Introduction. Patients with osteonecrosis of the femoral head are typically younger, more active, and often require high rates of revision following primary total hip arthroplasty. However, outcomes of revision hip arthroplasty in this patient population have been rarely reported in the literature. The purpose of this study was to report the intermediate-term clinical and radiographic outcomes of revision hip arthroplasty in patients with osteonecrosis of the femoral head. Materials & Methods. Between November 1994 and December 2009, 187 revision hip arthoplasty were performed in 137 patients who had a diagnosis of osteonecrosis of the femoral head. Exclusion criteria included infection, recurrent instability, isolated polyethylene liner exchange, and inadequate follow-up (less than 3 years). The final study cohort of this retrospective review consisted of 72 patients (75 hips) with a mean age of 53.3 years (range, 34 to 76). Components used for the acetabular revision included a cementless porous-coated cup in 58 hips and an acetabular cage in 2 hips. Components used for the femoral revision included a fully grit-blasted tapered stem in 30 hips and a proximally porous-coated modular stem in 9 hips. The mean duration of follow-up was 7 years (range, 3 to 17). Results. Mean Harris hip score improved 49 points preoperatively to 90 points. At the time of final follow-up, 11 hips (14.7%) patients required additional reoperation procedure. Of these, six for aseptic loosening of acetabular cup and/or femoral stem, two for deep infection, one for recurrent dislocation, one for periprosthetic femoral fracture, and one for ceramic head fracture. Kaplan-Meier survivorship with an end point for cup revision for aseptic loosening was 98.4% at 5 years, 93.4% at 10 years, and with an end point for stem revision for aseptic loosening was 100% at 5 years, 97.4% at 10 years (Fig. 1). Conclusions. Unlike the previous report, our study showed lower failure rate of femoral stem after revision hip arthroplasty using modern cementless femoral components in patients with osteonecrosis of the femoral head. Aseptic cup loosening or osteolysis is the most common mechanism of failure at the medium-term follow-up following revision hip arthroplasty in these patients group

Revision of the femoral component during revision hip arthroplasty may pose significant technical challenges, most notably femoral fracture and bone perforation. The in-cementing technique allows use of the original bone-cement interface which has been proven to be biomechanically stronger than recementing after complete removal of the original cement mantle. This study reviews a series of 54 consecutive revision hip arthroplasty procedures carried out by the senior author using the in-cementing technique from November 1999 to March 2003. Patients were followed up clinically and radiologically with serial outpatient reviews and their functional outcome was assessed using the Harris hip scoring system, the Oxford hip scoring system and the University of California at Los Angeles (UCLA) activity profile. Their physical and mental well-being was also assessed using the SF-36 self-questionnaire. Fifty-four procedures were performed on 51 patients. There were 31 males and 20 females. The average age was 70.3+/-8.1 years (range: 45-83 years). The average time to revision from the original procedure was 132.8+/-59.0 months (range: 26-286 months). The average length of follow-up was 29.2+/-13.4 months (range: 6-51 months) post revision arthroplasty. Two patients suffered dislocations, one of which was recurrent and was revised with a Girdlestone's procedure. No patient displayed any evidence of radiographical loosening. The average Harris hip score of the study group was 85.2+/-11.6 (range: 51.9-98.5). The average Oxford hip score recorded was 19.6+/-7.7 (range: 12-41) and the average UCLA activity profile score was 5.9+/-1.6 (range: 3-8). The SF-36 questionnaire had an average value of 78.0+/-18.3 (range: 31.6-100). In conclusion, the results of this study show excellent clinical and radiological results of the in-cementing technique with high patient satisfaction in terms of functional outcome. This technique merits consideration where possible in revision hip arthroplasty

