Background: Revision of the femoral component of a total hip
replacement with use of cement has been associated with early mechanical
failure due to aseptic loosening. The purpose of the present study was to
determine the long-term survival after revision of the femoral component with
cement and to identify factors that were predictive of failure.
Methods: The results of 129 revision total hip arthroplasties that
had been performed with use of a cemented femoral stem were reviewed to
determine component survival. Ninety-seven hips that had been followed for a
minimum of five years were included in survival analysis and tests of
significance. Harris hip scores were used to quantify clinical outcomes.
Clinical and surgical factors were analyzed to determine whether they were
predictive of failure.
Results: The mean Harris hip score improved from 52 points
preoperatively to 71 points at the time of the most recent follow-up (p <
0.001). The ten-year survival rate was 91% with rerevision of the femoral
component because of aseptic loosening as the end point and 71% with
mechanical failure as the end point. Patients who were more than sixty years
old had greater long-term component survival and less pain than younger
patients did (p < 0.05). A good-quality postoperative cement mantle was
associated with better long-term radiographic signs of fixation (p <
0.001). Poor femoral bone quality was associated with an increased rate of
rerevision for aseptic loosening (p = 0.021).
Conclusions: Revision with use of a cemented femoral component
remains an option for selected patients, with an acceptable ten-year survival
rate and fair radiographic evidence of fixation. Our patients had acceptable
clinical outcomes at ten years, and few had notable pain. The best results may
be achieved in older patients (those who are sixty years old or more) with
adequate bone stock who are managed with modern cementing techniques.
Level of Evidence: Prognostic study, Level II-1
(retrospective study). See Instructions to Authors for a complete description
of levels of evidence.