Background: Recent studies have indicated that the rate of
successful long-term outcome after primary total hip arthroplasty for patients
with osteonecrosis may be improved with the use of later-generation
porous-coated prostheses (biologic ingrowth fixation) and cement techniques
(cement fixation). Less is known about the long-term outcome after revision
arthroplasty in the same patient population. The purpose of this study was to
characterize the clinical and radiographic outcomes of revision total hip
arthroplasty in patients with osteonecrosis.
Methods: We evaluated thirty-four osteonecrotic hips in thirty
patients who had undergone revision of a femoral component of a prior total
hip arthroplasty. There were nineteen men (twenty-two hips) and eleven women
(twelve hips) with a mean age of forty-six years. Thirty one of thirty-four
hips were implanted without cement. The cementless prostheses were of
different stem lengths, but thirty of thirty-one were proximally porous
coated. The mean duration of follow-up was 8.2 years. Prerevision radiographs
were used to determine the degree of femoral bone loss according to the
classification system of Della Valle and Paprosky. The need for revision was
analyzed for correlation to known risk factors for osteonecrosis, age and
gender of the patient, and degree of prerevision femoral deficiency. A
clinical and radiographic evaluation of outcome was performed.
Results: This was the first revision for twenty-seven hips, the
second for five hips, and the third for two hips. Preoperatively, the defects
included four Type I, nine Type II, fifteen Type IIIA, two Type IIIB, one Type
IV, and three unknown. The femoral component was rerevised in twelve of the
thirty-four hips. One of the failures was the only fully porous-coated stem
that was implanted. One of the three cemented implants failed, as compared
with eleven of the thirty-one noncemented implants. Survival rates were 90.9%
at five years, 54.8% at ten years, 54.8% at fifteen years, and 27.4% at twenty
years. With the small sample size, no relationship could be identified with
regard to frequency of re-revision and defects, associated risk factors,
patient age, or gender.
Conclusions: There was a high failure rate of revised, uncemented,
proximally coated femoral components in patients with osteonecrosis of the
femoral head at the time of the intermediate-term follow-up. The cause of
failure could not be correlated with patient age, gender, risk factors for
osteonecrosis, or femoral bone stock.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors on
jbjs.org for a
complete description of levels of evidence.