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Proximal femoral replacement in contemporary revision total hip arthroplasty for severe femoral bone loss: a review of outcomes
- Source :
- The bonejoint journal. (3)
- Publication Year :
- 2016
-
Abstract
- AimsLoss 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.Patients and MethodsA 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.ResultsThe 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.ConclusionPFRs 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 J 2017;99-B:325–9.
- Subjects :
- Male
Reoperation
medicine.medical_specialty
Arthroplasty, Replacement, Hip
Kaplan-Meier Estimate
Prosthesis Design
03 medical and health sciences
0302 clinical medicine
Medicine
Humans
Orthopedics and Sports Medicine
030212 general & internal medicine
Femur
Registries
Bone Resorption
Cementation
Aged
Retrospective Studies
Aged, 80 and over
030222 orthopedics
Proximal femur
business.industry
Middle Aged
Surgery
Prosthesis Failure
Radiography
Treatment Outcome
Femoral bone
Female
Hip Prosthesis
business
Total hip arthroplasty
Follow-Up Studies
Subjects
Details
- ISSN :
- 20494408
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- The bonejoint journal
- Accession number :
- edsair.doi.dedup.....20f0be9366323a7ef27a961f082752aa