Revision Arthroplasty for Bilateral McKee-Farrar Hip Prostheses 48 Years Following Implantation

The McKee-Farrar hip prosthesis gained popularity in the 1960s and was one of the first widely used prostheses to employ a metal-on-metal design. Eventually, it laid the framework for the development of second and third-generation hip replacement prostheses. In time, the McKee-Farrar prosthesis was found to have high rates of early aseptic loosening and fell out of favor, especially with the development of the Charnley low-friction metal-on-polyethylene design. We present an interesting case of a patient who underwent bilateral total hip arthroplasty with a McKee-Farrar hip prostheses at the young age of 28 years, in view of secondary hip osteoarthritis resulting from ankylosing spondylitis. The implants lasted approximately 48 years after initial implantation in this case, which is an unusually long survival of this prosthesis. He presented to us at the age of 76 years with groin pain and difficulty to weight-bear, worse on the right side. Significant osteolysis around the acetabular component was noted, greater on the right side. Infection was excluded, and the patient underwent staged revision bilateral hip replacements one year apart. Extraction of the femoral components on both sides was done with the aid of extended trochanteric osteotomies. For both revisions, uncemented acetabular revision shells (TMARS, Zimmer Biomet, Warsaw, Indiana) were used for the acetabulum and long uncemented diaphyseal engaging interlocked stems (Arcos ILS, Zimmer Biomet) were used for the femoral side. No complications were encountered during the procedures. The patient made excellent progress following the procedures with immediate weight-bearing, as tolerated, and physiotherapy input. No subsequent postoperative complications occurred till the time of the patient's death five years later from unrelated medical causes. It is rare to encounter and revise the McKee-Farrar prosthesis in modern orthopaedic practice. This, to the best of our knowledge, is the longest-described survival of this prosthesis in literature.