Background: The decision as to whether to revise
a well-fixed femoral component in hips requiring isolated acetabular
revision is challenging. The purpose of the present study was to
determine the long-term results of, and the complications associated
with, retention of a stable and well-fixed femoral component during
isolated acetabular revision.
Methods: We retrospectively reviewed the clinical
and radiographic results for thirty-one patients (thirty-two hips)
who underwent isolated revision acetabuloplasty without removal
of a well-fixed femoral component. The reason for acetabular revision was
aseptic loosening in thirty-one hips and malposition in one hip.
Of the thirty-two femoral components, twenty-one were cemented and
eleven were cementless. The average duration of follow-up from the
time of the index revision was 8.1 years (range, 6.4 to 12.5 years),
and the average duration of total service of the femoral component
was seventeen years (range, seven to twenty-five years) from time
of the initial implantation. The average age of the patients at
the time of the index revision was sixty-six years (range, twenty-nine
to eighty-seven years).
Results: Thirty-one (97%) of the primary
femoral components were judged to be stable and well fixed at the
latest follow-up evaluation. One femoral component (3%)
was revised because of aseptic loosening, eight years after the
index acetabular revision and seventeen years after the initial
total hip arthroplasty. Radiographic evaluation of the thirty-one
femoral components that were not revised demonstrated no evidence
of loosening or subsidence. There were no dislocations, nerve palsies,
or intraoperative fractures associated with retention of the femoral
component. Twenty-seven (84%) of the acetabular components
were judged to be stable at the latest follow-up evaluation.
Conclusion: In hips treated with isolated acetabular
revision, a well-fixed femoral component can be retained successfully
without adversely affecting the acetabular exposure; the placement, position,
or stability of the acetabular component; or the ability to restore
bone stock. The data from the present study support the decision
to retain a well-fixed femoral component when the acetabular component
needs to be revised.