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.
1 Division of Orthopaedic Surgery, London Health Sciences Centre— University Campus, 339 Windermere Road, London, ON, N6A 5A5, Canada. E-mail address for C.M. Haydon: email@example.com