Extensive and severe bone loss of the femur may be a result of a failed total hip arthroplasty (THA) or total knee arthroplasty (TKA) with multiple revision surgeries which may be caused by factors such as infection, periprosthetic fracture or osteolysis. The aim of this study was to assess outcomes of using the “Push-Through Total Femoral Prosthesis” (PTTF) for revision of a total hip replacement with extreme bone loss.

Fourteen patients who had extensive bone defects of the femur due to failed THR's and were treated with PTTF between 2012 and 2020 were included in this study. Primary functional outcomes were assessed using Harris Hip Score (HHS), Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) scores. Range of motion, complications, and ambulatory status were also recorded to assess secondary outcomes.

Two of 14 patients underwent surgery with PTTF for both knee and hip arthroplasty revision. The mean time between index surgery and PTTF was 15 years (3 to 32 yrs.). Acetabular components were revised in six of 14 patients. After a mean follow-up of 5.9 years, hip dislocations occurred in 3 patients. All dislocated hips were in patients with retained non-constrained acetabular bearings. Patient satisfaction was high (MSTS: 67%, HHS: 61.2%, TESS 64.6%) despite a high re-operation rate and minor postoperative problems.

PTTF is a unique alternative that may be considered for a failed THA revision procedure in patients with an extreme femoral bone defect. Patients are able to ambulate pain free relatively well. Routine usage of constrained liners should be considered to avoid hip dislocation which was our main problem following the procedure.

Two-staged exchange arthroplasty with an antibiotic-impregnated PMMA cement spacer in-between two stages has a success rate of 85% to 95% in eradication of infection. Use of vancomycine in high doses has a high potential for complications due to nephrotoxicity.

The aim of this study was to evaluate the results of two-staged exchange arthroplasty in infected hip arthroplasty using low-dose vancomycine-impregnated PMMA cement as an interim spacer between stages.

Thirty-five (20 females, 15 males, average age: 60) patients with a confirmed infected total hip arthroplasty who were treated between 1999 and 2005 were the subjects of the study. In the first stage after removal of the prosthesis and debridement, a spacer made of 40 grams of PMMA cement impregnated with 1 gr vancomycine was placed in the infected joint space. Postoperatively, patients were treated with 6 weeks of intravenous antibiotics in consultation with an infectious disease consultant. When CRP and ESR returned to normal levels, revision surgery with cementless components was performed.

The average follow-up after the second stage was 4 years. The ESR and CRP decreased significantly before the second stage with this treatment protocol (from 81.28 to 17.54 mm/h p< 0.001 and 10.05 to 0.64 mg/dl respectively, p< 0.001). The mean interval between the two stages was 193.3 days. A second debridement was needed in 4 patients (10.8 %) because they did not respond to treatment. Two patients (5.4 %) had recurrent infections after reimplantation and underwent a resection arthroplasty. None of the patients suffered from antibiotic toxicity.

Two-stage exchange arthroplasty using a low dose vancomycine-impregnated cement spacer was an effective method in treating infected hip replacements. With using a lower dose than previously reported, we were able to avoid antibiotic toxicity while effectively treating our patients with the same success rate.

We have reviewed 54 patients who had undergone 61 total hip replacements using bulk femoral autografts to augment a congenitally dysplastic acetabulum. There were 52 women and two men with a mean age of 42.4 years (29 to 76) at the time of the index operation. A variety of different prostheses was used: 28 (45.9%) were cemented and 33 (54.1%) uncemented. The graft technique remained unchanged throughout the series.

Follow-up was at a mean of 8.3 years (3 to 20). The Hospital for Special Surgery hip score improved from a mean of 10.7 (4 to 18) pre-operatively to a mean of 35 (28 to 38) at follow-up.

The position of the acetabular component was anatomical in 37 hips (60.7%), displaced less than 1 cm in 20 (32.7%) and displaced more than 1 cm in four (6.6%). Its cover was between 50% and 75% in 34 hips (55.7%) and less than 50% in 25 (41%). In two cases (3.3%), it was more than 75%.

There was no graft resorption in 36 hips (59%), mild resorption in 21 (34%) and severe resorption in four (6%).

Six hips (9.8%) were revised for aseptic loosening. The overall rate of loosening and revision was 14.8%. Overall survival at 8.3 years was 93.4%.

The only significant factor which predicted failure was the implantation of the acetabular component more than 1 cm from the anatomical centre of rotation of the hip.