• O E Bischel, J B Seeger, and A J Suda.
• Investigation Performed at BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67 071, Ludwigshafen, Germany.
• Arch Orthop Trauma Surg. 2022 May 1; 142 (5): 763-768.

IntroductionCementless femoral revision total hip arthroplasty (RTHA) after periprosthetic fracture, aseptic loosening or infection is a challenging surgical procedure. The aim of this study was to evaluate the incidence and reasons for failure after two-stage septic revision, periprosthetic fracture or aseptic loosening that may reveal a rationale for cementless RTHA in two-stage revisions.Materials And MethodsA consecutive series of 105 cases using cementless femoral revision prostheses were evaluated retrospectively. Indications for revision were 39 two-stage revisions after infection, 49 aseptic loosenings, and 17 periprosthetic fractures. A Kaplan-Meier analysis was performed using infection with or without removal of the implant as an endpoint.ResultsIncidence of infection with or without implant removal was significantly higher in patients treated for periprosthetic fractures compared to two-stage revisions or aseptic loosening (log-rank P < 0.0001). The mean follow-up period was 6.4 (2.0-13.7) years. Using infection with or without implant removal as the endpoint, 12 patients were diagnosed after the index operation resulting in a cumulative risk after 13.7 years of 29.9% (95% CI 0-61.2).ConclusionCementless revision using a modular tapered device is reliable with respect to reinfection risk in two-stage procedures.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.

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