Medium-term follow-up of 92 femoral component revisions using a third-generation cementing technique

Abstract

Background and purpose — Very little has been published on the outcome of femoral cemented revisions using a third-generation cementing technique. We report the medium-term outcome of a consecutive series of patients treated in this way.Patients and methods — This study included 92 consecutive cemented femoral revisions performed in our department with a third-generation cementing technique and without instrumented bone impaction grafting between 1996 and 2007. The average age of the patients at revision was 66 (25–92) years. None of the patients were lost to follow-up. At review in December 2013, 55 patients were still alive and had a non-re-revised femoral revision component in situ after a mean follow-up of 11 (5–17) years.Results — The mean preoperative Harris hip score was 50, and improved to 73 at final follow-up. 2 patients died shortly after the revision surgery. 1 stem was re-revised for aseptic loosening; this was also the only case with radiolucent lines in all 7 Gruen zones. A femoral reoperation was performed in 19 hips during follow-up, and in 14 of these 19 reoperations the femoral component was re-revised. Survivorship at 10 years, with femoral re-revision for any reason as the endpoint, was 86% (95% CI: 77–92). However, excluding 8 patients with reinfections after septic index revisions and 1 with hematogenous spread of infection from the survival analysis, the adjusted survival for re-revision for any reason at 10 years was 92% (95% CI: 83–96). With re-revision for aseptic loosening as endpoint, the survival at 10 years was 99% (CI: 90–100).Interpretation — Femoral component revision with a third-generation cemented stem results in acceptable survival after medium-term follow-up. We recommend the use of this technique in femoral revisions with limited loss of bone stock.

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“…G ood medium-term results for cemented femoral revisions have been shown using thirdgeneration cementing techniques [11] and impaction allografting [10]. As a result, cemented stem revisions remain a useful option for older, less-active patients with extensive metaphyseal and diaphyseal defects and cortical thinning, although others have suggested that cemented revisions are technically demanding, and poor results have also been reported with that approach [2].…”