Introduction. The aim of this study is to report the results of Revision hip arthroplasty using large diameter, metal on metal bearing implants- minimum 2 year follow up. Methods. A single centre retrospective study was performed of 22 consecutive patients who underwent acetabular revision surgery using metal on metal bearing implants between 2004 and 2007. Birmingham hip resurfacing (BHR) cup was used in all patients - monoblock, uncemented, without additional screws in 16 cases and cemented within reinforcement or reconstruction ring in 6 cases. Femoral revisions were carried out as necessary. Results. There were 16 men and 6 women with a mean age of 71 years (51-83). Revision surgery was performed for aseptic loosening in 10, infected primary hip arthroplasty in 8, infected Hemiarthroplasty in 1 and Peri-prosthetic fracture with loosening in 3 patients. A 2-stage revision was performed for all infected hips. One patient died and the remaining 21 patients had clinical and radiological assessment at a mean 35 months (24-60). The mean Harris hip score was 75 (23-98) with 50% good to excellent results. Only 1 patient had further revision to a proximal femoral replacement and constrained cup in 2 stages for recurrent infection at 24 months. There were 2 recurrent infections (both revised for septic loosening) and 1 non-union of trochanteric osteotomy. There were no dislocations in the group. No radiological loosening of implants or metal ion complications have been seen at last follow up. Conclusions. We believe this is the first reported series on the use of large diameter metal on metal bearing surfaces for revision hip arthroplasty. Our series shows satisfactory short to medium term results in this complex group of patients with no component loosenings, despite monoblock cups and no dislocations

We have followed a consecutive series of revision hip arthroplasties, performed for severe femoral bone loss using anatomic specific proximal femoral allografts. Forty-nine revision hip arthroplasties, using anatomic specific proximal femoral allografts longer than five centimetres were followed for a mean of 10.4 years. The mean preoperative HHS improved from 42.9 points to 76.9 points postoperatively. Six hips (12.2%) were further revised, four for non-union and aseptic failure of the implant (8.2%), one for infection (2%), and one for host step-cut fracture (2%). Junctional union was observed in 44 hips (90%). Three hips underwent re-attachment of the greater trochanter for trochanteric escape (6.1%). Asymptomatic non-union of the greater trochanter was noticed in three hips (6.1%). Moderate allograft resorption was observed in five hips (10.2%). Two fractures of the host step-cut occurred (4.1%). There were four dislocations (8.2%), two of them developed in conjunction with trochanteric escape. By definition of success as increase of HHS by 20 points or more, and no need for any subsequent re-operation related to the allograft and/or the implant, a 75.5% rate of success was found. Kaplan-Meier survivorship analysis predicted 73% rate of survival at 12 years, with the need for further revision of the allograft and/or implant as the end point. We conclude that the good medium-term results with the use of large anatomic- specific femoral allografts justify their continued use in cases of revision hip arthroplasty with severe bone stock loss

Background. Highly porous acetabular components are widely used in revision hip surgery. The purpose of this study is to compare the mid-term survivorship, clinical and radiological outcomes of a hemispherical cup (Stryker Tritanium Revision component) and a peripherally expanded cup (Zimmer TM modular component) in revision hip surgery. Methods. Between 2010 and 2017, 30 patients underwent revision hip replacement using a hemispherical cup and 54 patients using a peripherally expanded cup. The surgery was carried out by two arthroplasty surgeons, both fellowship-trained in revision hip surgery. Kaplan-Meier analysis was used to determine the survivorship of the components. Clinical outcomes were measured using the Oxford Hip Score. Radiographs were analysed for the presence of radiolucent lines in the DeLee and Charnley zones. Results. Follow up of both components ranged from 2 – 8 years. All the hemispherical cups were reinforced with screws whilst 86% of the peripherally expanded cups required screws. Four (13%) of the hemispherical cups required re-revision surgery for aseptic loosening. One (2%) of the peripherally expanded cups was revised for dislocation, but none for aseptic loosening. None of the peripherally expanded cups exhibited significant radiolucency as compared to 8 (27%) hemispherical cups. The mean Oxford Hip Score of the hemispherical and peripherally expanded cups was 38 and 40 respectively. Using revision for any cause as the end, survivorship of the hemispherical cups at 7.6 years was 80.66% while the peripherally expanded cups at 8.2 years was 98.15%. Conclusions. In our case-series, a peripherally expanded cup has shown a better mid-term radiological and clinical result, with a lower rate of re-revision surgery, when compared to a hemispherical cup

