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Extensively Porous-Coated Stems for Femoral Revision: A Choice for All Seasons

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Abstract

We reviewed the outcome of 905 femoral revisions performed at our institution between June 1980 and August 2006 using extensively porous-coated, cylindrical stems. A total of 20 femoral rerevisions were identified, including 12 for aseptic loosening, 4 for infection, 3 for stem fracture, and 1 in conjunction with a periprosthetic femur fracture. All stem rerevisions occurred within the first 10 years after surgery. Kaplan-Meier survivorship, using stem rerevision for any reason as an end point, was 97.5% ± 1.3% (95% confidence intervals) at 5 years, declined to 95.9% ± 1.9% at 10 years, and remained constant thereafter. With long-term follow-up, extensively porous-coated, cylindrical stems used for femoral revision continue to demonstrate excellent survivorship.

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Materials and Methods

To identify our study population, we queried our institutional database for all revision THA procedures where the femoral component was revised using an extensively porous-coated stem with a cylindrical distal geometry. The specific implant designs included standard versions of the Anatomic Medullary Locking (AML), Solution, Prodigy, and Proximal Femoral Replacement (PFR) stems (Fig. 1). Custom components were excluded from the study population. All stems were manufactured by DePuy (a Johnson &

Results

Using our institutional database, we identified 905 femoral revisions performed with extensively porous-coated stems between June 1980 and August 2006. If a patient had undergone multiple revision procedures, the index THA for this study was the first revision at our institution where an extensively porous-coated component was implanted. The stem revisions were performed among 491 women and 414 men with a mean age of 62.6 ± 14.5 years at the time of the index revision. The mean follow-up among

Discussion

The current study reviewed our long-term results using cylindrical, extensively porous-coated stems. Although current follow-up was not available for all cases, 25% (224 THAs) had been seen within the past year and 42% (380 THAs) within the past 3 years. To account for censored values, we used a survivorship analysis [3]. Similar to our previous reports [4], we found the femoral fixation achieved with extensively porous-coated stems to be durable. Although rerevisions for stem loosening

References (33)

  • F. Dorey et al.

    The validity of survivorship analysis in total joint arthroplasty

    J Bone Joint Surg Am

    (1989)
  • C.A. Engh et al.

    Distal ingrowth components

    Clin Orthop

    (2004)
  • D.J. Berry et al.

    Survivorship of uncemented proximally porous-coated femoral components

    Clin Orthop

    (1995)
  • P.M. Pellicci et al.

    Long-term results of revision total hip replacement

    J Bone Joint Surg Am

    (1985)
  • W.F. Mulroy et al.

    Revision total hip arthroplasty with the use of so-called second-generation cementing techniques for aseptic loosening of the femoral component. A fifteen-year-average follow-up study

    J Bone Joint Surg Am

    (1996)
  • B.F. Kavanagh et al.

    Revision total hip arthroplasty

    J Bone Joint Surg Am

    (1985)
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    Benefits or funds were received in partial or total support of the research material described in this article. These benefits or support were received from the following sources: General research funding was provided by Inova Health Services. Although no benefits or funds were received from any other commercial entity to support this research study, two of the authors serve as consultants for DePuy, a Johnson & Johnson company. One of the authors receives royalties from DePuy and also owns Johnson & Johnson stock.

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