Long-term results of proximal femoral replacement for non-neoplastic disorders

We reviewed retrospectively 50 consecutive total hip arthroplasties with proximal femoral replacement prostheses in 49 patients. All the patients had massive bone loss. There were 31 women and 18 men who had undergone a mean of 3.1 hip operations. At the last review, 15 patients had died and two had been lost to follow-up, so that 32 patients (33 hips) were available for assessment. The mean age of the patients at the time of the operation was 60.6 years. The mean length of clinical follow-up was 11.1 +/- 4 years, and mean radiographic follow-up was 7.6 +/- 3.2 years. The average preoperative Harris hip score was 46 +/- 13 points, which improved to 80 +/- 10 points after one year and to 76 +/- 16 points at the latest follow-up. The most frequent complication was dislocation, which occurred in 11 hips. Four femoral components and seven acetabular prostheses were revised because of aseptic loosening. With revision at the end point, survivorship after total hip arthroplasty with a proximal femoral replacement prosthesis was predicted to be 64% at 12 years. Although our preliminary results of hip salvage with a proximal femoral replacement prosthesis were encouraging, a longer follow-up has shown a higher rate of failure.