INTRAOPERATIVE COMPLICATIONS OF REVISION HIP-ARTHROPLASTY USING A FULLY POROUS-COATED STRAIGHT COBALT-CHROME FEMORAL STEM

The operative complications of a consecutive series of 135 cementless revision total hip arthroplasties using a fully porous-coated straight cobalt-chrome femoral stem were reviewed. Intraoperative complication s occurred in 59 cases (44%), 22 of which (37%) involved more than one complication. Three categories of intraoperative complications were r ecorded: eccentric reaming, femoral perforation, and femoral fracture. Complications were noted to decrease throughout the period of the stu dy. Surgical approach did not affect the complication rate. Stem lengt h, stem diameter, and host-bone quality all affected the complication rate. Femoral perforations and fractures were more numerous with femor al stems longer than 200 mm. Larger-diameter femoral stems (greater th an or equal to 18 mm) were associated with a higher complication rate (55%). Complications were also more numerous with poorer-quality host- bone. In cases of multiple complications, eccentric reaming often pred isposed bone to perforation and subsequently to fracture. There was al so greater blood loss in patients with intraoperative complications. I ntraoperative complications may be avoided with the use of implants, a s well as reaming no longer than absolutely necessary, and the use of intraoperative radiographs or flexible reamers early in femoral canal preparation.