Results in revision Hip surgery are compromised where there is extensive bony destruction or significant bone loss. While restoration of bone stock and a return to normal anatomy is the gold standard this is not always possible and may not be required in those patients with lower functional demands and other co-morbidities. The senior authors designed a new hip prosthesis as an aid to revision Arthroplasty and to allow them to bypass defects in the proximal femur. This was a titanium modular cemented prosthesis of varying lengths (from 140mm to 220mm) with a distal flange to transmit compressive loads. It used cement to obtain fixation in the remaining bone, had a short offset designed to reduce torsional loading and a standard (12/14mm) trunion to allow the use of a variety of modular heads.

Operative technique: A transfemoral approach was used allowing easy removal of the old prosthesis, cement and other debris. This also gives an excellent view of the acetabulum if this is also to be revised. The distal femur is sectioned transversely and an appropriately sized component selected, the remaining femur is reamed to 14mm and cemented in place. The proximal femur is then closed over the prosthesis and held with cerclage bands. Full weight bearing was allowed once quadriceps function had been regained.

Results: 48 proximal femoral replacements were performed in 47 patients between December 1992 and June 1997. 12 patients died and 6 declined follow up. The remaining patients were seen in clinic and radiographs of the femur were performed. There was a significant reduction in the postoperative pain score (p< 0.01), and improvement in the Harris hip score. 7 patients suffered dislocations, 4 responding to conservative measures after a single episode. There were 5 implants revised, 3 to total femoral replacements and 1 to a calcar replacing prosthesis. Most patients were satisfied with their result, and all but 1 walk with minimal walking aids. Despite its high complication rate we continue to use this prosthesis as we feel that it remains as a useful alternative in the management of selected low demand patients.