Abstract
To review prospectively collected data on patients undergoing femoral revision arthroplasty for failed cemented or cementless primary stems.
Materials & Methods
All patients undergoing primary and revision joint replacement surgery at our institution are prospectively entered into a database which includes history and physical examination, radiology, WOMAC and SF-36 scores. These investigations are repeated 3 months, 6 months, 1 year and yearly thereafter at each patient visit.
This database identified all patients undergoing femoral revision arthroplasty over the last 10 years.
Results
There were a total of 231 patients with 248 revision procedures performed. There were 127 female and 104 male patients and the mean age at the time of revision surgery was 69.4 years. Twenty-two of these patients had had at least one prior revision operation on the index hip. Thirty hips were treated with a cemented Echelon stem and 218 treated with a cementless Echelon stem. Of the 248 hips 14 patients were lost to follow-up (14 hips) and 9 patients (9 hips) are deceased. The average follow-up was 5.9 years.
Of the 225 hips remaining in the follow-up series there was a single case of aseptic loosening confirmed radiologically. Twenty-one hips were diagnosed with infection (9.3%); 6 of those patients had had at least one prior revision procedure and 4 additional patients had a prior diagnosis of infection. Therefore, 10 of the 21 hips were either definitely or probably infected at the time of their revision operation on which we are reporting. Nine patients (4%) had multiple dislocations post-operatively. These were patients who had undergone multiple revisions or whose primary revision operation was for instability. An additional 18 patients (8%) had a single dislocation treated by closed reduction requiring no further treatment.
There were 6 hips with intra-operative fracture requiring immediate re-revision plus fracture fixation and a further 12 hips (5.3%) who sustained a peri-prosthetic fracture some time after their revision procedure.
Despite the number of complications the majority of patients required no further surgical treatment. Eleven hips (4.8%) required re-revision of the femoral component. Therefore the overall survival rate at 5.9 years of the Echelon revision stem was 95.2%.
Discussion
Femoral revision total hip arthroplasty is a difficult operation with uncertain outcome. All series recognize a significant complication rate primarily as a consequence of infection, instability or intra-operative or peri-operative fractures secondary to poor bone quality.
Our experience with the Echelon revision stem demonstrates excellent incorporation of the implant with a negligible rate of re-revision for failure of bone ingrowth; the other complications are consistent with those reported in other series.
Conclusions
Although the complication rate in this group of patients is high only 4.8% of the hips required re-revision of the femoral component Of significance was the lack of re-revision necessitated by aseptic loosening of this revision stem
