Table 4.
Complications and survivorship of different revision THAs for severe femoral bone loss
| Study | Numbers of hips or patients | Followup | Complications | Survivorship | |
|---|---|---|---|---|---|
| Circumferential proximal femoral allografts (Roos et al. [30]) | 20 hips | Mean 8 years | Allograft resorption | 8 hips (40%) | 18 hips (90%) |
| Allograft nonunion | 1 hip (5%) | ||||
| Allograft partial union | 1 hip (5%) | ||||
| Trochanteric migration | 1 hip (5%) | ||||
| Total | 11 hips (55%) | ||||
| Impaction bone grafting with cemented stem (Iwase et al. [20]) | 99 hips | Mean 5.2 years | Intraoperative fracture or perforation | 20 hips (20%) | 93.1% at 5.2 years as revision end point |
| Resorption of allograft | 9 hips (9%) | ||||
| Subsidence of stem (> 5 mm) | 2 hips (2%) | ||||
| Total | 31 hips (31%) | ||||
| Impaction bone grafting with cementless stem (Wimmer et al. [31]) | 243 hips | Mean 4.4 years | Aseptic loosening | 7 hips (2.9%) | 93.8% at 4.4 years as revision end point |
| Revision rates | 21 hips (8.6%) | ||||
| Total | 28 hips (12%) | ||||
| Proximal femoral allograft-prosthesis composite (Babis et al. [2]) | 57 patients | Mean 12 years | Aseptic loosening | 4 patients (7%) | 69.0% at 10 years as revision end point |
| Allograft resorption | 3 patients (5%) | ||||
| Allograft nonunion | 2 patients (4%) | ||||
| Allograft fracture | 4 patients (7%) | ||||
| Fracture of stem | 1 patient (2%) | ||||
| Deep infection | 5 patients (9%) | ||||
| Rerevision | 19 patients (44%) | ||||
| Total | 38 patients (67%) | ||||
| Proximal femoral replacement (Jaiswal et al. [21]) | 27 patients | Mean 55.3 months | Dislocation | 2 patients (7%) | Success rate at 55.3 months = 86.4% |
| Change in polyethylene liner and head | 1 patient (4%) | ||||
| Cup revision | 1 patient (4%) | ||||
| Deep infection | 3 patients (11%) | ||||
| Total | 7 patients (26%) | ||||
| Fluted tapered modular femoral stem (Amanatullah et al. [1]) | 92 patients | 6.4 years (2–12 years) |
Intraoperative fracture | 11 hips (12%) | 97% (88 of 92 hips) at 6.4 years |
| Postoperative periprosthetic fracture | 7 hips (8%) | ||||
| Dislocation | 17 hips (19%) | ||||
| Deep infection | 6 hips (7%) | ||||
| Other | 11 hips (12%) | ||||
| Revision | 18 hips (20%) | ||||
| Total | 70 hips (76%) | ||||
| Fluted tapered modular femoral stem (Brown et al. [8]) | 58 patients | 5.6 years (2–12.6 years) |
Subsidence (> 4 mm) | 6 patients (10%) | 98% (95% CI, 89.5–99.5%) at 12 years |
| Thigh pain | 11 patients (19%) | ||||
| Reoperation | 10 patients (17%) | ||||
| Total | 27 patients (47%) | ||||
| Current series | 130 hips | Mean 16.1 years | Dislocation | 4 hips (3%) | 91% (95% CI, 0.88–0.96) at 16 years with revision endpoint Worst case scenario: 83% (95% CI, 0.78–0.88) with revision endpoint |
| Deep vein thrombosis (calf vein) | 5 hips (4%) | ||||
| Deep infection | 6 hips (5%) | ||||
| Femoral shaft | 4 hips (3%) | ||||
| Revision | 12 hips (9%) | ||||
| Total | 31 hips (24%) |