Background: Numerous factors may give rise to the loss of femoral
bone stock that can be encountered in revision hip arthroplasty. Proximal
femoral replacement is an option for the treatment of severe proximal femoral
bone loss. In this study, we sought to determine the outcome of reconstructive
surgery with the use of a modular proximal femoral replacement (a so-called
megaprosthesis) in patients with proximal femoral bone loss due to
Methods: A review of computerized databases from two institutions
identified forty-eight patients with a mean age of 73.8 years who had
undergone the placement of a modular megaprosthesis with or without
bone-grafting. The indication for proximal femoral replacement was a
periprosthetic fracture in twenty patients, reimplantation because of a deep
infection in thirteen, a failed arthroplasty in thirteen, nonunion of an
intertrochanteric fracture in one, and radiation-induced osteonecrosis with a
subtrochanteric fracture in one. Three patients died before the minimum
two-year follow-up interval had elapsed, and two additional patients were lost
to follow-up. The mean duration of follow-up for the remaining study group of
forty-three patients was 36.5 months.
Results: At the time of follow-up, there was a significant
improvement in function as measured with the Harris hip score (p < 0.05).
The proximal femoral replacement achieved an excellent or good functional
outcome in twenty-two of the forty-three hips. The functional outcome was
found to be fair in ten hips and poor in the remaining eleven. Ten patients
required a reoperation or revision because of at least one complication. With
revision used as the end point, the survivorship of the implant was 87% at one
year and 73% at five years.
Conclusions: Patients with severely compromised bone stock in whom
the use of a conventional prosthesis is precluded because of an inability to
achieve adequate fixation may be candidates for proximal femoral replacement.
Our short-term results suggest that this is a viable salvage procedure for
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.