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Femoral Revision With Extensively Porous-Coated Stems
Regardless of the reason for revision of the femoral component in THA, adherence to certain reconstructive principles is necessary to achieve clinical success. Proper implant sizing reduces stem subsidence and helps to obtain initial fixation of the implant. Axial and rotational stability of the implant is critical and requires proper implant positioning with adequate interference fit to optimize the surface area available for biologic fixation. The choice of femoral implant for the reconstruction is based on the location of bone loss (metaphyseal versus diaphyseal), the amount of residual bone stock (loss of cancellous bone support), and the amount of remaining femoral isthmus available for fixation of the femoral implant. For example, Paprosky type II defects, the most common bone loss pattern, have more extensive proximal metaphyseal cancellous bone loss. Slight proximal femoral remodeling into varus and retroversion is commonly encountered. These defects require the use of a diaphyseally engaging stem such as an extensively porous-coated stem. Excellent clinical results have been reported with this type of reconstruction. This chapter discusses the indications and contrainidcations for using femoral components with an extensively porous-coated stem in revision THA. Results from the literature, surgical keys for success, and tips for avoiding pitfalls and complications are also presented.