Implant options
Standard primary femoral stem
Long stem cemented revision femoral stem
Extensively porous coated diaphyseal fitting uncemented stem
Modular diaphyseal fitting, proximal filling uncemented stem
Impaction bone grafting and cemented femoral stem
Paprosky classification femoral bone loss
| Type I |
Minimal metaphyseal cancellous bone loss Intact diaphysis |
|---|---|
| Type II |
Extensive metaphyseal cancellous bone loss Intact diaphysis |
| Type IIIA |
Metaphysis severely damaged > 4cm diaphyseal bone for distal fixation |
| Type IIIB |
Metaphysis severely damaged < 4cm diaphyseal bone for distal fixation |
| Type IV |
Extensive metaphyseal and diaphyseal bone loss Isthmus non supportive |
Paprosky Type I / II: Mild to moderate metphyseal bone loss
Options
Standard primary femoral stem
Long stem cemented revision femoral stem
Impaction bone grafting
Technique
JSJS Essential surgical techniques femoral impaction bone grafting PDF
Results
Primary standard length uncemented stems
Cavagnaro et al Musculoskeletal Surg 2018
- systematic review of revision with primary cementless revision stems
- 450 type I / II femoral defects
- 96% survival at 5 years
Impaction bone grafting
Wilson et al Bone Joint J 2016
- 700 revision THA treated with femoral impaction bone grafting
- 88% 20 year survival
Cases
Paprosky Type I revision to standard length cemented femoral stem
Paprosky Type I/II revised to long cemented femoral stem
Paprosky Type III: Severe bone loss
Options
Long stem cemented revision stem
Extensively porous coated diaphyseal fitting implant
Modular diaphyseal fitting, metaphyseal filling uncemented prosthesis
Impaction bone grafting
Results
Long cemented stem
Solomon et al Bone Joint J 2015
- revision with cemented femoral stems
- 219 cases mostly Paprosky Type IIIA with mean 14 year follow up
- long cemented stems: 97% survival
- standard cemented stems: 91%
Cases
Paprosky Type IIIA revision to modular femoral replacement stem
Revision of Paprosky Type IIIA with impaction bone grafting
Segmental bone defects
Options
Calcar replacement
Bulk structural allograft
Proximal femoral replacement
Results
Calcar replacement
Bulk structural allograft
Proximal femoral replacement
Cases
Calcar replacing revision stem