The rationale for cementless revision total hip replacement with contemporary technology.

Undoubtedly, the number of revisions for failed cemented total hip arthroplasties will increase over time based on current survival statistics. Although contemporary cementing techniques may improve the outcome of some procedures, long-term results of cemented revisions are less than ideal. Poor bone quality with cortical deficiencies and endosteal sclerosis make long-term stability and implant survival less likely with cemented techniques. In the very elderly patient requiring revision, PMMA may provide a simpler option with an adequate short-term result. Using uncemented techniques, the complications associated with the inherent properties of cement can be avoided. Bone grafting is a viable option, with the hope that long-term implant stability can be achieved by biological ingrowth into porous surfaces. Reconstitution of previously attenuated cortical bone is seen after bone grafting in association with a noncemented femoral or acetabular implant, although ingrowth into porous-coated surfaces via allograft bone is unlikely. In general, short- and mid-term results with respect to clinical performance are good or excellent in at least 90% of the cases evaluated. With the increased application of uncemented components to revision situations, attention may shift from "cement" disease to "polyethylene" disease. Although not the focus of this article, recent literature with respect to primary uncemented hip and knee arthroplasty supports this contention. We believe that proximal canal fill and biologic ingrowth can provide implant stability, avoid proximal stress shielding of the femur, and improve long-term implant survival and clinical success in the revision situation.