Bone remodeling after a mean of 10 years in diaphyseal cortical defects repaired with femoral revision using bypass fixation of extensively porous-coated stems with high stiffness.

Abstract

Femoral component revisions with extensively porous-coated stems have shown promising clinical results, although there are still concerns over stress-shielding. We retrospectively reviewed data for 18 patients undergoing femoral component revisions with extensively porous-coated stems with high stiffness. The average length of follow-up was 10 years (range 6-13.7 years). Radiographic evidence of a bone-ingrown stem was present in 94 % of the hips, and stable fibrous fixation was present in only one hip, but no hips were considered unstable. There was mild stress-shielding in 15 hips, moderate stress-shielding in one hip, and severe stress-shielding in two hips. In one of the latter two hips, stress-shielding was progressive even 8 years after revision surgery. In 12 (92 %) of the 13 hips in which bypass fixation for diaphyseal cortical defects was used, there was good remodeling. We suggest that femoral component revision using extensive porous-coated stems is a useful option that may allow for healing of diaphyseal cortical defects.