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Purpose: Implant loosening represent the most common indication for stem revision in hip revision arthroplasty. This study compares femoral bone loss and the risk of initial revisions between cemented and uncemented loosened primary stems, investigating the impact of fixation method at primary implantation on femoral bone defects., Methods: This retrospective study reviewed 255 patients who underwent their first revision for stem loosening from 2010 to 2022, receiving either cemented or uncemented stem implants. Femoral bone loss was preoperatively measured using the Paprosky classification through radiographic evaluations. Kaplan-Meier analysis estimated the survival probability of the original stem, and the hazard ratio assessed the relative risk of revision for uncemented versus cemented stems in the first postoperative year and the following two to ten years., Results: Cemented stems showed a higher prevalence of significant bone loss (type 3b and 4 defects: 32.39% vs. 2.72%, p < .001) compared to uncemented stems, which more commonly had type 1 and 2 defects (82.07% vs. 47.89%, p < .001). In our analysis of revision cases, primary uncemented stems demonstrated a 20% lower incidence of stem loosening in the first year post-implantation compared to cemented stems (HR 0.8; 95%-CI 0.3-2.0). However, the incidence in uncemented stems increased by 20% during the subsequent years two to ten (HR 1.2; 95%-CI 0.7-1.8). Septic loosening was more common in cemented stems (28.17% vs. 10.87% in uncemented stems, p = .001). Kaplan-Meier analysis indicated a modestly longer revision-free period for cemented stems within the first ten years post-implantation (p < .022)., Conclusion: During first-time revision, cemented stems show significantly larger femoral bone defects than uncemented stems. Septic stem loosening occurred 17.30% more in cemented stems., (© 2024. The Author(s).)

Background: Femoral bone deficiency is a challenging problem in revision femoral arthroplasty in younger patients. We evaluated outcomes of revision femoral arthroplasty using a freeze-dried allograft prosthetic composite (APC)., Methods: This was a retrospective review of 16 patients (12 men and 4 women) who had unilateral proximal femoral deficiencies (Paprosky type III B, 13 patients; type IV, 3 patients) revised with freeze-dried APC. Follow-up at mean 7 years included assessment with Merle D'Aubigné score and radiographs., Results: At follow-up, the average hip score was improved for pain, function, and range of motion. The 5-year graft survival was 87%, and the estimated median survival was 8.8 years. There were 3 patients who walked without support, 10 patients who walked unlimited distance with a cane, 2 patients who walked with 2 crutches, and 1 patient who walked with a walker. Radiographs showed nonunion at the graft-host junction in 3 hips (19%), but only 1 patient was symptomatic. Asymptomatic trochanteric nonunion was observed in 4 hips (25%). There was moderate graft resorption in 2 patients at 9 years after surgery and mild graft resorption in 1 graft at 7 years. There was subsidence of <2 cm in 2 patients and 3.5 cm in 1 patient., Conclusion: The present study showed acceptable results in treatment of major femoral deficiencies using freeze-dried APC in younger patients. Freeze-dried APC may be a useful for revision femoral arthroplasty., (Copyright © 2016. Published by Elsevier Inc.)

The purpose of this prospective multicenter study was to evaluate results of 122 revision THAs using a 2nd generation modular femoral implant in 120 patients. Majority of cases had significant femoral bone loss. HHS improved from a pre-operative mean score of 46 to 88 points, and SF-36 scores improved from 31 to 44 points at 2- to 5-year follow-up. There were 18 cases of intraoperative fractures of which 10 were femur shaft, 7 trochanteric, and 1 acetabular. Dislocation incidence was 9% and overall survivorship at 5 years was 97%. Use of modular femoral implants provides versatility and simplification to restore stability, limb length and offset in patients undergoing femoral component revision, Additional steps need to be undertaken to minimize incidence of fracture and dislocation., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Several studies have evaluated the survivorship and clinical outcomes of proximal femoral replacement (PFR) in complex primary and revision total hip arthroplasty with severe proximal femoral bone loss; however, there remains no consensus on the overall performance of this implant. We therefore performed a systematic review of the literature in order to examine survivorship and complication rates of PFR usage.Methods: A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles using various combinations of keywords.Results: In all, 18 articles met the inclusion criteria. A total of 578 PFR were implanted. The all-cause reoperation-free survivorship was 76.6%. The overall complication rate was 27.2%. Dislocation was the most common complication observed and the most frequent reason for reoperation with an incidence of 12.8 and 7.6%, respectively. Infection after PFR had an incidence of 7.6% and a reoperation rate of 6.4%. The reoperation rate for aseptic loosening of the implant was 5.9%. Overall, patients had improved outcomes as documented by postoperative hip scores.Conclusion: PFR usage have a relatively high complication rate, however, it remains an efficacious treatment option in elderly patients with osteoporotic bone affected by severe proximal femoral bone loss. Modular designs have shown reduced dislocations rate and higher survivorship free from dislocation. However, PFR should only be used as salvage procedure when no other reconstruction options are available. [ABSTRACT FROM AUTHOR]

