Algorithmic approach for reconstruction of proximal femoral bone loss in revision total hip arthroplasty

Reconstruction of the femur depends on the quantity of bone loss and the quality of the remaining bone stock. Multiple classifications and reporting systems can be used to characterize the bone defect. We present a simple algorithmic approach for proximal femoral bone loss reconstruction during revision total hip arthroplasty. Quantity of bone loss is assessed using radiographs based on different classification systems, whereas quality of the remaining bone stock is assessed intraoperatively. Based on the type of proximal bone loss and the quality of the available bone, we describe our preferred reconstruction technique. For minor bone loss, the metaphysis is expanded but intact with partially absent calcar. There is minimal bone loss anteriorly and posteriorly, and the diaphysis is intact. For significant bone loss, the metaphysis is compromised, and there is no calcar. There is minimal bone loss anteriorly and posteriorly. The available proximal bone may be thin, sclerotic, and incapable of support. However, the diaphysis is intact. For massive bone loss, there is complete circumferential bone loss in the metaphysis, extending to the diaphysis. The anterolateral bone and supporting subtrochanteric metaphyseal bone are absent. The metaphysis is not stable and will not offer rotational stability. There is massive bone loss anteriorly and posteriorly. The stability of the implant is dependent on distal diaphyseal fixation. For complete proximal bone loss, there is extensive circumferential segmental bone loss proximally and extensive cavitary loss involving the entire diaphysis. Additionally, there is extensive ectasia of the diaphysis.