Background: Revision total hip arthroplasty in the setting of a
large proximal segmental femoral deficiency and/or discontinuity between the
proximal and distal parts of the femur remains a challenging problem. We
describe the use of a cementless stem with distal cross-locking screws to
provide stability of the femoral implant in this situation.
Methods: Seventeen custom fully porous and hydroxyapatite-coated
titanium femoral stems with distal cross-locking titanium screws were
implanted in sixteen patients during revision total hip arthroplasty.
Preoperatively, all of the patients had Paprosky grade-IIIB or IV femoral
deficiencies. At the time of follow-up, the Harris hip scores were calculated
and radiographs were made. A successful result was defined as a postoperative
increase in the Harris hip score of >20 points, a radiographically stable
implant, and no additional femoral reconstruction.
Results: At the time of final follow-up, at a mean of 5.3 years
postoperatively, the result was successful in sixteen of the seventeen hips,
the mean Harris hip score had improved from 35 to 76 points, and all implants
were clinically and radiographically stable. There were no postoperative
infections or hip dislocations.
Conclusions: The use of a custom femoral stem with distal
cross-locking screws can provide at least intermediate-term clinical and
radiographic stability in patients with Paprosky grade-IIIB or IV femoral
deficiencies. Longer follow-up will be required to determine the longevity of
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.