Revision surgery in total hip arthroplasty: surgical technique and results

Revisions in failed total hip arthroplasty have produced some good results. In cases of stem fracture, the problem is lack or loss of proximal support in the presence of distal fixation of the stem. This aspect must be borne in mind during primary and revision surgery. Routine use of long intramedullary stems has little to commend it. Proximal support of the stem is essential. In revision for deep sepsis, antibiotic-loaded cement has increased the success rate. Sound component fixation is, however, of paramount importance. If success is to be achieved in revision surgery, the patients at risk must be carefully followed up by serial radiographs. The timing of the revision will depend on awareness of the problem rather than the patients' symptoms. This, at times, may mean revising early and for radiographic changes alone if the quality of the bone stock is to be preserved, and if the chances of success are to be improved.