Revision total hip replacement using the S-ROM femoral component.

The proximally porous-coated, modular S-ROM femoral component was used in 52 complex total hip revisions done in 48 patients. These patients had severe bone loss, leg length inequality, and instability. Twenty-two patients required structural femoral allografts; 8 had previous resection arthroplasties for sepsis. The mean number of previous hip operations was 3. The stem was press fit, and the metaphyseal sleeve was selectively cemented to the allograft. The preoperative Harris rating was 44 points; at a mean of 3 years, followup was 82 points. Eighty-four percent of the patients were satisfied with their outcomes. No radiographic or histologic evidence of fretting at the modular sleeve-stem junction or along the stem was seen. Significant thigh pain persisted in 2 patients and was directly related to stem diameters > 17 mm. Complications in these complex cases were not infrequent, reflecting the need for allograft augmentation, and included greater trochanter bursitis and nonunion in 20 hips, minor nonpropagating fracture in 13 hips, and 12 dislocations. Mechanical loosening occurred in 5 hips. There were no complications attributable to the S-ROM modular femoral component, and the prosthesis has proven to be versatile and did well in these very difficult cases.