Uncemented revision total hip arthroplasty: a 4-to-6-year review

A review of 52 cementless revision total hip arthroplasties in 51 patients with a 4- to 6-year clinical and radiographic followup was conducted. Mallory Head titanium alloy prostheses using proximally porous-coated femoral stems were used in all cases. There were 2 revisions of the femoral component only and 1 was an acetabular revision. At an average followup of 4.6 years, 5 (10%) unstable femoral stems had been rerevised and another 7 (14%) stems were unstable radiographically, but rerevision had been refused or postponed. Three (6%) sockets were considered unstable but no acetabular revisions have been done. Eleven of the 12 stem failures were in femora with moderate or severe prerevision femoral bone loss. The Harris Hip Score averaged 76 points for the entire group, and scores were much worse in patients with preexisting femoral bone deficiency. Twenty (40%) femoral fractures occurred during stem insertion. This short-term study shows inadequate fixation of proximally porous-coated femoral stems in revisions with femoral bone loss; adequate stability is achieved if bone loss is limited. Porous-coated acetabular fixation using fins and screws where necessary is adequate in the majority of cases.