Stable Lord Madreporic Femoral Stem 32 Years After Revision Total Hip Arthroplasty: A Case Report

The Lord total hip prosthesis was discontinued because of high rates of failure of the threaded acetabular component and marked proximal femoral bone atrophy related to stress shielding. We report an exceptionally long-term follow-up of a Lord femoral stem that remains stable 32 years after implantation. In 1994, a 37-year-old tailor underwent left revision total hip arthroplasty (THA) using the Lord system. Fifteen years later, in 2009, he presented in our orthopedic department with pain and substantial functional impairment. Imaging demonstrated aseptic loosening of the Lord acetabular cup with massive bone loss, and revision arthroplasty was performed. Periprosthetic bone loss was reconstructed with 120 cc of impacted cryopreserved morselized cancellous allograft, followed by implantation of a Burch-Schneider (Zimmer Biomet, IN, USA) anti-protrusio cage. The Lord femoral stem showed excellent osseointegration and mechanical stability and was therefore retained. An attempt to exchange the femoral head was unsuccessful due to cold welding at the Morse taper. In 2014, five years after the Lord acetabular revision, radiographs demonstrated fracture of the distal flange of the acetabular cage with lateralization of the implant. However, the patient remained asymptomatic and maintained satisfactory joint function, using a 2 cm shoe lift and a cane. A conservative watchful-waiting strategy was adopted. In 2026, at the 32-year follow-up, the Lord femoral stem continued to demonstrate clinical and radiographic stability, with no subsidence or progressive radiolucent lines besides secondary acetabular reconstruction challenges. To our knowledge, this represents one of the longest documented follow-up periods for a stable Lord femoral stem in the literature.