Clinical application of uncemented distal stem fixation for revising femoral prosthesis of hip arthroplasty in elderly patients

Abstract

Objective To evaluate the effectiveness of uncemented distal stem fixation for elderly patients needing revision of femoral prosthesis of hip arthroplasty. Methods From July 2005 to January 2013, 22 patients(12 males and 10 females)aged from 70 to 85 years(average: 76 years old)with aseptic loosening of the femoral stem undergone revision via uncemented distal stem fixation were enrolled into this study.Of all patients, 10 had revision on the right side and 12 on the left side; 11 patients received artificial replacement of the femoral head; 9 had total hip replacements; 2 had femoral fractures.According to the Paprosky classification system, 2 cases were type I, 12 were type Ⅱ, 6 were type ⅢA, and 2 were type ⅢB.Femoral stems for revision included MP(Link)and Solution(Depuy). The Harris score, clinical and radiological results were retrospectively analyzed. Results All patients were followed up for 48 to 78 months(mean: 61 months). The average Harris score increased from 38(25-46)to 87(76-94). All prostheses were initially stable, and no infection, dislocation or complication like deep venous thrombosis was observed after revision.All patients were able to walk without assistance; two of them had minor claudication; radiographs after surgery showed well-positioned implants with increased bone density and thickness around the prosthesis and without loosening or subsidence. Conclusions Reliable axial and anti-rotational stability can be achieved by using uncemented distal stem fixation, with good short-and medium-term clinical results for revision in elderly patients with less severe bone defects than those in Paprosky Ⅳ. Key words: Hip joint; Revision; Femur