Proximal femoral megaprosthesis for failed total hip arthroplasty.

BACKGROUND The purpose of this study was to assess the clinical outcome and complications of megaprostheses for massive proximal femoral bone loss after failed total hip arthroplasty. METHODS Between June 1997 and December 2002, 12 patients (12 hips) with massive proximal femoral deficiencies had reconstruction of the hip using proximal femoral megaprostheses. The average age of the patients was 59 years (range 25 to 75). RESULTS At an average of 5.7 years (range 3.3 to 9) after surgery, eight patients (67%) had a satisfactory result, one had fair and three had poor results. The complications included dislocation in 5 (42%), deep infection in 4 (33%), ectopic ossification in 1 (8%), leg shortening > 3 cm in 2 (16.7%), displacement of the greater trochanter in 3 (25%) and aseptic loosening of the megaprosthesis in 1 (8%). The early dislocation rate was 75% but this was subsequently reduced to 14% in the later period after use of an abduction brace postoperatively. The average Harris hip score of the 12 patients preoperatively was 30 points (range 16-42). The average Harris hip score of the 9 patients with a retained megaprosthesis was 83 points (range 68 to 92). CONCLUSION Patients with a failed total hip arthroplasty and massive proximal femoral bone loss can be salvaged with a proximal femoral megaprosthesis if there is no other alternative. However, this procedure is technically demanding and has a high rate of complications. The routine use of an abduction brace postoperatively is advised to reduce the dislocation rate.