Combined Femoral Fixation in Revision Total Hip Arthroplasty: Five-Year Outcomes of Distal Cementation with Proximal Porous Coating | ||
| The Egyptian Orthopaedic Journal | ||
| Articles in Press, Accepted Manuscript, Available Online from 06 October 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/eoj.2025.416955.1075 | ||
| Authors | ||
| Mahmoud MI Abd Ghafar* 1; Tamer Ahmed Niazy2; Moheib Mohamed Ahmed3 | ||
| 1orthopedic department, faculty of medicine Mansoura university | ||
| 2Assistant professor of the orthopedic department, faculty of medicine, Mansoura University | ||
| 3Orthopedic Department, Faculty of Medicine, Mansoura University. Egypt | ||
| Abstract | ||
| Background: Revision total hip arthroplasty in the setting of Paprosky IIIB–IV femoral defects remains a formidable challenge due to deficient bone stock and compromised canal morphology. Achieving both immediate stability and long-term biological fixation is critical, Objective: To evaluate the mid-term clinical and radiographic outcomes of a combined fixation strategy—distal diaphyseal cementation with a proximally porous-coated stem—in elderly patients with severe femoral bone loss. Methods: A retrospective case series of 24 hips (22 patients, with a mean age of 64.4 years) revised between 2014 and 2020 was analyzed. Inclusion criteria were age ≥60 years, aseptic loosening, and Paprosky IIIB–IV defects. Outcomes included the Harris Hip Score, Oxford Hip Score, time to full weight-bearing, radiographic fixation (Engh classification), cement mantle quality (Barrack grading), stem subsidence, and Kaplan–Meier implant survival. Results: At a mean follow-up of 84.4 months, HHS improved from 46.2 to 84.6 (p<0.001) and OHS from 19.3 to 42.6 (p<0.001). Mean time to full weight-bearing was 6.1 weeks. Radiographically, 83.3% demonstrated bone ingrowth, with Barrack A/B cement mantles in 91.3% of cases. Subsidence of greater than 3 mm occurred in 8.3% of cases, but without clinical loosening. The five-year implant survival rate, free from aseptic loosening, was 95.7%. Conclusion: Distal cementation with a proximal porous coating provides a reproducible and cost-effective solution for complex femoral revisions, enabling early mobilization and durable fixation. This dual-zone strategy addresses both mechanical and biological demands, making it particularly valuable in elderly patients and resource-limited settings. | ||
| Keywords | ||
| Revision total hip arthroplasty; femoral bone loss; Paprosky classification; hybrid fixation; distal cementation | ||
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