Long Cemented Femoral Stem in Hip Revision: Variables Affecting the Early Results

Background
It is believed that total hip arthroplasty (THA) has made a revolution in the way of treatment of hip arthritis. With an increasing number of younger patients undergoing THA, the incidence of revision hip surgery is on the rise. Revision THA is a technically difficult procedure and associated with higher complication rates.
Purpose
The aim of this study was to evaluate the results of long stem femoral component in revision THA.
Subjects and Methods
This study included 20 patients, 15 (75%) men and five (25%) women. The mean age of 61.8 years ranging from 50 to 75 years. The right side was affected in 12 (60%) patients and the left side was affected in eight (40%) patients. Nine (45%) patients were retired employees, six (30%) were employees and five (25%) were housewives. The mean of the patients’ BMI was 25.9, ranging from 20.6 to 31.2. Two (10%) patients were diabetes mellitus and two (10%) patients were hypertensive. Lateral approach was used in all patients. Indication for revision was aseptic loosening in 13 (65%) patients, septic loosening in four (20%) patients, and recurrent dislocation in three (15%) patients. The mean evaluation period was 35.75 months (range from 12 to 56 months). The patients were evaluated both clinically using Harris Hip Score (HHS) and radiologically which improved from mean of 46.2 to 78.35 points.
Results
Seven (35%) cases of intraoperative femoral fractures, 2 (10%) cases had dislocations, one (5%) case had superficial infection. 12 (60%) patients had the femoral stem in a neutral position, six (30%) had it in a varus position while two (10%) patients had the stem in a valgus position. As regards lucent lines around the femoral stem, nine (45%) patients had it in 1 zone, four (20%) patients in 2 zones, and one (5%) patient in 3 zones. These lines were not progressive and did not affect the clinical outcome of these patients. Significant negative correlation was found between the final Harris Hip Score and patients’ BMI and Trendelenburg test. Pain and patient activity and mobility improved significantly after revision with a long stem femoral prosthesis.
Conclusion
Long-stem is a useful option in revision THA but with high incidence of intra and postoperative complications. Intraoperative femoral fracture is the commonest complication and usually easy to manage by cerclage wiring.