Extensively Porous-coated Stems for Femoral Revision: Reliable Choice for Stem Revision in Paprosky Femoral Type III Defects

Between January 1999 and August 2008, ninety-six femoral revisions were performed with extensively porous-coated stems in Paprosky type III femoral defects (89 type IIIA and 7 type IIIB defects). Seven type IIIB defects with a mean canal of 16.5 mm were observed; 6 defects achieved stable bone ingrowth and 1 achieved stable fibrous condition. Average postoperative Harris Hip Score was 92.3 +/- 8 (range, 77-100), and all scores improved postoperatively. At a mean follow-up of 65.7 months, 92 stems achieved bone ingrowth, and 1 stem (type IIIB) achieved a stable fibrous condition. Three patients died from causes unrelated to the surgery during follow-up. The most frequent diagnosis for revision of the femoral component was loosening of the cementless stem (53 patients; 55.2%), followed by status after a Girdlestone procedure (21 patients; 21.8%), after total hip arthroplasty with acetabular wear (10 patients; 10.4%), loosening of the cemented stem (7 patients; 7.3%), and periprosthetic fracture (5 patients; 5.2%). The authors performed 65 total hip arthroplasty revisions, 23 femoral component revisions, and 8 revisions of femoral components with cemented liners in patients with well-fixed acetabular shells. Extensively porous-coated stems in femoral revision for Paprosky type III femoral defects provided good mid-term durability.