Abstract
Introduction: An increasing number of patients present for revision hip replacement with severe bone loss. The results of cemented revision in these cases are poor. This study was conducted to determine the medium term clinical and radiological outcome of 50 consecutive revision hip replacements performed using custom femoral stems.
Materials and Method: 50 consecutive hips (49 patients) performed by the senior author between 1992 and 1995 were identified. The indications for revision were aseptic loosening in 42 cases, infection in 7 cases (6 of which were revised using a two-stage technique), and dislocation in one case. The stems are manufactured on the basis of standardised measurement films using specially developed software. The design includes proximal macrogrooves with hydroxyapatite coating, an anterior flare, a lateral flare and a collar. The average follow up was 88.4 months (range 12–111 months). All patients were evaluated radiologically and using Harris, Oxford and WOMAC hip scores.
Results: The patients were assessed by an independent observer. All had severe bone loss according to AAOS and Paprosky classifications. 5 patients died due to causes unrelated to their hip replacement, 5 were lost to follow up or did not respond to questionnaires sent. The remaining patients had average preoperative scores of HHS 40.8 (range 8–87), Oxford 43.5 (range18–56) and WOMAC 82.5 (range 40–120) and had improved to HHS 74.4 (range 19–99), Oxford 25.5(range 12–51) and WOMAC 43.8 (range 13–89).
Conclusions: The use of customised revision stems allows the implant to be tailored to the patient’s bone stock and femoral anatomy. This technique avoids the massive inventory of implants and trials needed for highly modular revision systems, but nevertheless leads to excellent bone implant apposition and interface stability. The clinical results are excellent at medium term review, and the survivorship compares very favourably with other revision series.
These abstracts were prepared by Mr Peter Kay. Correspondence should be addressed to him at The Hip Centre, Wrightington Hospital, Appley Bridge, Wigan, Lancashire WN6 9EP.
