Revision THA for Massive Bone Defect of the Femur with Megaprosthesis Combined with Impaction Bone Grafting —A Case Report

• Published in: Orthopedics & Traumatology Vol. 61; no. 4; pp. 683 - 687
• Main Authors: Tominaga, Hiroyuki, Kakoi, Hironori, Yokouchi, Masahiro, Tsuneyoshi, Yasuhiro, Setoguchi, Takao, Kamizono, Junichi, Ishido, Yasuhiro, Yoshii, Riichiro, Nagano, Satoshi, Tanaka, Motoyuki, Komiya, Setsuro
• Format: Journal Article
• Language: Japanese
• Published: West-Japanese Society of Orthopedics & Traumatology 25.09.2012
• Subjects: femoral reconstruction; megaprosthesis; revision THA
• ISSN: 0037-1033; 1349-4333
• DOI: 10.5035/nishiseisai.61.683

Loss of femoral bone stock presents a significant challenge in hip revision surgery. We report a case whose massive bone defect of the femur was reconstructed with a megaprosthesis combined with impaction bone grafting. A 76-year-old woman underwent bipolar hemiarthroplasty for femoral neck fracture 25 years ago. Two years later, she underwent revision surgery with long stem for periprosthetic femoral fracture. But bone union failed. Sinking of the stem and bone defect of the femur progressed gradually. In 2010 she came to our hospital suffering from impending fracture of the lateral condyle of the femur caused by the sinking of the stem. The femur was shorter than the unaffected side by 13 cm. CT demonstrated complete absence of the proximal femur. To achieve adequate fixation of the stem, distal medullary canal was reconstructed with circumferential metal mesh and impacted bone grafts, and proximal canal was reconstructed with a megaprosthesis. This method may be useful for massive and circumferential bone defects of the proximal femur.