Outcomes of Primary Cementless Femoral Stems Used in Revision Hip Arthroplasty

An abundance of literature exists assessing outcomes of revision total hip arthroplasty (THA) using diaphyseal-engaging stems; however, there is little research into the use of primary-style femoral stems in revision THA. Primary stems may have benefits, including cost reduction, maintenance of proximal bone stock, and ease of potential future reconstructions. The purpose of this study was to evaluate the aseptic survival rate of revision THAs using primary femoral stems.

A review of our registry was performed to identify patients from 2010 to 2020 who underwent all-cause revision THA utilizing a primary metaphyseal-engaging stem for femoral reconstruction. Patients who had a history of previous revision THA or those treated with cement or bone graft augmentation were excluded. There were seven patients excluded due to a lack of 2-year follow-up. Implant survival, complications requiring revision surgery, and ambulatory status at final follow-up were documented. There were 78 patients who met the final inclusion criteria. The mean follow-up was 5.2 years (range, 2.0 to 10.0).

The most common indications for index revision were aseptic loosening (44%) or infection (34%). Prerevision Paprosky classification of the femur was Type I in 41 patients (52%), Type II in 37 patients (47%), and Type IIIA in one patient (1%). Overall, 13 patients (16.5%) required rerevision, five for periprosthetic fracture, six for instability, and two for recurrent infection. Of those, seven of 13 required femoral component revision. When excluding recurrent infections, the aseptic femoral component survivorship for the cohort was 94%. There were three patients who sustained a fracture requiring stem rerevision. A Vancouver B1 fracture was sustained > 2 years postoperatively, and two Vancouver B2 fractures were sustained within 6 months postoperatively. There were no femoral rerevisions for aseptic loosening.

Primary metaphyseal-engaging femoral stems provide reliable fixation during revision THA in patients who have preserved proximal metaphyseal bone, with similar complication rates to those previously reported in the literature for revision THA.