Extensively Porous-coated Stems for Femoral Revision: Reliable Choice for Stem Revision in Paprosky Femoral Type III Defects

Abstract

Between January 1999 and August 2008, ninety-six femoral revisions were performed with extensively porous-coated stems in Paprosky type III femoral defects (89 type IIIA and 7 type IIIB defects). Seven type IIIB defects with a mean canal of 16.5 mm were observed; 6 defects achieved stable bone ingrowth and 1 achieved stable fibrous condition. Average postoperative Harris Hip Score was 92.3±8 (range, 77-100), and all scores improved postoperatively. At a mean follow-up of 65.7 months, 92 stems achieved bone ingrowth, and 1 stem (type IIIB) achieved a stable fibrous condition. Three patients died from causes unrelated to the surgery during follow-up. The most frequent diagnosis for revision of the femoral component was loosening of the cementless stem (53 patients; 55.2%), followed by status after a Girdlestone procedure (21 patients; 21.8%), after total hip arthroplasty with acetabular wear (10 patients; 10.4%), loosening of the cemented stem (7 patients; 7.3%), and periprosthetic fracture (5 patients; 5.2%). The authors performed 65 total hip arthroplasty revisions, 23 femoral component revisions, and 8 revisions of femoral components with cemented liners in patients with well-fixed acetabular shells. Extensively porous-coated stems in femoral revision for Paprosky type III femoral defects provided good mid-term durability.

Classifications In Brief: The Paprosky Classification of Femoral Bone Loss

“…Based on clinical studies by Paprosky et al [22,23], use of an extensively porous coated stem when at least 4 cm of intact diaphyseal bone was present was associated with excellent survivorship (95% survivorship; mean followup, 13.2 years). Other authors [5,21] have reported similar results. Conversely, 21% of patients experienced stem loosening if diaphyseal fixation was less than 4 cm [23].…”

Use of a Modular Tapered Fluted Femoral Component in Revision Total Hip Arthroplasty Following Resection of a Previously Infected Total Hip: Minimum 5-year Follow-Up

“…Cylindrical fully-porous coated femoral stems have been shown to be another valuable option for revision THA in the setting of proximal femoral bone loss [10,[22][23][24]. Reports on the use of this stem design have shown reliable ingrowth, however thigh pain and stress shielding are potential concerns when using this style of femoral stem [10,[22][23][24].…”

“…Reports on the use of this stem design have shown reliable ingrowth, however thigh pain and stress shielding are potential concerns when using this style of femoral stem [10,[22][23][24]. Likewise many authors recommend against using this type of stem in the setting of Paprosky IIIb and IV femoral deficiency [10,[22][23][24].…”

Management of Severe Femoral Bone Loss in Revision Total Hip Arthroplasty

“…These defects are typically reconstructed using an extensively porous coated stem or a modular tapered stem. Chung and colleagues 35 …”