REVISION TOTAL HIP-ARTHROPLASTY IN DEFICIENT PROXIMAL FEMUR USING A DISTAL LOAD-BEARING PROSTHESIS

Eleven revision total hip replacements (THR) were performed with the u se of transfemoral distally fixing stems. Nine Wagner and two Link cem entless stems were used. The mean age of the patients was 62 years (ra nge 44-78) and in mean they had undergone 2.4 previous hip operations. The mean follow-up was 43 months in nine patients and two patients ha d a new revision during the follow-up. The reasons for these revisions were loosening of stems in association with proximal lysis and peripr osthetic fracture in eight cases, proximal femoral resection after inf ection in one case, loosening and deficient proximal bone in one case and proximal intraoperative fracture in a dysplastic hip after previou s intertrochanteric osteotomy in one patient. The subsidence of the st em varied from 0 to 40 mm and two stems were revised during the first year because stability was lost due to subsidence. In those nine cases who were not revised the mean Harris hip score was 74 points. The fin al results were excellent in two, good in three, fair in two and poor in four cases. Our results suggest that revision total hip arthroplast y in cases where the proximal femur is deficient after lysis, old infe ction or fracture, using a distal load bearing stem gives satisfactory results in more than half of cases.