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Reconstruction of the Failed Femoral Component and Proximal Femoral Bone Loss in Revision Hip Surgery

Dr. Maurer is Resident, Department of Orthopaedic Surgery, New York University Medical Center–Hospital for Joint Diseases Orthopaedic Institute, New York. Dr. Baitner is Research Fellow, Hospital for Joint Diseases Orthopaedic Institute. Dr. Di Cesare is Director, Musculoskeletal Research Center, and Co-Director, Surgical Arthritis Service, New York University Medical Center–Hospital for Joint Diseases.

Reprint requests: Dr. Di Cesare, New York University Medical Center, 301 East 17th Street, New York, NY 10003.

Advances in implant technology and surgical techniques have greatly improved the results of femoral stem revision in total hip arthroplasty. The 10-year results obtained with extensively coated noncemented revision stems parallel those obtained with cemented stems revised by using contemporary techniques. Proximal femoral bone loss is an important consideration when planning and performing revision arthroplasty. Proximal femoral bone defects can be managed with either metal or bone. Insignificant defects can be reconstructed by using primary hip arthroplasty techniques. Proximal femoral replacement prostheses are best restricted to sedentary elderly patients. Cortical strut grafts can be used reliably to reconstruct noncircumferential segmental defects. Calcar allografts are associated with unacceptably high rates of resorption. Proximal femoral allografts with either noncemented or cemented long-stem prostheses have the potential advantage of biologic soft-tissue attachment and restoration of bone stock. Impaction allografting with cement is indicated for cavitary defects and may also restore bone stock.

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