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Bone scan to look for loosening
10%
292/2788
Touch down weight bearing and physical therapy
1%
29/2788
Revision with a tumor prosthesis
2%
69/2788
Revision of femoral component with metaphyseal cement fixation of the stem
14%
383/2788
Revision to a cementless femoral component with diaphyseal press-fit fixation of the stem
72%
1999/2788
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The radiograph shows lucency around the femoral stem cement mantle consistent with loosening. There is bone loss in the proximal femur. Diaphyseal fixation is the best option from the choices available. Revision to a cementless femoral stem is the most appropriate management. Paprosky et al. described their results of revision to cementless femoral components and report 95% survivorship with a minimum of 10 years follow up. Haydon et al showed that despite historical literature discouraging the use of cemented femurs for revision, in their experience cemented femoral revision had 91% survivorship when the cause was aseptic loosening. They found early generation cementing techniques, poor cement mantle, poor bone quality, age of less than 60, and male gender to be risk factors for failure in cemented revisions.
2.8
(42)
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