Which length for the revision stem?

The results of 79 stem implantations performed between 1981 and 1992 are presented. Mean clinical and radiographic follow-up was obtained 36 months after surgery. All of the prostheses were substituted due to aseptic loosening: of these 68% were cemented. Femoral osteolytic lesions secondary to loosening was classified based on the Paprosky protocol. A severe femoral osteolytic defect (type 2b, 2c or 3 according to Paprosky) was associated with 4% of the cases of loosened cementless prostheses, and with 37% of the cemented ones. Homoplastic bone grafts were used in 40% of the patients. The length of the stems used for reimplantation was short (12-13 cm) in 43%, standard (17-18 cm) in 49%, and long (> or = 22 cm) in 7% of the cases. These stems were cemented in 32% of the cases. The incidence of cementation was different in relation to length, as 62.5% of the short stems were cemented, as compared to 5.3% of the stems of standard length. Clinical results were excellent in 90% of the cases submitted to surgery with short stems, in 80% of those treated with standard stems, and in 50% of the cases of revision surgery where long stems were used. Radiographically, 97% of the short stems were osteointegrated, as compared to 94% of the standard stems and to 25% of the long ones, which were only used in a very few cases to be considered quite complex ones.