Reconstruction of Major Segmental Loss of the Proximal Femur in Revision Total Hip Arthroplasty

Reconstruction of major proximal femoral seg-mental defects is one of the most difficult chal-lenges in revision total hip arthroplasty (THA). One technique that has been successful is the use of a modular, long-stemmed prosthesis, cemented to an allograft proximal femur and press-fit to the host bone. Since J u l y 1989, the authors have used this technique in 30 hips (29 patients). The tro-chanteric slide approach was used in all cases. Sixty pounds of weight bearing was encouraged for six weeks, then full weight bearing as tolerated. The mean follow-up period was 22 months (range, two to 46 months). All but two grafts united to the host bone clinically and radiographically. Compli-cations included five dislocations, one graft-host nonunion, one graft resorption, and one deep infec-tion requiring resection arthroplasty. The latter pa-tient was subsequently reconstructed successfully using the same technique. Although the follow-up period is short, the authors have been encouraged by the early success of these allograft-prosthetic composites. Advantages of this approach include rapid return to weight bearing, physiologic loading of the distal femur, and reconstitution of vital proximal bone stock. One of the most difficult challenges in total hip arthroplasty (THA) is reconstruction of major segmental loss of the proximal femur. Small defects, proximal to the base of the lesser trochanter, are best dealt with usin