This study was performed in order to review the medium term clinical and radiographic outcome of long stem cemented femoral revisions using second generation cementing technique and identify factors predictive of success or failure.

110 long stem revision hip replacements in 106 patients were performed between 1983–1994. There were 51 males and 55 females of an average age of 69 years with a mean follow up of 6.7 years and a minimum follow-up of five years. Clinical assessment included chart review, and assessment by an independent observer using the Harris Hip Score and the Short Form-36. Radiographic review was performed by two independent observers assessing quality of cementing, loosening, trochanteric union, and heterotopic ossification. The cementing technique was evaluated in both the areas of previous fixation, as well as in the new bone below the tip of the previous stem. We reviewed 93 hips in 90 patients, the remainder having either died or been lost to follow-up. 89% of the patients had improved Harris hip score by more than 20 points. Using the Kaplan-Meier method, fifteen-year survivor-ship was calculated at 92.8%. Three (3.2 %) femoral components were revised, six (6.4%) additional femoral components subsided but were not revised; five of these showed poor cementing technique in the virgin zones beyond the area of the previous stem, and two had cortical perforations. Complications included; 7 (7.5%)dislocations, 6 (6.4%) periprosthetic fractures, 2 (2.2%) infections, and 14 (15%) trochanteric non-unions.

Most reports of femoral revision with cement in revision total hip arthroplasty have shown poor results. However, there are no reports that rely solely on long-stem components. This study shows that long stem cemented femoral revisions have an excellent medium term survivorship, good clinical results and high satisfaction rates. The quality of distal cementing is of great importance, as distal radiolucencies and poor cement technique are predictive of failure.