Proximal femoral replacement in non-oncologic patients undergoing revision total hip arthroplasty

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    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

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    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

    Article  Google Scholar 

  3. 3.

    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

    Article  Google Scholar 

  4. 4.

    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

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    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

    Article  Google Scholar 

  6. 6.

    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

    Article  Google Scholar 

  7. 7.

    Malkani AL, Paiso JM, Sim FH (2000) Proximal femoral replacement with megaprosthesis. Instr Course Lect 49:141–146

    CAS  PubMed  Google Scholar 

  8. 8.

    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

    Article  PubMed  Google Scholar 

  9. 9.

    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

    Article  PubMed  Google Scholar 

  10. 10.

    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

    Article  PubMed  Google Scholar 

  11. 11.

    Grauer JD, Amstutz HC, O’Carroll PF, Dorey FJ (1989) Resection arthroplasty of the hip. J Bone Joint Surg Am 71:669–678

    CAS  Article  Google Scholar 

  12. 12.

    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

    Article  PubMed  Google Scholar 

  13. 13.

    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

    Article  Google Scholar 

  14. 14.

    Murray WR, Lucas DB, Inman VT (1964) Femoral head and neck resection. J Bone Joint Surg Am 46:1184–1197

    CAS  Article  Google Scholar 

  15. 15.

    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

    Article  PubMed Central  Google Scholar 

  16. 16.

    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

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    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

    Article  PubMed  Google Scholar 

  18. 18.

    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

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    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

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Murray DW, Carr a J, Bulstrode C (1993) Survival analysis of joint replacements. J Bone Joint Surg Br 75:697–704

    CAS  Article  Google Scholar 

  21. 21.

    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

    Article  Google Scholar 

  22. 22.

    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

    Article  Google Scholar 

  23. 23.

    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

    Article  PubMed  Google Scholar 

  24. 24.

    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

    Article  Google Scholar 

  25. 25.

    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

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ivan De Martino.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest related directly or indirectly to the subject of this article.

Additional information

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.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • Revision total hip arthroplasty
  • Proximal femoral replacement
  • Megaprosthesis
  • Dislocation
  • Bone loss