Purpose. To evaluate the radiographic long-term result of femoral revision hip arthroplasty using impacted cancellous allograft combined with cemented, collarless, polished and tapered stem. Materials and methods. Among 28 patients with impacted cancellous allograft with a cemented stem, 28 hips from 26 consecutive patients were analyzed retrospectively. The average patient age was 59 years. The follow-up period ranged 9 years 6 months to 14 years 5 months (mean, 12, 5 years). Radiographic parameters analyzed in this study included subsidence of the stem in the cement, subsidence of the cement mantle in the femur, bone remodeling of the femur, radiolucent line, and osteolysis. Results. Radiographic analysis showed very stable stem initially. 27 stems showed minimal subsidence (less than 5 mm) and 1 stem showed moderate subsidence (about 10 mm) in the cement. But there was no mechanical failure and subsidence at the composit-femur interface. Evidence of cortical and trabecular remodeling were observed in all cases. No radiolucent line or osteolysis were found in the follow-up period. There were 4 proximal femoral cracks and 1 distal femoral splitting during operation. Conclusion. The result of cemented stem revision with the use of impacted cancellous allograft was good long-terand femoral bone stock deficiency may be reconstructed successfully

Femoral impaction grafting with cancellous bone and cement is an important technique in reconstituting deficient bone stock in revision hip arthroplasty. We report the medium to long term results of 75 consecutive patients using a collarless, polished, tapered femoral stem with an average age of 68 (±11.4) years and a mean follow up of 10.5 (±2.4) years (range 6.3 to 14.1 years). The median Endoklinik pre-operative bone defect score was 3 (IQR: 2–3) with a median subsidence at 1 year of 2mm (IQR: 1–3mm). At the most recent follow-up (mean 10.5±2.4 years), the median Harris Hip Score (HHS) was 80.6 (IQR: 67.6–88.9) and median subsidence 2mm (IQR: 1–4mm). Ten-year survivorship with any further femoral operation as an endpoint was 92%. Four prostheses required further revision. Subsidence of the Exeter stem continued, albeit at a slower rate after the first year and was related to the Endoklinik pre-operative bone loss (p=0.037). The degree of subsidence at 1 year was a strong predictor of long term subsidence (p<0.001). Neither subsidence nor bone stock were related to long term outcome (HHS). There was a correlation between previous revision surgery and a poor Harris Hip Score (p=0.028) and those who had undergone previous revision surgery for infection had a higher risk of complications (p=0.048). The good long term results of this technique commend its use in revision hip arthroplasty for patients with poor femoral bone stock

Aim

The duration of systemic antibiotic therapy following first-stage surgery is contentious. Our Institution's philosophy is to perform an aggressive debridement, use high concentration targeted antibiotics through cement beads and systemic prophylactic antibiotics alone. In the presence of significant soft tissue infection or microbiological diagnostic uncertainty; systemic antibiotics may be prescribed for 5 days whilst awaiting tissue culture results. The aim of this study was to assess the success of our philosophy in the management of PJI of the hip using our two-stage protocol.

Revision hip arthroplasty requires a comprehensive appreciation of abnormal bony anatomy. Advances in radiology and manufacturing technology have made three-dimensional representation of actual osseous anatomy obtainable. These models provide a visual and tactile reproduction of the bony abnormality in question. Life size three dimensional models were manufactured from CT scans of two patients. The first had multiple previous hip arthroplasties and bilateral hip infections. There was a pelvic discontinuity on the right and a severe postero-superior deficiency on the left. The second patient had a first stage revision for infection and recurrent dislocations. Specific metal reduction protocols were used to reduce artefact. The dicom images were imported into Mimics, medical imaging processing software. The models were manufactured using the rapid prototyping process, Selective Laser Sintering (SLS). The models allowed accurate templating using the actual prosthesis templates prior to surgery. Acetabular cup size, augment and buttress sizes, as well as cage dimensions were selected, adjusted and re-sterilised in advance. This reduced operative time, blood loss and improved surgical decision making. Screw trajectory simulation was also carried out on the models, thus reducing the chance of neurovascular injury. With 3D printing technology, complex pelvic deformities can be better evaluated and can be treated with improved precision. The life size models allow accurate surgical simulation, thus improving anatomical appreciation and pre-operative planning. The accuracy and cost-effectiveness of the technique were impressive and its use should prove invaluable as a tool to aid clinical practice

Background

Data regarding the diagnostic value of ultrasound (US)-determined fluid film and joint aspiration prior to revision total hip arthroplasty (THA) for suspected periprosthetic joint infections (PJIs) is limited. This study aimed to analyse (1) the value of US-determined fluid film, (2) characterisation of the pre- and intraoperative microbiological spectrum and resistance patterns and (3) the concordance between preoperative synovial fluid and intraoperative culture results.

