Introduction: Revision hip arthroplasty for aseptic loosening of femoral component is successfully treated with impaction bone grafting technique. Owing to easier technique and shorter operative time, distally fixed non-cemented long stems have gained popularity in the present era. However, use of long stems could make subsequent re-revision difficult due to further bone loss. The standard length stem has been often critiqued due to apprehension of peri-prosthetic fracture.

This study aims to determine the long-term outcomes of the impaction bone grafting of the femur for aseptic loosening in revision hip arthroplasty using standard length C-stems. 168 total hip revisions of 162 patients with impaction bone grafting and cemented standard C-stem (done with standardized technique) between 1995 and 2008 at a tertiary referral centre were included. Revisions for infection and segmental bone defects were excluded.

Mean follow-up of the 168 revision hips was 10.5 years (range 5 – 19.1 years). 14 patients (8.3%) were re-revised, reasons being, persistent deep infection (1.8%), repeated dislocations (1.2%), cup loosening (4.8%) and stem loosening (1.2%). Only 1 patient (0.6%) was re-revised due to stem loosening alone. No peri-prosthetic fractures (intra-operative or post-operative) or stem breakage were identified.

Use of standard stem length in hip revisions with impaction bone grafting does not increase the risk of peri-prosthetic fractures, instead, reconstitutes the bone stock. This questions the conventional principle of bypassing the distal cavitation of femur by 2 cortical diameters with the use of long stem. In our experience, a good proximal femur support is key to performance of standard length cemented stems in revision for aseptic loosening irrespective of grade of distal cavitation for cavitatory defects of femur when treated with impaction bone grafting.

Introduction

Severe osteolysis of the femur secondary to aseptic loosening in hip arthroplasty, remains a difficult revision scenario. Multiple techniques have been developed to aid the surgeon, including restoration of bone stock with impaction bone grafting or strut allografts, various distal fixation prostheses and mega-prostheses. Cemented femoral components, with integration of the cement into the cavitations, has largely fallen out of favour. We examined the long-term outcomes with this technique.