Cementless Revision Total Hip Arthroplasty--Clinical and Radiographic Analyses

　　　　　From 1985 through 1993, 218 cementless revision of hip prosthesis were performed in 213 patients who had acetabular or femoral failure of a total hip prosthesis. The surgical indications for cementless method were in the revision hips with adequate bone coverage and support for revised acetabular or femoral components. Insufficient segmental or cavitary defects were packed with cancellous autograft or allograft, or both. One hundred and twenty patients (122 hips, first revision) with a minimal follow-up of 2 years (mean, 5.4; range, 2-9 years) were included in this study. Combined cementless acetabular and femoral revisions were performed in 60 hips. Acetabular revision only were in 11 hips, and femoral revision only in 51 hips. The surgical diagnoses were aseptic loosening in 103 hips, septic loosening in 11, traumatic failure in 7, and recurrent dislocation in 1. Totally, 71 acetabular revisions and 111 femoral revisions were available for clinical and radiographical analysis. The revision acetabular prosthesis consisted of Mecron, Lord, Osteonics, and PCA types. The revision femoral prosthesis consisted of Mecron, Roy-Camille, Osteonics, and PCA types. Screw fixation for the acetabular component and long stem femoral component were performed if needed. The average age of patients was 58 (range, 38 to 72) years. The preoperative hip rating scores (modified d'Aubigne and Postel rating system) averaged 10.8 (3 to 12) points. The overall prevalence of repeat revision for loosening was 5.6% (4 hips) for the acetabular components and 7.2% (8 hips) for the femoral components. Radiographically unstable implants that remained in situ due to acceptable function were found in 8 acetabular components (11.2%) and 11 femoral components (9.9%). Surgical complications occurred in 17 hips (13.9%), including 6 fractures during operation, 3 post-operative dislocations, 3 superficial infections, 2 temporary sciatic nerve palsies, 2 deep infections, and 1 permanent sciatic nerve palsy. In the latest follow-up, the survival 110 hips had a mean hip scores of 15.8 (10-18) points at the latest follow-up. This study revealed that cementless revision could achieve acceptable midterm results in patients without major bone loss at the acetabulum and proximal femur.