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Abstract
Background and purpose Proximal bone loss due to stress-shielding is a matter of concern after uncemented femoral hip revision. We have used short, proximally hydroxyapatite-coated prostheses in revision since 1989, and we now report the results.
Methods 60 patients (62 hips) were revised because of aseptic loosening. Bone defects prior to revision were mostly of type II according to the Gustilo-Pasternak and Endo-Klinik classifications. Follow-up time was 73 (24–161) months. 9 patients had died before follow-up; 8 of these still had the stem in place. Clinical assessment was performed with the Harris hip score. Radiographs were evaluated for bone defects at revision, postoperative stem fixation, and periprosthetic bone remodeling.
Results Mean Harris hip score was 75 (30–100) points. There was no stem loosening or progressive subsidence. 8 patients had mild to moderate thigh pain. Osteolysis, present at revision, had diminished, partially or completely, in four-fifths of the hips at follow-up. 4 hips had required re-revision due to fracture or dislocation. The 6-year prosthesis survival rate was 95% (95% CI: 0.83–0.98).
Interpretation Uncemented revision with a short, proximally hydroxyapatite-coated prosthesis is a reliable procedure with encouraging results in the medium term if bone defects at revision are moderate.
Contributions of authors
MS examined all patients, collected the data, analyzed the radiographs, and prepared the manuscript. OS contributed with manuscript preparation, some statistical analyses, and examination of several patients. HB and TA scrutinized the radiographs and revised the manuscript. PA designed the study, supervised the statistical analyses, and proofread the manuscript.