The purpose of this study was to evaluate the clinical and radiographic
outcomes of revision of the femoral component of a hip arthroplasty with use
of an impaction bone-grafting technique and a cemented polished stem.
Thirty-three consecutive femoral reconstructions that were performed
between March 1991 and February 1996 with use of the X-change femoral revision
system, fresh-frozen morselized allograft, and a cemented polished Exeter stem
were followed prospectively. Femoral bone stock defects were classified
according to the Endoklinik classification. The average age of the patients at
the time of the femoral component revision was sixty-three years. No patient
was lost to follow-up, which was performed at a minimum of eight years, but
eight patients had died. None of the deaths was related to the surgery.
No femoral reconstruction had been rerevised at a mean of 10.4 years
postoperatively. There was one unrecognized intraoperative fracture, which
healed following nonoperative treatment. There were three postoperative
femoral fractures, all through cortical defects at the level of the tip of the
prostheses. All fractures healed after plate fixation, and all femoral
implants were left in situ. The average subsidence of the stem within the
cement mantle was 3 mm; seven stems migrated 5 mm. The average Harris hip
score improved from 49 points prior to surgery to 85 points (range, 68 to 100
points) at the time of this review. Subsidence did not affect the Harris hip
score. Kaplan-Meier analysis, with an end point of femoral revision for any
reason, showed a survival rate of 100% (one-sided 95% confidence interval,
100% to 91.3%).
Femoral revision with use of an impaction bone-grafting technique and a
cemented polished stem resulted in an excellent prosthetic survival rate at
eight to thirteen years postoperatively. The major problem that occurred was a
femoral fracture in four patients.