Abstract
Aims: The outcome analysis of different revision techniques should provide guidelines for future stem revisions. Methods: Between 1989 and 2000 revisions of 478 femoral stems were performed. 252 of them with cemented components and 226 without cement. In 86 cases a Wagner revision stem was used. The mean observation time was 6.4 years. Success and failures were analysed and classified. Results: Four types of defects and remaining bone stock patterns could be distinguished: Type I with normal diaphyseal bone and minor lesions at themetaphyseal side, type II with a regular isthmus but defects, mostly contained ones, of the proximal femur, type III a wide isthmus with a thin and cylindrical cortical wall, type IV with destructions of the proximal femur which need structural allografting to provide sufficient initial stability. Type I revisions can be performed with regular components as used in primary cases, type II revisions need a slightly longer revision stem with either conical or cylindrical diaphyseal part, type III should be treated with components, that allow for axial load transmission proximally and can take rotational loads distally (the “load sharing concept”). Type IV needs a long revision stem in combination with an appropriate choice of structural allografts. Conclusions: If the type and length of the revision stem is chosen according to this classification, the failure rate of stem revisions can be reduced and the us of expensive allografts can be limited.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