Background: Revision total hip arthroplasty (THA) remains a significant challenge when there is severe femoral bone loss. The purpose of this study was to evaluate the clinical and radiographic outcomes of revision THA in patients with femoral bone loss treated with Zweymüller SLR-Plus stem. Methods: A retrospective review of 82 patients who underwent revision THA using tapered rectangular femoral stem between 1997 and 2007 was undertaken. Of the 82 patients, 9 patients were lost to follow-up and were excluded from the study. The most common reason for revision was aseptic loosening (92%), periprosthetic femur fracture (5%), and infection (3%). Bone loss was categorised preoperatively according to the Paprosky classification. The mean clinical follow-up was 14 years (range 10–19 years). Their mean age at the time of index surgery was 54.7 ± 15.3 (range 30–82) years. Results: The mean Harris Hip Score was significantly improved at final follow-up (68.1 ±10.3) compared with that before the revision surgery (30.4 ± 7.7) (p < 0.0001). Of the 75 stems, 69 (92%) stems were radiographically stable at the last evaluation. Among the 69 stems, 64 hips (85%) had radiographic evidence of bone ingrowth and 5 (5%) had stable fibrous fixation of the stem. Among the 7 hips that were re-revised, 5 hips were re-revised for aseptic loosening, whereas 2 were re-revised for an infection. Kaplan-Meier survivorship analysis, with removal of the stem for any cause as the endpoint, revealed that the 15-year rate of survival of the components was 90% (95% CI, 0.83–0.97). Conclusion: Revision THA in patients with proximal femoral bone loss using Zweymüller SLR-Plus stem led to a high rate of osseointegration of the stem and good clinical results at long-term follow-up. [ABSTRACT FROM AUTHOR]

Cortical bone loss in revision hip arthroplasty requires an adequate stabilization to achieve a durable implant fixation. This case series shall illustrate possible indications for the use of allogenic grafts in revision hip arthroplasty. Twelve patients with femoral bone loss were treated with allografts. In addition to established clinical scores, the radiological follow-ups were analyzed for hints of implants loosening and the osteointegration of the allografts. After a mean follow-up of 3.0 years the mHHS was 61.3 points and the UCLA 3.8. One patient showed a non-progressive radiolucency around the hip implant. The osteointegration of all allogenic grafts happened on time. Up to the last follow-up no revision surgery of the hip implants and the associated femoral bone graft was observed. Allogenic bone grafts present a method for biological stabilization in situations of large femoral cortical bone defects in revision hip arthroplasty. [ABSTRACT FROM AUTHOR]

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 longterm 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. [ABSTRACT FROM AUTHOR]

Classification systems for femoral revision of a failed THA fail to address several of the more critical determinants. The aim of the present study was to assess the reliability of a simplified algorithm for decision making during cementless reconstruction for femoral loosening with respect to stem length, stem design and the need for an extended trochanteric osteotomy. Four observers with different levels of clinical experience blindly assessed 40 X-rays of hips scheduled for a femoral revision. Intra-observer and inter-observer reliability of 4 radiographic criteria were assessed: 1) diaphyseal bone loss extension to the isthmus; 2) proximal femoral remodelling; 3) presence of cement; and 4) cortical thickness. Inter-observer agreement relating to the four criteria was good (κ = 0.66) for the extension to isthmus, moderate (κ = 0.57) for proximal femoral remodelling and very good for presence of cement (κ = 1) and cortical thickness (κ= 0.88). Intra-observer agreement was good for extension to isthmus and proximal femoral remodelling and very good for presence of cement and cortical thickness. Based on these criteria, an algorithm has been developed to describe 4 reconstruction options. The algorithm seems reliable for decision making during femoral cementless revision, but research into comparison with intraoperative findings is still required. Level of evidence: Level II, Development of diagnostic criteria on consecutive patients. [ABSTRACT FROM AUTHOR]

To address femoral bone loss in revision total hip arthroplasty (THA) we developed a technique involving impaction allografting with intramedullary mesh moulded around the revision stem, to prevent excessive cement penetration of the allograft. The length of the revision stem was determined by the extent of femoral bone loss. Between 1986 and 1998, 32 such procedures were undertaken on 28 patients. The mean pre-operative HHS for function was 22 (range 5 to 42), improving to 41 (range 12 to 47) at final follow-up. Only 1 patient presented with aseptic loosening after revision at 147 months (12.2 years). The 12.5 year survivorship for the stem was 92.8%. The technique has provided stable and durable reconstruction, with good new bone formation visible radiologically. It is technically demanding and time consuming, but it avoids the previously published problem of massive subsidence within the bone graft. [ABSTRACT FROM AUTHOR]

Despite remarkable advances in the field of revision surgery during the last decades, the reconstruction in patients with massive femoral bone loss is still challenging. Proximal femoral replacement (megaprosthesis) and the use of an allograft-prosthesis composite are 2 valuable options for managing severe proximal femoral bone loss conditions. Although an allograft-prosthesis composite has several advantages, such as a potential restoration of proximal femoral bone mass and providing a site for soft-tissue attachment, a proximal femoral replacement has the benefit of being more readily available, technically less demanding, and more expeditious to implant than allograft-prosthesis composite. The outcome of megaprosthesis in non-neoplastic condition is dependent on several different issues, including patient selection, appropriate preoperative planning and templating, proper surgical techniques, and good postoperative care. We believe that proximal femoral replacement is a viable option for reconstruction of elderly and sedentary patients with severe femoral bone deficiency. [ABSTRACT FROM AUTHOR]