patients with 51 hips had died. No additional stems were classified as loose radiographically. Femoral revision using a cemented collarless double-taper stem, particularly with a long length stem, and in patients aged > 70 years, continues to yield excellent results up to 20 years post-operatively, including in hips with considerable femoral metaphyseal bone loss.
authors.affiliation: Royal Adelaide Hospital, L4 Bice Building, North Terrace, Adelaide, South Australia 5000, Australia.
authors.forename: L B
authors.initials: LB
authors.lastname: Solomon
authors.affiliation: Royal Adelaide Hospital, L4 Bice Building, North Terrace, Adelaide, South Australia 5000, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Costi
authors.affiliation: The Princess Alexandra Hospital, Hamstel Road, Harlow CM20 1QX, Essex, UK.
authors.forename: D
authors.initials: D
authors.lastname: Kosuge
authors.affiliation: Royal Adelaide Hospital, L4 Bice Building, North Terrace, Adelaide, South Australia 5000, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Cordier
authors.affiliation: Royal Adelaide Hospital, L4 Bice Building, North Terrace, Adelaide, South Australia 5000, Australia.
authors.forename: M A
authors.initials: MA
authors.lastname: McGee
authors.affiliation: Royal Adelaide Hospital, L4 Bice Building, North Terrace, Adelaide, South Australia 5000, Australia.
authors.forename: D W
authors.initials: DW
authors.lastname: Howie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D001843:Bone Cements; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements
keywords: Revision total hip arthroplasty; Cemented stem; Collarless stem; Double-tapered stem; Polished stem