Abstract
As the number of patients who have undergone total hip arthroplasty rises, the number of patients who require surgery for a failed total hip arthroplasty is also increasing. Reconstruction of the failed femoral component in revision total hip arthroplasty can be challenging from both a technical perspective and in preoperative planning. With multiple reconstructive options available, it is helpful to have a classification system which guides the surgeon in selecting the appropriate method of reconstruction. We have developed a classification of femoral deficiency and an algorithmic approach to femoral reconstruction is presented.
Type I: Minimal loss of metaphyseal cancellous bone with an intact diaphysis. Often seen when conversion of a cementless femoral component without biological ingrowth surface requires revision.
Type II: Extensive loss of metaphyseal cancellous bone with an intact diaphysis. Often encountered after the removal of a cemented femoral component.
Type IIIA: The metaphysis is severely damaged and non-supportive with more than four centimeters of intact diaphyseal bone for distal fixation. This type of defect is commonly seen after removal of grossly loose femoral components inserted with first generation cementing techniques.
Type IIIB: The metaphysis is severely damaged and non-supportive with less than four centimeters of diaphyseal bone available for distal fixation. This type of defect is often seen following failure of a cemented femoral component that was inserted with a cement restrictor and cementless femoral components associated with significant distal osteolysis.
Type IV: Extensive meta-diaphyseal damage in conjunction with a widened femoral canal. The isthmus is non-supportive.
