Cementless revision of total hip arthroplasty using proximal porous-coated femoral implants

Thirty patients had 32 cementless total hip arthroplasty revisions and were evaluated postoperatively for clinical function (Harris Hip Score) and radiographic evidence of implant stability. Of the 26 femoral components revised, 16 were revised with anatomic long-stem femoral prostheses, and 10 were revised with straight mid-stem-length components. All components were collared and had circumferential proximal fiber-mesh porous coating. Seven of 16 patients had radiographic subsidence after revision with long-stem components (2 to 30 mm); 6 of 10 patients had subsidence after revision with mid-stem femoral components (2 to 25 mm). Of the 13 patients with femoral subsidence, 8 had calcar reconstruction with allograft bone; of the 13 patients without radiographic subsidence, 8 did not require calcar reconstruction. One of 27 fiber-mesh, porous-coated acetabular components migrated (30 mm). No components have been removed or revised. Even with circumferential proximal porous coating, femoral implant stability remains unpredictable in total hip arthroplasty revision.