Management of Severe Femoral Bone Loss in Revision Total Hip Arthroplasty

Femoral bone loss is a complex problem in revision total hip arthroplasty. The Paprosky classification is used when determining the degree and location of bone loss. Meticulous operative planning is essential where severe bone loss is a concern. One must correctly identify the bone loss pattern, safely remove the existing components, and proceed with the proper reconstruction technique based on the pattern of bone loss. This article discusses the etiology and classification of bone loss, clinical and radiographic evaluation, components of effective preoperative planning, and clinical results of various treatment options with a focus on more severe bone loss patterns.

Key points

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Femoral bone loss is a complicated problem requiring meticulous preoperative patient evaluation and surgical planning.
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The Paprosky classification system is most commonly used to define femoral bone loss.
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The Paprosky system is based on the location of femoral bone loss, degree of residual proximal femoral bone stock, and the amount of residual isthmus available for diaphyseal fixation.
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More severe bone loss patterns have variable amounts of diaphysis remaining.
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Diaphyseal engaging stems are successful when used with adequate isthmic bone stock. Severe loss of isthmic bone typically requires a cemented option or a megaprosthesis.