Using Fully Porous-Coated Stems in Femoral Revision
Tips and technical pearls for obtaining distal fixation when revising the femoral component.
Various types of stems can be used for femoral component revision in a failed total hip arthroplasty (THA).
At the Philadelphia Revision Course, Nitin Goyal, MD, from the Anderson Orthopaedic Clinic in Alexandria, Virginia, discussed his experience with fully porous-coated stems, which he said are his choice for distal fixation in most femoral revision cases.
The concept behind this type of stem is to bypass the defect and obtain distal fixation using a porous-coated cylinder. Dr. Goyal said the goal is to obtain adequate interference fixation with direct contact with both cortices.
One advantage of fully porous-coated stems is that they are versatile and appropriate for more than 90% of revision cases with Paprosky Type II and Type IIIA bone loss. They also avoid modular junction issues, such as fracture and the potential for corrosion at the taper.
But, these stems do have some limitations. Results depend on the amount of femoral bone loss, Dr. Goyal said. They are less successful with Paprosky Type IIIB and Type IV bone loss, where there is little or no intact diaphysis.
In addition, stem diameter matters: Smaller-diameter stems are prone to breaking. Dr. Goyal said to beware of stems that are less than 13.5 mm with greater than 8 inches of stem length.
Dr. Goyal’s presentation, in which he addresses bone preparation and stem insertion and offers his technical pearls for the procedure, is available on ICJR.net.