Abstract
Background:Bone remodelling with lateral femoral cortex thinning is a major concern after extensively porous-coated long-stem in revision surgery. Extensive hydroxyapatite coated long-stems were introduced to improve osseointegration, but bone remodelling changes have not been quantified.Objective:The question of whether bone remodelling changes from extensive hydroxyapatite-coated long stems influence the durability of femoral revision, clinical outcome is assessed in follow-up radiographs.Methods:Uncemented straight monoblock hydroxyapatite-coated long-stems used in revision hip surgery for aseptic loosening were assessed in a consecutive series of 64 hips (60 patients). Mean follow-up was 8.6 years and the mean age at surgery was 70 years (27-91). The pre-operative bone defect was classified according to Paprosky. Cortical struts were not used in this series. Cortical index and femoral cortical width were measured at three different levels at different periods.Results:Four patients with pain under level 4 due to stem loosening needed an exchange surgery of their femoral component, but two patients rejected re-surgery. The cumulative probability of not having aseptic loosening was 91.2% (95% confidence interval 73.5-96.9) at 10 years according to Kaplan and Meier. Twenty-seven of 35 osteolytic lesions had disappeared or decreased at the last follow-up. The thickness of the lateral and medial cortex increased over the course of the study at different levels. Increases of femoral cortex thickness were greater in men and in cases with mild bone defects.Conclusion:Although clinical outcome of the hydroxyapatite-coated long stem in revision surgery is good but not outstanding, most osteolytic lesions heal and the femoral cortex thickness increases at different levels.
Highlights
Femoral loosening frequently causes major bone defects, making revision surgery difficult
An extensively porous-coated stem has been reported to give good clinical results in revision surgery after more than ten years, severe stress shielding resulting in proximal femur bone loss has been a side-effect that may render further revisions more complex in the long-term outcome of these extensively porous-coated stems in revision surgery
We address the question of clinical and radiographic outcomes, especially focused on bone remodeling changes with a fully HAP coated long-stem in femoral revision, which at least theoretically, may provide proximal as well as distal ongrowth
Summary
Femoral loosening frequently causes major bone defects, making revision surgery difficult. An extensively porous-coated stem has been reported to give good clinical results in revision surgery after more than ten years, severe stress shielding resulting in proximal femur bone loss has been a side-effect that may render further revisions more complex in the long-term outcome of these extensively porous-coated stems in revision surgery. Extensive HAP coating of the long stems was introduced to improve osseointegration in revision surgery anad survivorship greater than 95% has been reported after 8-12 years [18, 19]. Bone remodelling with lateral femoral cortex thinning is a major concern after extensively porous-coated long-stem in revision surgery. Extensive hydroxyapatite coated long-stems were introduced to improve osseointegration, but bone remodelling changes have not been quantified
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