Abstract
Introduction This study reviews the mid to long term results of revision THR with cemented, collarless double-tapered (CCDT) stems.
Methods We prospectively studied 192 revisions, in 183 patients, of femoral stems using standard (42%) or long (58%) Exeter and CPT CCDT stems. Results were analysed according to the length of stem, extent of pre-operative deficiency (Paprosky I:II:IIIa:IIIb:IV = 4:20:44:20:12%) and intra-operative bone loss. Postoperative radiographs were independently analysed for loosening and stress shielding. Risk factors of poor outcome were examined by multivariate logistic regression. The median follow-up was six years (2 to 17 years) with 55 patients having died (28%) and no cases lost to follow-up.
Results There were four stem re-revisions for sepsis (2%), three for aseptic loosening (1.5%) and three for component malpositioning (1.5%). The survivorship to femoral re-revision for aseptic loosening at eight years was 95% (95%CI=90–100%) for standard and 95% (90 – 100%) for long stems (p=0.674). Migration was less than five millimetre in unrevised stems. Survivorship and outcomes was independent of the Paprosky grade. There was a trend for better longer-term results in hips with long stems. Major stress shielding was not seen and thigh pain was not a problem.
Conclusions CCDT long stems are suitable for most femoral revisions in patients without severe segmental deficiency.
In relation to the conduct of this study, one or more of the authors is in receipt of a research grant from a non-commercial source.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
