(iii) Cementless femoral revision: The role of monoblock versus modular stems

A monoblock, extensively porous-coated stem can provide reliable long-term fixation for the majority of femoral revisions. However, stable long-term fixation may not be obtained in patients with moderate/severe bone loss or in patients with torsional femoral remodelling. If severe bone loss is present (Paprosky Type IV bone), a very large canal diameter is encountered (greater than 19 mm) or if torsion remodelling of the proximal femur has occurred, alternative methods of fixation, such as a distally based modular stem, should be considered.