Proximal Femur Replacement: Complexities and Learning Points

Main Article Content

Akshay Lekhi Kuntal Patel Deepak Herlekar

Abstract

Proximal femur replacement (PFR) or Proximal femur reconstruction is a way of salvaging excess bone loss in proximal femur and yet providing a total hip replacement


The article aims to highlight the technical difficulties and comorbidities associated with this complex procedure of proximal femur replacement. We retrospectively evaluated eight complex typical PFR cases performed under the care of same team of two surgeons, from 2013 to 2021, to highlight the various technical difficulties and complications that may be incurred during such a major salvage surgery. This was intended to help prepare the fellows, colleagues and future surgeons to have a plan of action and holistic approach towards the process. Average age of 87.4 years makes it a challenge both pre-operatively and post operatively in view of comorbidities existing in this age, apart from the technical difficulties of PFR. Complications observed were difficult rehabilitation, infection, pulmonary embolism deep vein thrombosis, dislocation, limb-length discrepancies and death. This is a level IV evidence case series with individual case description along with respective radiographs.

Article Details

How to Cite
LEKHI, Akshay; PATEL, Kuntal; HERLEKAR, Deepak. Proximal Femur Replacement: Complexities and Learning Points. Medical Research Archives, [S.l.], v. 10, n. 11, nov. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2992>. Date accessed: 17 june 2024. doi: https://doi.org/10.18103/mra.v10i11.2992.
Section
Research Articles

References

1. Haentjens P, Casteleyn PP, De Boeck H, Handelberg F, Opdecam P. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. J Bone Joint Surg Am 1989; 71:1214–25.
2. Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty two intertrochanteric hip fractures. J Bone Joint Surg. Am 1979; 61:216–21.
3. Mariani EM, Rand JA. Nonunion of intertrochanteric fractures of the femur following open reduction and internal fixation. Clin Orthop 1987; 218:81–9.
4. Mears DC, Durbhakula SM, Velyvis JH. Reconstructive total hip replacement after proximal femoral injuries. In: Browner BD, Levine AM, Jupiter JB, Trafton PG, editors. Skeletal Trauma. Philadelphia, PA. Saunders; 2003. p. 1817–31.
5. Haentjens P, Lamraski G. Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient: a review. Disabil Rehabil 2005; 27:1167 80.
6. Klein GR, Parvizi J, Rapuri V, Wolf CF, Hozack WJ, Sharkey PF, Purtill JJ. Proximal femoral replacement for the treatment of periprosthetic fractures. J Bone Joint Surg Am. 2005 Aug; 87(8):1777-81.
7. Sim FH, Chao EYS. Hip salvage by proximal femoral replacement. J Bone Joint Surg Am 1981;63:1228–39.
8. Haidukewych GI, Berry D. Salvage of failed treatment of hip fractures. J Am Acad Orthop Surg 2005;13:101–9.
9. Parvizi J, Sim FH. Proximal femoral replacements with megaprostheses. Clin Orthop 2004;420:169–75.
10. Paprosky WG, Aribindi R: Hip replacement: Treatment of femoral bone loss using distal bypass fixation. Instr Course. Lect 2000;49:119-130.
11. D’Antonio J, McCarthy JC, Bargar WL, et al: Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop Relat Res 1993;(296):133-139.
12. Shih ST, Wang JW, Hsu CC. Proximal femoral megaprosthesis for failed total hip arthroplasty. Chang Gung Med J 2007; 30:73–80.
13. Andrew J. Schoenfeld, Mark C. Leeson, Gregory A. Vrabec, Joseph Scaglione, Matthew J. Stonestreet. Outcomes of modular proximal femoral replacement in the treatment of complex proximal femoral fractures: A case series. International Journal of Surgery. Volume 6, Issue 2, 2008, Pages 140-146, ISSN 1743-9191.
14. Viste A, Perry KI, Taunton MJ, Hanssen AD, Abdel MP. Proximal femoral replacement in contemporary revision total hip arthroplasty for severe femoral bone loss: a review of outcomes. Bone Joint J. 2017 Mar;99-B(3):325-329.
15. Fahad S, Nawaz Khan MZ, Khattak MJ, Umer M, Hashmi P. Primary Proximal femur replacement for unstable osteoporotic intertrochanteric and subtrochanteric fractures in the elderly: A retrospective case series. Ann Med Surg (Lond). 2019 Jul 11; 44:94-97.
16. De Martino, I., D’Apolito, R., Nocon, A.A. et al. Proximal femoral replacement in non-oncologic patients undergoing revision total hip arthroplasty. International Orthopaedics (SICOT) 43, 2227–2233 (2019).
17. Abdel, M.P. and Padgett, D.E., 2013. Constrained liners in revision total hip replacement. The Bone & Joint Journal. 95, pp.1-4.
18. Berend, K.R., Lombardi, A.V. Jr., Mallory, T.H., Adams, J.B., Russell, J.H. and Groseth, K.L., 2005. The long-term outcome of 755 consecutive constrained acetabular components in total hip arthroplasty: examining the successes and failures. The Journal of Arthroplasty. 20(7), pp. 93–102.
19. Berend, K.R., Lombardi, A.V. Jr., Welch, M. and Adams, J.B., 2006. A constrained device with increased range of motion prevents early dislocation. Clinical Orthopaedics and Related Research. 447, pp. 70-75.
20. Clarke M T, Green J S, Harper W M.et al Screening for deep‐venous thrombosis after hip and knee replacement without prophylaxis. J Bone Joint Surg Br 199779787–791.
21. Culver D, Crawford J S, Gardiner J H.et al Venous thrombosis after fractures of the upper end of the femur. A study of incidence and site. J Bone Joint Surg Br 19705261–69.
22. Kelsey J L, Wood P H, Charnley J. Prediction of thromboembolism following total hip replacement. Clin Orthop Relat Res 1976114247–258.
23. Lerch M, Kurtz A, Windhagen H, et al.: The cementless Bicontact ® stem in a prospective dual-energy X-ray absorptiometry study. Int Orthop.(SICOT)2012;36(11):2211–2217.