Outcome of revision for mechanical stem failure using the cemented Charnley's stem. A study of 399 cases

Three hundred ninety-nine cemented stem revision total hip arthroplasties performed in cases with mechanical stem failure without infection and having a minimum follow-up period of 3 years were prospectively studied. Two hundred eighty-three were revised for aseptic stem loosening and 116 were revised for fractured stem. Bone-grafting was not performed in any of the cases. The average follow-up period was 7 years 5 months. At the last follow-up evaluation, 70.4% of the patients were pain free and 20.6% had only mild or occasional discomfort. On radiographic evaluation, 31 stems (7.8%) were loose. Thirty-five hips (8.8%) required a rerevision, of which only 20 (5.0%) were for recurrence of mechanical stem failure. Clinical survivorship of the revised stem was 93.9% at 10 years, whereas radiographic survivorship was 91.5% at 10 years. On radiographic analysis, the mechanical failure rate at the last follow-up evaluation was greater after revision for fractured stem than after revision for aseptic stem loosening. Prerevision femoral cortical bone stock did not appear to adversely affect the outcome of the procedure. The clinical and radiologic results achieved with cemented stem revision arthroplasty for mechanical stem failure are excellent.