Proximal femoral replacements (PFRs) have been recently utilized in complex revision arthroplasties where proximal femoral bone is compromised. The purpose of this study is to evaluate the clinical outcomes, complications, and survivorship of PFRs as a salvage treatment for severe bone loss after non-oncologic revision total hip arthroplasty.
This is a retrospective review of all patients who underwent femoral revision surgery using a single design PFR between 2004 and 2013 at our institution. Forty patients (41 hips) were included with a mean age of 64 years (29–90). According to Paprosky classification, 15 femurs had type IIIB defect, and 26 had type IV defect. Patients were followed for a mean of five years (2–10). The average length of reconstruction was 150 mm (81–261). A Kaplan–Meier analysis was used to determine the survival of the PFR.
A total of nine patients (9 PFRs, 22%) were re-operated upon. Three re-operations were for infection, two for dislocation, two for aseptic loosening, and two for periprosthetic fracture. The survivorship at five years was 95.1% for revision of the femoral stem for aseptic loosening. We did not find length of the segmental reconstruction or the indication for revision, to be a risk factor for implant failure or re-revision.
Proximal femoral replacements have shown an acceptable survivorship in non-oncologic revision hip arthroplasties for severe proximal femoral bone loss. The frequent use of constrained liners may decrease the risk of dislocation due to the loss of the abductor mechanism encountered in these complex reconstructions.
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Sakellariou VI, Babis GC (2014) Management bone loss of the proximal femur in revision hip arthroplasty: update on reconstructive options. World J Orthop 5:614–622. https://doi.org/10.5312/wjo.v5.i5.614
Della Valle CJ, Paprosky WG (2003) Classification and an algorithmic approach to the reconstruction of femoral deficiency in revision total hip arthroplasty. J Bone Joint Surg Am 85–A:1–6
Engh CA, Ellis TJ, Koralewicz LM, McAuley JP, Engh CA (2002) Extensively porous-coated femoral revision for severe femoral bone loss: minimum 10-year follow-up. J Arthroplast 17:955–960. https://doi.org/10.1054/arth.2002.35794
Buttaro MA, Comba F, Piccaluga F (2009) Proximal femoral reconstructions with bone impaction grafting and metal mesh. Clin Orthop Relat Res 467:2325–2334. https://doi.org/10.1007/s11999-009-0777-y
Rodriguez JA, Fada R, Murphy SB, Rasquinha VJ, Ranawat CS (2009) Two-year to five-year follow-up of femoral defects in femoral revision treated with the link MP modular stem. J Arthroplast 24:751–758. https://doi.org/10.1016/j.arth.2008.09.011
Lee SH, Ahn YJ, Chung SJ, Kim BK, Hwang JH (2009) The use of allograft prosthesis composite for extensive proximal femoral bone deficiencies: a 2- to 9.8-year follow-up study. J Arthroplast 24:1241–1248
Malkani AL, Paiso JM, Sim FH (2000) Proximal femoral replacement with megaprosthesis. Instr Course Lect 49:141–146
Parvizi J, Tarity TD, Slenker N, Wade F, Trappler R, Hozack WJ, Sim FH (2007) Proximal femoral replacement in patients with non-neoplastic conditions. J Bone Joint Surg Am 89:1036–1043. https://doi.org/10.2106/JBJS.F.00241
Viste A, Perry KI, Taunton MJ, Hanssen AD, Abdel MP (2017) Proximal femoral replacement in contemporary revision total hip arthroplasty for severe femoral bone loss: a review of outcomes. Bone Joint J 99–B:325–329. https://doi.org/10.1302/0301-620X.99B3.BJJ-2016-0822.R1
Grammatopoulos G, Alvand A, Martin H, Whitwell D, Taylor A, Gibbons CLMH (2016) Five-year outcome of proximal femoral endoprosthetic arthroplasty for non-tumour indications. Bone Joint J 98–B:1463–1470. https://doi.org/10.1302/0301-620X.98B11.BJJ-2016-0244.R1
