J Orthopaed Traumatol (2008) 9:57–62 Table 1 Patient data—medium-term follow-up (16 patients) Patient HSS pre HSS post Follow-up (years) Table 2 Patient data—long-term follow-up (8 patients) Patient Bone deﬁciency HSS pre Follow-up (years) Complications 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1 2 3 4 5 6 7 8 Bone deﬁciency None Large segmental Small cavitary Small cavitary None None Large segmental Small cavitary Small segmental None Small cavitary Small segmental None Small cavitary None Small segmental 17 66 43 35 40 44 32 40 18 43 58 44 40 24 38 42 Small cavitary 28 Small cavitary 41 Large segmental 54 None 52 None 45 Small cavitary 59 Large segmental 53 Small cavitary 55 93 100 87 89 68 97 91 100 86 72 100 84 59 75 86 97 HSS post 97 100 91 100 95 90 100 92 6.1 5.5 5.7 3.3 3.6 8.6 5.6 7.5 6.6 2 4.6 2 8.1 9.4 6.5 6.4 13.5 15 13.7 13.3 11.1 11.7 10.4 10.5 Complications None None None Stem settling None None None None None None None Calcar fracture None None Periprosthetic fracture None Stress shielding None None None None LT None IT None GT None None None None None None None Hypertrophy None IT None None Medial tip Medial tip Medial tip None LT Medial and lateral tip None Medial and lateral tip None None None None Greater trochanter fracture None •Acetabular revision •Calcar fracture None None None None None Stress shielding None None IT None IT LT None None Hypertrophy None None Medial and lateral tip None Medial tip None Mid stem None 59 Anterior thigh pain Pain meds at F/U Anterior Pain meds thigh pain at F/U No No No No Yes No No No No Yes No No Yes No No No No No No No No No No No No No No No Yes No Yes No No Yes No No Yes No No No No No No No No No No No stem was re-revised for any reason. The mean follow-up was 7.4 years (range 2–15 years). The mean Harris hip score improved from a preoperative mean of 42–90 points at ﬁnal follow-up. There was no signiﬁcant difference in the mean Harris hip scores at the 2-year (82 [95% CI:71– 94]), 5-year (87 [95% CI:81–92]), and 10-year (96 [95% CI:88–104]) intervals (P = 0.10). Eight patients died dur- ing the follow-up interval. In this group, all hips were reported by family members to be doing well at the time of the patients death. The remaining 16 patients were all functioning well at last follow-up. The mean Harris score for the living patients was 90 (range 59–100). Three patients experienced occasional anterior thigh pain related to activities; four patients (including the three with thigh pain) took occasional analgesics for pain related to their THAs. Complications included: one greater trochanter, and two calcar fractures during surgery. Circlage wires were used for the calcar fractures, while no treatment was required for the trochanter fracture (Fig. 1). All patients did well without any residual problems related to their fractures. One additional patient sustained a femoral shaft fracture from trauma 2 years after surgery that was successfully treated with open reduction and internal ﬁxation without stem revision. There was no infection, dislocation, or clinical thromboembolism in the series. Brooker [12] II heterotopic ossiﬁcation was seen in one hip. The patient’s functional status was not altered. One isolated acetabular revision was done 14 years after the index revision and the stem was found to be stable at that time. Radiographic evaluation demonstrated stable stem ﬁx- ation in all hips (100%) (Fig. 2). One stem did subside 123