title: Proximal femoral replacement in contemporary revision total hip arthroplasty for severe femoral bone loss: a review of outcomes.
abstract: OBJECTIVE
  Loss or absence of proximal femoral bone in revision total hip arthroplasty (THA) remains a significant challenge. While the main indication for the use of proximal femoral replacements (PFRs) is in the treatment of malignant disease, they have a valuable role in revision THA for loosening, fracture and infection in patients with bone loss. Our aim was to determine the clinical outcomes, implant survivorship, and complications of PFRs used in revision THA for indications other than malignancy.
  
  
  METHODS
  A retrospective review of 44 patients who underwent revision THA using a PFR between 2000 and 2013 was undertaken. Their mean age was 79 years (53 to 97); 31 (70%) were women. The bone loss was classified as Paprosky IIIB or IV in all patients. The mean follow-up was six years (2 to 12), at which time 22 patients had died and five were lost to follow-up.
  
  
  RESULTS
  The mean Harris Hip Score improved from 42.8 (25.9 to 82.9) pre-operatively to 68.5 (21.0 to 87.7) post-operatively (p = 0.0009). A total of two PFRs had been revised, one for periprosthetic infection eight years post-operatively and one for aseptic loosening six years post-operatively. The Kaplan-Meier survivorship free of any revision or removal of an implant was 86% at five years and 66% years at ten years. A total of 12 patients (27%) had a complication including six with a dislocation.
  
  
  CONCLUSIONS
  PFRs provide a useful salvage option for patients, particularly the elderly with massive proximal femoral bone loss who require revision THA, with significant clinical improvement. While the survivorship of the implant is good at five years, dislocation continues to be the most common complication. The judicious use of larger femoral heads, dual-mobility constructs, or constrained liners may help to minimise the risk of dislocation. Cite this article:Bone Joint J2017;99-B:325-9.
authors.affiliation: Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
authors.forename: A
authors.initials: A
authors.lastname: Viste
authors.affiliation: Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
authors.forename: K I
authors.initials: KI
authors.lastname: Perry
authors.affiliation: Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Taunton
authors.affiliation: Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Hanssen
authors.affiliation: Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Abdel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods; D001862:Bone Resorption / Q000000981:diagnostic imaging / Q000601:surgery*; D002484:Cementation; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012042:Registries; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Proximal femur; Revision; Total hip arthroplasty