REVISION OF A FAILED CEMENTED TOTAL HIP-PROSTHESIS WITH INSERTION OF AN ACETABULAR COMPONENT WITHOUT CEMENT AND A FEMORAL COMPONENT WITH CEMENT - A 5 TO 8-YEAR FOLLOW-UP-STUDY

Sixty-one consecutive so-called hybrid revision total hip arthroplasti es were performed in fifty-five patients by one surgeon, from 1986 thr ough 1988, for mechanical failure of a cemented total hip prosthesis. In all of the patients, the acetabular and femoral components were rev ised to a porous-coated Harris-Galante acetabular component inserted w ithout cement and an Iowa femoral component inserted with cement. Cont emporary cementing techniques were used, but structural bone graft was not. The over-all prevalence of repeat revision for aseptic loosening was 0 per cent for the acetabular components and 3 per cent (two hips ) for the femoral components. In addition, 2 per cent (one) of the ace tabular components and 5 per cent (three) of the femoral components de monstrated radiographic evidence of loosening. In the forty-three pati ents (forty-nine hips) who were alive at an average of seventy-four mo nths (range, sixty to ninety-five months) after the revision, none of the acetabular components and 2 per cent (one) of the femoral componen ts were revised again for aseptic loosening. An additional 2 per cent (one) of the acetabular components and 6 per cent (three) of the femor al components were radiographically loose. Ninety-eight per tent (fort y-one) of the forty-two living patients (98 per cent [forty-seven] of the forty-eight hips) who had a clinical examination at least five yea rs after the revision had increased function; 90 per cent (thirty-eigh t) of these patients (forty-four [92 per cent] of the hips) sere satis fied with the result. The group that had a hybrid revision was compare d with a group of seventy patients (seventy-four hips) who had had a r evision total hip arthroplasty with use of contemporary cementing tech niques for both components. These revisions had been performed by the same surgeon, before he performed the hybrid revisions, and the preval ence of repeat revision of the acetabular component was 7 per cent (fi ve hips) and that of the femoral component was 4 per cent (three hips) . In addition, 16 per cent (twelve) of the acetabular components and 3 per cent (two) of the femoral components were radiographically loose. The comparison group was not a consecutive series, as only the patien ts who had had radiographs made five to eight years after the revision were evaluated, In the fifty-two such patients (fifty-six hips) who w ere alive at five years after the revision with cement (average durati on of radiographic follow-up, seventy-seven months; range, sixty to ni nety-nine months), 9 per cent (five) of the acetabular components and 5 per cent (three) of the femoral components were revised again for as eptic loosening. An additional 21 per cent (twelve) of the acetabular components and 4 per cent (two) of the femoral components were radiogr aphically loose. The results of the present study demonstrated a signi ficant improvement (p = 0.0001) in the survival of the acetabular comp onent of so-called hybrid revision total hip arthroplasties compared w ith that of revision total hip arthroplasties with cement performed by the same surgeon and followed for a comparable period.