Modern Proximal Femoral Replacement in Revision Total Hip Arthroplasty for Nononcologic Indications

Nathanael D Heckmann; Haley L Nakata; Brian C Chung; Jackson R Baker; Donald B Longjohn; Alexander B Christ; Daniel A Oakes

doi:10.1016/j.arth.2022.02.057

Modern Proximal Femoral Replacement in Revision Total Hip Arthroplasty for Nononcologic Indications

J Arthroplasty. 2022 Aug;37(8S):S958-S963. doi: 10.1016/j.arth.2022.02.057. Epub 2022 Feb 18.

Authors

Nathanael D Heckmann¹, Haley L Nakata¹, Brian C Chung², Jackson R Baker², Donald B Longjohn¹, Alexander B Christ¹, Daniel A Oakes¹

Affiliations

¹ Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA.
² Keck School of Medicine of the University of Southern California, Los Angeles, CA.

PMID: 35189288
DOI: 10.1016/j.arth.2022.02.057

Abstract

Background: Advances in surgical technique and prosthesis design have expanded the non-neoplastic indications for proximal femoral replacement (PFR) to include fracture nonunion, periprosthetic fracture, and severe bone loss in the setting of revision total hip arthroplasty (THA). The purpose of this study is to assess outcomes of PFRs used for nononcologic indications.

Methods: A single-institution, retrospective, cohort survey study was conducted between August 2015-February 2020 of consecutive patients undergoing PFR for nononcologic indications in revision THA. Patient demographics, surgical variables, complications, and revision procedures were collected. Patient satisfaction and Oxford Hip scores were assessed via a telephone questionnaire. Implant survivorship was estimated using the Kaplan-Meier method.

Results: In total, 24 patients (27 PFRs) were available for analysis with an average age of 69.3 ± 12.9 years (range: 37-90). The average number of operations prior to PFR implantation was 3.1 ± 2.1 (range: 0-7). At a mean follow-up of 2.4 years (range: 0.5-5.1), the mean Oxford Hip Score was 31.7 ± 10.2, and mean patient satisfaction was 4.9/5. Six patients (20.7%) experienced a postoperative complication, with dislocation occurring in three patients (10.3%). None of the patients with dual mobility articulations (n = 4) had dislocation. Three-year survivorship was 85.2% (95% CI 71.8%-98.6%) with all-cause reoperations as the endpoint and 100% (95% CI 100.0%-100.0%) with revision for aseptic loosening as the endpoint.

Conclusion: The current study demonstrates excellent short-term survivorship, satisfactory patient-reported outcomes, and high patient satisfaction following PFR for nononcologic indications during revision THA utilizing modern techniques. The most common mode of failure was dislocation requiring reoperation with revision to constrained acetabular components.

Keywords: THA; dislocation; modular; nononcologic; proximal femoral replacement; revision.

MeSH terms

Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip* / methods
Hip Prosthesis* / adverse effects
Humans
Middle Aged
Prosthesis Design
Prosthesis Failure
Reoperation / adverse effects
Retrospective Studies
Treatment Outcome