Good results with an uncemented proximally HA-coated stem in hip revision surgery: 62 hips followed for 2–13 years

Figures & data

Table 1.  Demographic data for the patients

Age at follow-up, years^a	65 (35–84)
Male/female	37/23
Weight, kg^a	81 (51–128)
Height, cm^a	174 (159–191)
BMI^a	27 (18–39)
Harris hip score at follow-up^a	75 (30–100)
Charnley clinical classi.cation (A/B/C)	17/11/26

^amean (range)

Figure 1. Box plot of Harris hip score (53 hips) in the different Charnley classes. (HHS; median, quartile and extreme

Table 2.  Femoral bone defects at revision (53 hips)

Type	Gustilo and Pasternak	Endo-Klinik
I	17	4
II	35	38
III	1	11
IV	0	0

Figure 2. Remodeling changes around the stem. Arrows indicate heterotopic ossi.cation (A), calcar round-off (B), and regression of osteolysis (C).

Figure 3. Remodeling changes around the stem. Arrows indicate spot welds (A), pedestal formation (B), and distal cortical hypertrophy (C).

Table 3.  Bone remodeling at follow-up (53 hips)

	No.
Stem stability parameters
Fixated stems	53
Subsidence (maximum 8 mm)	19
Change in varus-valgus alignment	0
Spot welds	30
Stress-shielding parameters
Calcar resorption	16
Calcar “round-off”	7
Distal cortical hypertrophy (1–4 mm)	14
Bone remodeling parameters
Osteolysis at revision	48
Regression of osteolysis
total	7
partial	37
Newly formed osteolysis	2
Unspecific parameters
Pedestal formation	36
Reactive lines	16
Heterotopic ossification
grade 1	13
grade 2	6
grade 3	5
grade 4	0

Table 4.  Studies on uncemented femoral revisions with proximally coated stems

First author	Follow-up (years)	No. of hips	Type of stem	Survival rate	Comments
Berry (1995)	8	375	6 different types	58% aseptic	Insufficient fixation
				survival rate	proximally due to
					inadequate bone stock
Peters etal. (1995)	5(4–7)	49	Long, curved	Endpoints	Unacceptably high
				-revision 96%	incidence of
				-rev. or subsidence 37%	progressive subsidence
Malkani (1996)	3(2–5)	69	Metaphyseal	82% for entire group	Intraoperative
			filling, long, curved	58% in fracture group	fractures in 46%
Mulliken (1996)	5(4–6)	52	Metaphyseal	76% overall mechanical	Intraoperative
			filling, long, curved	survival rate	fractures in 40%
					Insufficient fixation if
					moderate or severe
					bone defects
Suominen and	5	39	Long, curved	Endpoints	Unacceptably high
Santavirta (1996)				-revision 83%	incidence of revision
				-rev. or stem loosening 72%	or radiographical
					loosening
Emerson et al. (2003)	12(9–15)	66	Metaphyseal	94% overall and	Used strut allografts if
			filling, long, curved	97% aseptic survival rate	insufficient bone stock
					proximally
Kelly (2006)	5(4–7)	33	Straight, tapered	100%	Good results if
					sufficient bone stock

Figure 4. Remodeling changes around the stem. Arrows indicate proximal osteopenia (A), distal cortical hypertrophy (B), and pedestal formation (C).

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