The Journal of Bone and Joint Surgery, Vol 76, Issue 8 1137-1148, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Revision total hip arthroplasty with the BIAS (Biologic Ingrowth Anatomic System) femoral component. Three to six-year results
O Hussamy and PF Lachiewicz
Division of Orthopaedic Surgery, University of North Carolina School of Medicine, Chapel Hill 27599-7055.
The BIAS femoral component was used for most of the revision total hip
arthroplasties performed during a four-year period by one surgeon.
Forty-one BIAS femoral components were implanted in thirty-nine patients
and were followed prospectively for a mean of five years (range, three to
six years). The mean age of the patients was fifty-seven years.
Twenty-eight (68 percent) of the femora were classified preoperatively as
having severe loss of bone distal to the intertrochanteric line. Cancellous
autogenous graft from the iliac crest or fresh-frozen cancellous allograft
was used in all hips to fill the proximal defects. Weight-bearing was
delayed for three months after the operation. Clinical and radiographic
evaluation was performed with the use of accepted criteria. The mean
preoperative Harris hip score was 36 points (range, 0 to 71 points) and
improved postoperatively to 85 points (range, 53 to 100 points). Thirty-two
(78 percent) of the hips had a good or excellent result at the most recent
follow-up examination. Thirty-six patients (thirty-eight hips [93 percent])
had no or slight pain, and twenty-nine patients (thirty hips [73 percent])
walked with a slight or no limp. There was an association between one or
more previous revisions of the femoral component and an increased
prevalence of pain in the thigh or hip (p < 0.009). Radiographic
analysis showed that thirteen components (32 percent) subsided, but eleven
of them stabilized and subsidence was not associated with less satisfactory
clinical results. The hip scores were not notably lower in this group. No
component was revised, and no patient had clinical symptoms for which
revision was indicated at the most recent examination. Revision total hip
arthroplasty with use of this implant, which has a partial proximal porous
coating and which is inserted without cement, provided similar clinical
results but inferior fixation, as seen on radiographs, compared with
reported revisions in which components were implanted with modern cementing
techniques. However, the apparent reconstitution of femoral bone structure
in areas of previous osteolysis or cortical thinning is encouraging. The
senior one of us no longer routinely uses this specific implant for
revision arthroplasty done without cement, but does use a similar, revised
version of the prosthesis.
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