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Updated: Jun 28, 2026
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
[Should monobloc cemented stems be systematically revised during revision total hip arthroplasty? A prospective
G Grosjean1, J-P Courpied, M Moindreau
1Centre de recherches orthopédiques cliniques, centre hospitalo-universitaire Cochin-Port-Royal (AP-HP), université Paris-V, 27, rue du Faubourg-St-Jacques, 75014 Paris, France.
Insights
Revision total hip arthroplasty (THA) often involves retaining the femoral component. However, this study found significant femoral head damage in most cases, recommending systematic femoral component revision in THA regardless of the reason.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Implant Wear Analysis
Context:
- Revision total hip arthroplasty (THA) is frequently necessitated by polyethylene wear and periacetabular osteolysis, often leading to acetabular component loosening.
- In such cases, the monobloc cemented femoral stem may remain stable, raising questions about whether it can be retained during revision surgery.
Purpose:
- To evaluate the surface and sphericity damage of femoral heads in a series of revision THAs where the cemented monobloc femoral component was systematically revised.
- To determine the extent of in vivo wear and damage to the femoral head component of Charnley-type THAs.
Summary:
- Twenty-two Charnley-type cemented total hip arthroplasties were revised. Femoral heads were analyzed for surface roughness (Ra, Rt) and sphericity.
- Results showed significant deviations from international standards in roughness and sphericity for a majority of the explanted femoral heads (over 80% for roughness, 59% for sphericity).
- No significant association was found between patient age, BMI, time to revision, or reason for revision and the degree of femoral head damage.
Impact:
- The findings suggest that retaining the femoral component during revision THA is often inadvisable due to prevalent in vivo surface damage.
- Systematic revision of the monobloc femoral component is recommended in THA revisions to avoid potential complications related to worn or damaged femoral heads.
- This study provides critical data for surgical decision-making in revision hip arthroplasty, emphasizing component integrity over potential cost savings from retention.
Purpose Of The Study:
The main reason for revision of Charnley type total hip arthroplasty is socket loosening related to high polyethylene wear and periacetabular osteolysis. In these situations, the monobloc cemented stem is frequently not loosened and it is not clear whether the femoral component can be retained during the revision procedure. The aim of this study was to evaluate surface and sphericity damage to the femoral head of a prospective and consecutive series of revision total hip arthroplasties during which the cemented monobloc femoral component has been systematically revised.
Materials And Methods:
We performed 22 revisions of both components of Charnley type cemented total hip arthroplasties. In all cases, the 22.2 mm head of the monobloc femoral component was made of 316 L stainless steel. The international standard for such femoral heads includes an average surface roughness (Ra) of 0.05 microm, a total roughness (Rt) value of 0.5 microm and a sphericity of +/-5 microm. The mean age of the patients at the time of the index arthroplasty was 51.3 years. The average time to revision was 14.8 years (seven to 25 years). The reasons for revision included isolated socket loosening (12), extensive periacetabular osteolysis without socket loosening (two), recurrent dislocation associated with socket loosening (one), sepsis without implant loosening (one), loosening of both components (one), and isolated loosening of the femoral component (five). Hence, 15 of the 22 (68.2%) femoral components could theoretically have been retained. The surface roughness of the femoral heads was evaluated using a contact-type profilometer. For each head, the apex and two zones, either macroscopically scratched or with loss of the mirror finish, were analyzed. Moreover, the sphericity of the heads was measured using a spherometer.
Results:
The stem explanted after recurrent dislocation was analyzed separately as the femoral head had major scratches. The mean Ra and Rt of the series at the apex was 0.029 and 0.876 microm, respectively. The mean Ra and Rt of the series for the macroscopically damaged areas was 0.05 microm and 1.540 microm, respectively. The mean sphericity of the series was 7.2 microm. Hence among the 22 explanted stems, 10 femoral heads (45.4%) had Ra or Rt apex and 18 (81.8%) Ra or Rt scratched area values beyond ISO standards, respectively. Sphericity was greater than +/-5mm for 13 of the 22 femoral heads (59.1%). With the numbers available, the age at the time of the index arthroplasty, the BMI, the time and the reason for revision were not significantly associated with the degree of femoral head damage for both roughness and sphericity parameters.
Discussion:
Retaining the femoral component during revision of the total hip arthroplasty including a monobloc femoral component is theoretically an interesting alternative. However, femoral head surface damage occurring in vivo would have lead us to retain severely scratched heads in over 80% of the hips, and heads with abnormal roughness and sphericity values in over 90% of the hips. Bases upon our results, we recommend systematically revising the femoral component during revision THA including a monobloc stem, irrespective of the reason for revision.