Grauer JD, Amstutz HC, O’Carroll PF, Dorey FJ (1989) Resection arthroplasty of the hip. J Bone Joint Surg Am 71:669–678
Rogers B a, Sternheim A, De Iorio M, Backstein D, Safir O, Gross AE (2012) Proximal femoral allograft in revision hip surgery with severe femoral bone loss: a systematic review and meta-analysis. J Arthroplasty 27:829–836.e1. https://doi.org/10.1016/j.arth.2011.10.014
Parvizi J, Sim FH (2004) Proximal femoral replacements with megaprostheses. Clin Orthop Relat Res 420:169–175. https://doi.org/10.1097/01.blo.0000122696.06623.30
Murray WR, Lucas DB, Inman VT (1964) Femoral head and neck resection. J Bone Joint Surg Am 46:1184–1197
Capanna R, Scoccianti G, Frenos F, Vilardi A, Beltrami G, Campanacci DA (2014) What was the survival of megaprostheses in lower limb reconstructions after tumor resections? Clin Orthop Relat Res 473:820–830. https://doi.org/10.1007/s11999-014-3736-1
Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu A, Buckley L (2009) Modular endoprosthetic replacement for tumours of the proximal femur. J Bone Joint Surg Br 91:108–112. https://doi.org/10.1302/0301-620X.91B1.20448
Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J (2006) Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res 450:164–171. https://doi.org/10.1097/01.blo.0000223978.36831.39
Rasouli MR, Porat MD, Hozack WJ, Parvizi J (2012) Proximal femoral replacement and allograft prosthesis composite in the treatment of periprosthetic fractures with significant proximal bone loss. Orthop Surg 4:203–210. https://doi.org/10.1111/os.12000
Friesecke C, Plutat J, Block A (2005) Revision arthroplasty with use of a total femur prosthesis. J Bone Joint Surg Am 87:2693–2701. https://doi.org/10.2106/JBJS.D.02770
Murray DW, Carr a J, Bulstrode C (1993) Survival analysis of joint replacements. J Bone Joint Surg Br 75:697–704
Korim MT, Esler CNA, Ashford RU (2014) Systematic review of proximal femoral arthroplasty for non-neoplastic conditions. J Arthroplast 29:2117–2121. https://doi.org/10.1016/j.arth.2014.06.012
Haddad FS, Spangehl MJ, Masri BA, Garbuz DS, Duncan CP (2000) Circumferential allograft replacement of the proximal femur. A critical analysis. Clin Orthop Relat Res 371:98–107
Maury AC, Pressman A, Cayen B, Zalzal P, Backstein D, Gross A (2006) Proximal femoral allograft treatment of Vancouver type-B3 periprosthetic femoral fractures after total hip arthroplasty. J Bone Joint Surg Am 88:953–958. https://doi.org/10.2106/JBJS.E.00120
Du Z, Tang S, Yang R, Tang X, Ji T, Guo W (2018) Use of an artificial ligament decreases hip dislocation and improves limb function after total femoral prosthetic replacement following femoral tumor resection. J Arthroplast 33:1507–1514. https://doi.org/10.1016/j.arth.2017.12.017
Barry JJ, Thielen Z, Sing DC, Yi PH, Hansen EN, Ries M (2017) Length of endoprosthetic reconstruction in revision knee arthroplasty is associated with complications and reoperations. Clin Orthop Relat Res 475:72–79. https://doi.org/10.1007/s11999-016-4836-x
This work was performed at the Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA.
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The authors declare that they have no conflicts of interest related directly or indirectly to the subject of this article.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
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De Martino, I., D’Apolito, R., Nocon, A.A. et al. Proximal femoral replacement in non-oncologic patients undergoing revision total hip arthroplasty. International Orthopaedics (SICOT) 43, 2227–2233 (2019). https://doi.org/10.1007/s00264-018-4220-4
- Revision total hip arthroplasty
- Proximal femoral replacement
- Bone loss