Contemporary Cemented Revision Stems Demonstrate Excellent Survivorship in Revision Total Hip Arthroplasty up to 13-Year Follow-Up.

BACKGROUND

An extended diaphyseal femoral fixation can be mandatory in complex femoral revision total hip arthroplasty (THA). While outcomes of uncemented revision components are well documented in this context, little data are available about cemented revision stems with different options. This study aimed to evaluate survivorship, risk factors for re-revision, and radiographic and clinical outcomes of a series of one contemporary monoblock cemented revision stem implanted for femoral revision.

METHODS

Between 2008 and 2022, 230 cemented revision femoral components were implanted in revision THAs in 227 patients. The mean age was 77 years, with 59% being women. The Kaplan-Meier method was used to estimate survival with its confidence interval (95% CI). Risk analysis used the Cox proportional hazard method. Preoperative bone stock deficiency and stem fixation were assessed. Harris Hip Scores (HHSs) were collected at the last follow-up. The mean follow-up was five years (range, two to 13).

RESULTS

The 10-year survivorships free from aseptic femoral loosening and from any femoral revision were 98 (95% CI [confidence interval]: 92 to 99) and 84% (95% CI: 56 to 95), respectively. There were 12 femoral re-revisions: nine chronic infections and three cases of femoral loosening. Vancouver C femoral fractures were the main cause for reoperation (eight cases, 3% of the cohort). Demographics, cause for revision, preoperative bone stock deficiency, and implant characteristics were not predictors for femoral re-revision. Radiographic analysis showed two cases (1%) of osteolysis and radiolucencies. The mean postoperative HHS was 78, and patients who had been revised for periprosthetic femoral fracture (P < 0.0001) or periprosthetic joint infection (P < 0.007) had inferior HHS scores than those revised for femoral loosening.

CONCLUSIONS

Contemporary long cemented revision stems were associated with a low risk for femoral re-revision at 10 years, with no influence of demographics, cause for revision, or surgical factors. While femoral loosening was rare (1%), Vancouver C femoral fractures were the main cause for reoperation.

LEVEL OF EVIDENCE: IV (retrospective study).