Distal ingrowth components.

The literature documents that distal ingrowth fixation provides a reproducible, durable option that can be used in many femoral revision situations. In this review, we describe our use of cylindrical, extensively porous-coated stems to achieve distal fixation. The procedure involves choosing 5 cm to 7 cm of diaphyseal bone and reaming it cylindrically for a porous-coated femoral stem. Surgical implantation is uncomplicated because the femoral diaphysis aligns the component and imparts a reproducible press-fit sensation during impaction. The complications are well documented and can be avoided with adequate exposure, intraoperative radiographs, and surgical experience. Survivorship data based on femoral revisions done at our institution with extensively porous-coated stems show overall excellent results although a relatively poorer outcome is associated with patients whose prerevision cortical damage involves bone more than 10 cm below the lesser trochanter.