Table 1.

Treatment algorithm for femoral defects

Gross’ classification	Type of defect	Treatment alternatives
Type 1	No significant bone loss	Conventional cemented or uncemented femoral component
Type 2	Contained (cavitary) bone loss	Proximally porous-coated implantExtensively porous-coated implants for ingrowthExtensively grit-blasted titanium implants for ongrowthImpaction grafting with a cemented componentModular implants for proximal or extensive ingrowth or ongrowthLong-stemmed cemented implants
Type 3	Segmental (full circumferential) bone loss from the proximal femur that is less than 5 cm in length and involves the calcar and the lesser trochanter but does not extend into the diaphysis	As in Type 2 with a calcar replacement option
Type 4	Segmental (full circumferential) bone loss of greater than 5 cm in length extending into the diaphysis	Allograft-prosthesis composite or tumor prosthesis
Type 5	As in Type 4 with the addition of a periprosthetic fracture	Allograft-prosthesis composite or tumor prosthesis