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Cemented Charnley revision arthroplasty for severe femoral osteolysis
V V Raut1, P D Siney, B M Wroblewski
1John Charnley Research Institute, Wrightington Hospital for Joint Disease, Wigan, UK.
Insights
Cemented stem revision for severe femoral bone loss without infection is effective. This study shows high rates of pain relief and stable implants, demonstrating satisfactory outcomes for revision hip arthroplasty.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
Background:
- Severe femoral endosteal bone lysis presents a challenge in revision hip arthroplasty.
- Maintaining stem stability is crucial for long-term implant survival.
Purpose of the Study:
- To evaluate the outcomes of prospectively cemented stem revision in patients with severe femoral endosteal bone lysis.
- To assess implant stability, pain relief, and survivorship after revision arthroplasty without bone grafting.
Main Methods:
- Prospective review of 106 patients undergoing cemented stem revision for severe femoral endosteal bone lysis.
- No bone grafts were used; intramedullary cement plugs were employed for stability in most cases.
- Minimum follow-up of three years, with radiographic and clinical assessments.
Main Results:
- 95.3% of stems were radiographically well-fixed and stable at follow-up.
- 76.4% of patients were pain-free, with an additional 17.9% experiencing only mild discomfort.
- Seven-year stem survivorship, based on radiological loosening, was 95.8%; only 3.8% required revision for loosening.
Conclusions:
- Cemented stem revision arthroplasty is a satisfactory option for hips with massive endosteal cavitation.
- The technique provides durable fixation and good clinical outcomes, even without bone grafting.
- Intramedullary cement plugs contribute to improved stability during revision surgery.
Abstract:
We reviewed prospectively cemented stem revision in 106 patients with severe femoral endosteal bone lysis without infection. Bone grafts were not used in any of the patients. The minimum follow-up was three years (mean 6 years 4 months). At the last review 76.4% of the patients were free of pain and 17.9% had only mild or occasional discomfort; radiographs showed well-fixed stable stems in 101 (95.3%). An intramedullary cement plug was used at revision to improve stability in 97.7%. There was new endosteal osteolysis after revision in 17 patients; only two had severe changes. Seven hips (6.6%) required a second revision; only four of these (3.8%) were for stem loosening. Survivorship of the revised stem, using radiological evidence of stem loosening as the end point, was 95.8% at seven years. The results of stem revision arthroplasty using cement in the presence of massive endosteal cavitation are satisfactory.