title: Use of an 'internal proximal femoral replacement' with distal fixation in revision arthroplasty of the hip.
abstract: We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with failed total hip replacement and severe proximal femoral bone loss by revision using a distal fix/proximal wrap prosthesis. The mean follow-up was for 55.3 months (25 to 126). The mean number of previous operations was 2.2 (1 to 4). The mean Oxford hip score decreased from 46.2 (38 to 60) to 28.5 (17 to 42) (paired t-test, p < 0.001) and the mean Harris Hip score increased from 30.4 (3 to 57.7) to 71.7 (44 to 99.7) (paired t-test, p < 0.001). There were two dislocations, and in three patients we failed to eradicate previous infection. None required revision of the femoral stem. This technique allows instant distal fixation while promoting biological integration and restoration of bone stock. In the short term, the functional outcome is encouraging and the complication rates acceptable in this difficult group of patients.
authors.affiliation: Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK. pkjaiswal05@googlemail.com
authors.forename: P K
authors.initials: PK
authors.lastname: Jaiswal
authors.forename: J
authors.initials: J
authors.lastname: Jagiello
authors.forename: L A
authors.initials: LA
authors.lastname: David
authors.forename: G
authors.initials: G
authors.lastname: Blunn
authors.forename: R W J
authors.initials: RW
authors.lastname: Carrington
authors.forename: J A
authors.initials: JA
authors.lastname: Skinner
authors.forename: S R
authors.initials: SR
authors.lastname: Cannon
authors.forename: T W R
authors.initials: TW
authors.lastname: Briggs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001862:Bone Resorption / Q000601:surgery*; D002484:Cementation; D005260:Female; D006621:Hip Joint / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D016896:Treatment Outcome