Total hip arthroplasty in severe segmental femoral bone loss situations: Use of a reconstruction modular stem design (JVC IX™)

SummaryBackgroundManagement of extensive proximal femur bone loss secondary to tumor resection or major osteolysis remains controversial. The possible options include a composite allograft/stem prosthesis, a modular type megaprosthesis or a custom-made megaprosthesis. Modularity allows versatility at reconstruction and avoids the delay required manufacturing a custom-made implant.Hypothesis and type of study: A retrospective radiological and clinical study investigated whether a special reconstruction modular stem design (JVC IX™) would provide medium term success in the treatment of severe proximal femur bone loss.Material and methodsBetween 1995 and 2005, 23 JVC IX™ hip replacements were performed for severe segmental proximal femur bone loss. Etiology was: 13 cases of tumor resection, eight of extensive osteolysis secondary to femoral implant loosening, and two traumatic situations. Follow-up was annual. Functional assessment used the Musculo-Skeletal Tumor Score (MSTS), and implant survival rates underwent Kaplan-Meier analysis, with surgical revision (to replace or remove the implant) as the end point.ResultsAll 23 patients (23 hips) were followed up for a mean 5.4 years (±3.7 yrs). Mean MSTS was 16.2 (max.=30). All stems demonstrated good fixation at radiological assessment, except for one case of probable loosening in contact with a metastatic osteolysis. Four implants had to be revised: two for non-controlled infection, one for tumor extension, and one for stem fatigue fracture. At 10 years’ follow-up, implant survivorship was 81.5% (range: 62% to 100%).DiscussionSevere proximal femur bone loss is a difficult situation to deal with, offering no ideal treatment option. Modular megaprostheses are salvage procedures. Their results at a mean 5.4 years’ follow-up are encouraging, and appear comparable to the ones obtained with alternative solutions (composite allograft/stem prostheses).Type of studyLevel IV retrospective, therapeutic study