Revision Total Hip Arthroplasty with a Custom Cementless Stem with Distal Cross-Locking Screws: Early Results in Femora with Large Proximal Segmental Deficiencies

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Background: Revision total hip arthroplasty in the setting of a large proximal segmental femoral deficiency and/or discontinuity between the proximal and distal parts of the femur remains a challenging problem. We describe the use of a cementless stem with distal cross-locking screws to provide stability of the femoral implant in this situation.

Methods: Seventeen custom fully porous and hydroxyapatite-coated titanium femoral stems with distal cross-locking titanium screws were implanted in sixteen patients during revision total hip arthroplasty. Preoperatively, all of the patients had Paprosky grade-IIIB or IV femoral deficiencies. At the time of follow-up, the Harris hip scores were calculated and radiographs were made. A successful result was defined as a postoperative increase in the Harris hip score of >20 points, a radiographically stable implant, and no additional femoral reconstruction.

Results: At the time of final follow-up, at a mean of 5.3 years postoperatively, the result was successful in sixteen of the seventeen hips, the mean Harris hip score had improved from 35 to 76 points, and all implants were clinically and radiographically stable. There were no postoperative infections or hip dislocations.

Conclusions: The use of a custom femoral stem with distal cross-locking screws can provide at least intermediate-term clinical and radiographic stability in patients with Paprosky grade-IIIB or IV femoral deficiencies. Longer follow-up will be required to determine the longevity of these implants.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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