Medium-term follow-up of 92 femoral component revisions using a third-generation cementing technique

Figures & data

Figure 1. The flow chart showing the identification of eligible patients for the study. ^aProximal femoral replacement prosthesis placed for oncologic reasons or because the bone stock loss was too extensive to perform a conventional revision.

Table 1. Original indications for the 92 primary THAs/hemiarthroplasties and revisions

	n
Indications for the primary THAs/hemiarthroplasties
Primary osteoarthritis	31
Congenital hip dysplasia	15
Trauma	16
Rheumatoid arthritis	11
Osteonecrosis	8
Miscellaneous	4
Unknown	7
Indications for the revisions
Aseptic loosening	44
Septic loosening	29
Dislocation	6
Malposition of femoral component	6
Ankylosis	3
Protrusion of head, hemiarthroplasty	2
Trauma	2

Table 2. 19 hips with 1 or more femoral reoperations. In 14 of these cases, a re-revision of the femoral component was performed

Case	Revision indication	First femoral re-revision/reoperation	FU^a	Later femoral re-revision/reoperation	FU^a
Femoral component re-revised
1	Septic loosening	Loosening of cup + femoral mismatch	14.1
2	Malpositioning of stem	Debridement for infection^b	2.6	Permanent excision arthroplasty	4.7
3	Aseptic loosening	Refixation pseudoarthrosis, greater trochanter	9.1	Two-stage re-revision for infection (hematogenous spread after open ankle fracture)^d	10.1
4	Aseptic loosening	Permanent excision arthroplasty for infection^b	2.7
5	Septic loosening	Two-stage re-revision for infection^c	2.1
6	Malpositioning of stem	Permanent excision arthroplasty for infection^b	4.1
7	Septic loosening	Permanent excision arthroplasty for infection^c	1.6
8	Septic loosening	Permanent excision arthroplasty for infection^c	1.1
9	Septic loosening	Permanent excision arthroplasty for infection^c	3.8
10	Septic loosening	Two-stage revision for infection^c	2.6
11	Recurrent dislocations	Femoral component reimplanted 1.5 cm higher for recurrent dislocations	0.8
12	Septic loosening	Plate fixation, spontaneous periprosthetic fracture	3.8	Re-revision of femoral component for pseudoarthrosis, periprosthetic fracture	4.7
13	Aseptic loosening	Debridement for infection^b	0.1	Re-revision for aseptic loosening	6.2
14	Septic loosening	Permanent excision arthroplasty for infection^c	0.5
Femoral component retained
15	Septic loosening	Debridement for infection^c	0.1
16	Septic loosening	Debridement for infection^c	0.1
17	Aseptic loosening	Plate fixation, periprosthetic fracture after fall	0.6
18	Aseptic loosening	Plate fixation, periprosthetic fracture after fall	5.8
19	Septic loosening	Reconstruction of fissure greater trochanter during cup revision	0.6

a FU: follow-up in years from index femoral revision.

b new infection;

c reinfection after a previous septic index revision;

d hematogenous spread of infection

Figure 2. Kaplan-Meier survival curves with re-revision of the femoral component for any reason (A), aseptic loosening (B), femoral reoperation for any reason (C), or subsidence of ≥ 5 mm (D) as the endpoint.

Figure 3. A. A 43-year-old woman at presentation with a loose cemented hemiarthroplasty with protrusion of the head. B. Directly after the conversion to a total hip arthroplasty (the acetabulum was reconstructed with metal meshes and bone impaction bone). C. 11 years postoperatively, showing a stable femoral and acetabular component without any signs of loosening.