Mid-term clinical and radiographic outcomes of a long cementless monobloc stem for revision total hip arthroplasty

Abstract Background For the past 2 decades, the authors have been using a long tapered cementless stem made of titanium and fully coated with hydroxyapatite (HA) for revision total hip arthroplasty (THA). The purpose of this multicentric study was to assess clinical outcomes, radiographic outcomes, re-revision rates, and survival rates of this revision stem at a minimum 5 year follow-up. Methods The records of a multicentric continuous series of 335 adults undergoing revision THA using the Corail revision stem (KAR®) (DePuy, Leeds, UK) between 2000 and 2012 were retrospectively reviewed. The Harris Hip Score (HHS), Oxford Hip Score (OHS) and Engh score were recorded. Survival was assessed using the Kaplan-Meier (KM) method and cumulative incidence function (CIF). Results Seventy-seven patients died with their revision stem in place, 47 could not be contacted, and 22 had stem re-revisions. This left a final cohort of 201 patients, aged 70±12 years at revision surgery, with a BMI of 26±4. The KM survival was 93.9% for re-revision of any component for any reason, 96.7% for re-revision of the stem for any reason and 99.3% for re-revision of the stem for aseptic reasons. At last follow-up, the HHS was 84.8±13.1, the OHS was 21.0±7.8 and the Engh score was 16.4±6.7. Conclusions The long tapered cementless revision stem had excellent clinical and radiographic outcomes at a minimum follow-up of 5 years. The revision stem enabled restoration of bone stock in femurs with pre-revision bone defects, confirming that the HA coating promotes osseointegration, even in femurs with extensive bone loss.