A 72-year-old woman with a cemented total hip replacement performed 10 years ago presents with progressive groin pain and radiological loosening of the acetabular component. The femoral component remains well-fixed. Revision arthroplasty is planned. Which intraoperative finding would MOST reliably indicate that the femoral component should also be revised?

• A Visible fibrous membrane around the proximal femoral stem on direct inspection ✓
• B Calcar resorption of >5 mm on preoperative radiograph
• C Stem subsidence of 2 mm per year on serial X-rays
• D Complete cement mantle fracture on postoperative CT

Explanation

During revision THR, a well-fixed cemented stem is typically not revised unless indicated. However, if direct inspection reveals a fibrous membrane (false membrane) intervening between stem and cement or cement and bone — signifying aseptic loosening — revision of that component is warranted. Calcar resorption, minor subsidence, or cement mantle cracks on CT alone do not mandate revision if the stem is clinically stable and shows no pain on intraoperative stress testing.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.