Cementless femoral revision arthroplasty of the hip: minimum 5 years followup.

Durable fixation of the femoral component to the bone in femoral revision arthroplasty of the hip is the main ingredient to a successful reconstruction. Because of poor durability of cemented fixation in revision, in 1984, one author began to use cementless fixation with extensively porous-coated chrome cobalt stems. The current authors report the durability of that fixation technique in 137 hips (134 patients) followed up 5 to 16 years. With a mean followup of 9.3 years, 10 (7%) of the stems have been removed. Five (4%) were removed for fixation problems and five (4%) were removed for infection. Using the radiographic criteria of Engh et al, 83% of the stems achieved bony ingrowth. No late failure of fixation was observed. Canal-filling prostheses were more likely to have bone ingrowth as were stems placed in femurs with lesser degrees of bone stock deficiency. Significant thigh pain was seen in 7% of bone ingrown stems, 16% of stable fibrous fixated stems, and 75% of unstable stems. Significant thigh pain in bone ingrown stems was observed more commonly in osteoporotic femurs and bone stock deficient femurs. Severe stress shielding correlated with preoperative osteoporosis and larger diameter stems but has not caused failure. Excellent durability of this fixation technique is evident.