Cemented Revision of Failed Total Hip Arthroplasty

Abstract

A review of 107 total hip arthroplasties performed with acrylic cement in 89 patients at Columbia-Presbyterian Medical Center by 1 surgeon from 1971 to 1990 revealed a clinical survivorship of 97% at 5 years and 76% at 10 years. The average followup was 7.7 years. Analysis of radiographs revealed a 94% success rate at 5 years and 62% at 10 years. A transtrochanteric approach was used in 99% of procedures. The 13 definite failures (12.1%) included 8 rerevisions (7.5%) and 5 failures (4.6%) pending revision. Modified Merle d'Aubigné and Postel postoperative scores increased significantly from preoperative values (pain, 2.8-5.3 points; movement, 3.2-5.2 points; function, 2.6-5.4 points). Bone grafting was required in 33% of procedures and did not affect survivorship: 24% of procedures required acetabular bone grafts; 4% femoral bone grafts; and 5% acetabular and femoral grafts. In 46% of hips, removal of the original well-fixed femoral cement and plug was deliberately incomplete. Stems of standard length were used for these partially rechannelized femurs because the old distal cement column served as a plug for the canal. Old osseointegrated polymethylmethacrylate was left behind to bond with the new cement column. Cement fracture, complete demarcation, and young age were negatively correlated with survivorship.