Cementless Primary or Revision Stem in the First-time Revision Hip Arthroplasty for Aseptic Stem Loosening? A Retrospective Comparative Study.

Introduction: The use of primary or revision stem during the first-time revision total hip arthroplasty(THA) procedure for aseptic stem loosening remains controversial. The aim of this study was to compare the outcome of patients that underwent revision THA with a primary or revision stem.Materials and MethodsWe retrospectively reviewed 78 patients that received first-time revision THA for aseptic stem loosening using primary(N=28) or revision stems(N=50). The bone defects were classified as Paprosky type I or II. The mean follow-up duration was 72.3±34.7 months. The primary outcome domains included surgical complications and implant failures. The secondary outcome domains included medical complications, 30-day and 90-day readmission, and Harris hip score (HHS).ResultsThe use of revision stem was associated with higher incidence of patient having complications (60.0% vs. 32.1%, p=0.018), including intraoperative femur fracture (28.0% vs. 7.1%, p=0.029) and greater trochanter fracture (16.0% vs. 0%, p=0.045), compared with the use of primary stem. The implant survival was comparable in both groups. HHS at the final follow-up was similar.ConclusionWith a lower risk of surgical complication and similar mid-term implant survival, cementless primary stem might be a better alternative to revision stem in the first-time revision THA for aseptic stem loosening.