Management of femoral bone loss in revision total hip arthroplasty.
Femoral bone loss is frequently encountered during revision total hip arthroplasty. The quality and quantity of remaining bone helps determine the best method for reconstruction. Extensively porous-coated cylindrical stems or titanium fluted tapered devices that achieve fixation in the diaphysis have both demonstrated excellent long-term survivorship. Titanium fluted tapered stems with a modular proximal body allow for more accurate leg length, offset, and version adjustments independent of the distal stem which may optimise hip biomechanics. Intraoperative fractures are more common with cylindrical stems and subsidence with tapered stems, particularly monoblock designs and in both dislocation continues to be one of the most common postoperative complications. In salvage situations in which an ectatic femoral canal is unable to support an uncemented device, impaction bone grafting, allograft-prosthetic composite, or a segmental proximal femoral replacement may be required.
Department of Orthopedic Surgery, Mayo Clinic, Rochester - USA.
Peter K
PK
Sculco
Matthew P
MP
Abdel
David G
DG
Lewallen
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001851:Bone Diseases, Metabolic / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D011475:Prosthesis Failure; D012086:Reoperation