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Which length for the revision stem?

A Toni1, A Sudanese, A L Bueno Lozano

  • 1Clinica Ortopedica dell'Università, Istituto Ortopedico Rizzoli, Bologna.

La Chirurgia Degli Organi Di Movimento
|October 1, 1994
PubMed
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Revision hip arthroplasty outcomes reveal that short stems, especially when uncemented, offer excellent clinical and radiographic results. Cemented short stems showed higher rates of osteolysis, indicating a preference for cementless fixation in revision cases.

Area of Science:

  • Orthopedic surgery
  • Biomaterials science

Background:

  • Aseptic loosening is a primary cause of hip arthroplasty failure.
  • Evaluating stem characteristics in revision surgery is crucial for long-term implant survival.

Purpose of the Study:

  • To analyze the clinical and radiographic outcomes of hip revision arthroplasty using different stem lengths and fixation methods.
  • To determine the association between stem fixation (cemented vs. cementless) and femoral bone defects.

Main Methods:

  • Retrospective review of 79 hip revision arthroplasties performed between 1981 and 1992.
  • Classification of femoral osteolytic lesions using the Paprosky protocol.
  • Assessment of clinical outcomes and radiographic evidence of osteointegration.

Main Results:

Related Experiment Videos

  • All prostheses required revision due to aseptic loosening; 68% were cemented.
  • Severe femoral osteolysis (Paprosky type 2b-3) was more common with cemented stems (37%) than cementless (4%).
  • Short stems (12-13 cm) demonstrated excellent clinical results (90%) and high osteointegration (97%), particularly when uncemented.

Conclusions:

  • Short stems in hip revision arthroplasty are associated with superior clinical and radiographic outcomes compared to standard or long stems.
  • Cementless fixation appears to reduce the incidence of severe femoral osteolysis in revision hip surgery.
  • The choice of stem length and fixation method significantly impacts the success of revision hip arthroplasty.