J Korean Hip Soc.  2010 Sep;22(3):189-196. 10.5371/jkhs.2010.22.3.189.

Revision Total Hip Arthroplasty Using a Fully Porous-Coated Long Stem: a Minimum 5 Years Follow up

• Cho YJ
• Kwak SJ
• Chun YS
• Rhyu KH
• Ko TS
• Yoo MC

• KMID: 1461169
• DOI: http://doi.org/10.5371/jkhs.2010.22.3.189

Abstract

PURPOSE
We wanted to evaluate the mid-term results of revision total hip arthroplasty using a fully porous-coated long stem.
MATERIALS AND METHODS
A retrospective series of 20 hips in 19 patients who underwent stem revision with a fully porous-coated long stem were evaluated at a mean follow-up of 64.6 months. The causes of revision were aseptic loosening, periprosthetic fracture and infected arthroplasty. Four kinds of implants had previously been used and an additional bone graft procedure had been done in 17 cases. The Harris hip scores, thigh pain, limping and ROM were reported. Radiological changes of the radiolucent signs, subsidence, loosening and the stress shielding signs were evaluated.
RESULTS
The Harris hip score improved from an average of 56.5 to 91.9 and the ROMs were satisfactory. The only case with persistent thigh pain showed stable bony ingrowth. No signs of subsidence or loosening of the stem was found in all the cases. There were 2 cases of periprosthetic fracture. None of the patients experienced re-revision surgery.
CONCLUSION
The mid-term results of revision hip arthroplasty using a fully porous coated long stem have demonstrated that it provides a reliable initial fixation with a propensity for stable longevity. It is relatively easy for the techniques, and there is the opportunity to restore the bone stock by bone-grafting procedures with diaphyseal fixation and bypassing a bone defect. Yet alternative techniques may be required for the femur with extensive diaphyseal bone loss. There are some concerns about the technique and the possibility of making a crack in the femur during the operation, which will cause thigh pain at the follow-up. So, only by employing great caution when performing this technique can successful results be guaranteed.

Keyword

Femur; Osteolysis; Revision total hip arthroplasty; Fully porous coated long stem

MeSH Terms

Arthroplasty
Femur
Follow-Up Studies
Hip
Humans
Longevity
Osteolysis
Periprosthetic Fractures
Retrospective Studies
Thigh
Transplants

Figure

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  Fig. 1 (A) 35-year-old female with Paprosky type IIIA bone defect in her left femur showed significant loosening of the primary cemented stem. (B) The hip was revised using Versys™ (Zimmer, U.S.A.) 200 mm stem and impaction morselized allograft with wire mesh support. We used wire fixation for the extended trochanteric osteotomy area. (C) 68-month after revision surgery, it showed stable bony ingrowth at diaphysis with successful consolidation and remodeling of allograft.

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  Fig. 2 35-year-old male. (A) A cemented stem was placed into a femur with a Paprosky type IIIA bone defect. Bone loss of the greater trochanter, perforated by loosening stem, is shown in the anteroposterior preoperative radiograph. (B) The hip was revised with Versys™ (Zimmer, U.S.A.) 200 mm stem. Bony supporting with strut allograft and impaction morselized allograft was done. (C) 68-month after revision surgery, radiograph revealed a sign of stable bony ingrowth at diaphyseal area with a sign of allograft consolidation. The patient experienced a mild thigh pain with irritation pain at greater trochanteric area.

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  Fig. 3 40-year-old male. (A) His right femur was under the state of 10-year-after PROSTALAC insertion due to the infection primary total hip arthroplasty. It showed aseptic loosening and Paprosky type IIIB bone loss. (B) His femur has revised using Versys™ (Zimmer, U.S.A.) 200 mm stem with strut allograft to made up proximal bony support. (C) 72-month from the surgery, we could not find any evidence of micro-motion or implant loosening. It showed stable bony ingrowth fixation with partial allograft absorption. He has complained persistent mild thigh pain.

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  Fig. 4 Post-operative changes of the range of motion.

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