Femoral revision with conical stem of distal fixation.

BackgroundProximal bone loss at the femoral stem is the main challenge facing surgeons at the time of revisión total hip arthroplasty. The aim of revision surgeries to obtain a stable placement of components and to restore joint kinematics. ObjectivesThe purpose of this paper is to present our experience in hip revisions with tapered distal stem fixation with a minimum follow-up of 2 years. Evaluate the survival of the implants used, Harris hip score, complications and reinterventions associated with the use of these stems for complex femoral revision surgeries.Study Design & MethodsSeries of Cases. We evaluated 37 patients (39 hips) between 2010 and 2014 in which non-cemented femoral stems were used (28 modular and 11 non-modular).The average age was 63.5 years (SD 13.3). Study patients included 18 (48.64%) women and 19 (51.35%) men. Causes of reoperation included 14 (35.89%) cases of aseptic loosening, 14 (35.89%) infections, 7 (17.94%) periprosthetic fractures, 3 (7.69%) stem fracture and 1 (2.56%) for instability. Mean follow-up was 42 months (range, 24-74 months).ResultsThe survival of the femoral stem for any reason according to Kaplan-Meier's analysis was 92.3%. The average Harris score improved from 37 (10-77) points before the operation to 81 points (33-96) at last follow-up. Four patients (10,2 %) presented dislocation; one (2,5 %) deep infection; one (2,5 %) had an intra-operative fracture; subsidence took place in 3 (7,6 %) patients and it was necessary to reurse 2 (5,1 %) femoral implants.ConclusionsThe femoral stem has showed satisfactory results in 2 to 6 years of follow-up in several conditions of femoral revision surgeries. It requires a simple technique with clinical improvement that has been widely published in the literature