Revision total hip arthroplasty in deficient proximal femur using a distal load-bearing prosthesis

Eleven revision total hip replacements (THR) were performed with the use of transfemoral distally fixing stems. Nine Wagner and two Link cementless stems were used. The mean age of the patients was 62 years (range 44-78) and in mean they had undergone 2.4 previous hip operations. The mean follow-up was 43 months in nine patients and two patients had a new revision during the follow-up. The reasons for these revisions were loosening of stems in association with proximal lysis and periprosthetic fracture in eight cases, proximal femoral resection after infection in one case, loosening and deficient proximal bone in one case and proximal intraoperative fracture in a dysplastic hip after previous intertrochanteric osteotomy in one patient. The subsidence of the stem varied from 0 to 40 mm and two stems were revised during the first year because stability was lost due to subsidence. In those nine cases who were not revised the mean Harris hip score was 74 points. The final results were excellent in two, good in three, fair in two and poor in four cases. Our results suggest that revision total hip arthroplasty in cases where the proximal femur is deficient after lysis, old infection or fracture, using a distal load bearing stem gives satisfactory results in more than half of cases.