Revision of Failed Total Hip Arthroplasties with Uncemented Porous-Coated Anatomic Components

This series represents a relatively short follow-up study of patients who were treated with cementless revisions for failed previous arthroplasties. Many of these cases required extensive bone grafting to the acetabulum and often to the femur. Despite extensive bone grafting, there were no infections. There has been but a single graft resorption after a hemiarthroplasty conversion for recurrent dislocations. To date, all other grafts have remained intact and have shown signs of union. Even though the acetabular components were not anchored in place by adjuvant fixation devices such as screws, migration of the acetabular component has not been a problem. All other components have remained stable, and the supporting grafts appear to have united successfully. Femoral revision has been more technically demanding because the largest stem possible should be placed within the femur to prevent subsidence and provide good stabilization in the proximal metaphyseal area. These short-term results compared favorably with similar series of cemented revisions. Patient selection is important and there are definite candidates for cemented femoral components, particularly with first-time revisions in elderly patients. If there is massive osteolysis in the femur, cemented revision is probably not indicated. Long stems should not be used unless necessary. Cortical defects at the tip of the standard stem obviously would require bypassing the stress riser with a longer stem. If, however, the cortex is intact in this region and stability can be achieved, revision should be carried out with a relatively short stem. Techniques for cementless revision are demanding, but with meticulous attention to detail and technical perfection, the method has a most encouraging prognosis. Longer follow-up evaluations will be necessary to make an accurate evaluation of graft incorporation, but short-term results are encouraging to both surgeons and patients.