Introduction. There are conflicting reports in the literature regarding the migration of femoral stems in revision hip arthroplasty following the use of impaction allografting with or without cement. In some cemented series distal migration of the prosthesis within the cement mantle has been recorded, as well as migration of the whole cement/prosthesis construct into the graft. Method and Results. The results of 26 cases of revision hip replacement using femoral impaction allografting in the absence of bone cement are reported. The mean follow up was 8.5 years (range 4 to 17 years). The technique employed a Freeman stem coated proximally with hydroxyapatite. Three cases required further revision at 2, 4 and 5 years for high subsidence and unacceptable thigh pain. The remaining 23 cases stabilised following a period of initial settlement and overall results have been comparable to other series that have utilised cement. The initial sinkage in this series occurred mainly in the first six postoperative months. These results, from a single surgeon series, demonstrate that the method is highly technique dependent and relies on adequate graft impaction. Discussion. With sufficient graft and an appropriate prosthetic design, cement is not essential to the overall success of this method. However, the extent of the initial migration did not accurately predict a successful outcome for the procedure. The absence of cement removes any confusion as to the location of any migration. All prostheses settled into the graft bed. These results should be extrapolated to other prosthetic designs with caution

This study aimed to examine the changing trends in the reasons for total hip replacement (THR) revision surgery, in one country over a twenty-one year period, in order to assess whether changes in arthroplasty practices have impacted revision patterns and whether an awareness of these changes can be used to guide clinical practice and reduce future revision rates.

The reason for revision THR performed between January 1999 and December 2019 was extracted from the New Zealand Joint Registry (NZJR). The results were then grouped into seven 3-year periods to allow for clearer visualization of trends. The reasons were compared across the seven time periods and trends in prosthesis use, patient age, gender, BMI and ASA grade were also reviewed. We compared the reasons for early revision, within one year, with the overall revision rates.

There were 20,740 revision THR registered of which 7665 were revisions of hips with the index procedure registered during the 21 year period. There has been a statistically significant increase in both femoral fracture (4.1 – 14.9%, p<0.001) and pain (8.1 – 14.9%, p<0.001) as a reason for hip revision. While dislocation has significantly decreased from 57.6% to 17.1% (p<0.001). Deep infection decreased over the first 15 years but has subsequently seen further increases over the last 6 years. Conversely both femoral and acetabular loosening increased over the first 12 years but have subsequently decreased over the last 9 years. The rate of early revisions rose from 0.86% to 1.30% of all revision procedures, with a significant rise in revision for deep infection (13-33% of all causes, p<0.001) and femoral fracture (4-18%, p<0.001), whereas revision for dislocation decreased (59-30%, p<0.001). Adjusting for age and gender femoral fracture and deep infection rates remained significant for both (p<0.05). Adjusting for age, gender and ASA was only significant for infection.

The most troubling finding was the increased rate of deep infection in revision THR, with no obvious linked pattern, whereas, the reduction in revision for dislocation, aseptic femoral and acetabular loosening can be linked to the changing patterns of the use of larger femoral heads and improved bearing surfaces.

Introduction. The risk of hip dislocation after revision total hip arthroplasty is up to 20% following surgery for periprosthetic fractures. A technique was developed by the senior authors, involving a transtrochanteric osteotomy and superior capsulotomy to attempt to minimise this risk(1). Methods. This prospective study examines a cohort of 40 patients undergoing this novel technique, which involves extending the fracture proximally to the tip of the greater trochanter. This is then extended into the soft tissues in the mid lateral plane as a split of the glutei and a minimally superior capsulotomy (preserving the anterior and posterior capsule). This allows for revision of the femoral component, and retention of the socket and liner. The outcomes of interest to the authors were dislocation rates, clinical outcome measured using the Oxford hip score. These were assessed along with X-ray imaging at 1, 2 and 5-year intervals to confirm fracture union and measure stem subsidence. Results. Patients averaged 80 years of age, with a higher ratio of females (3:2). There were no cases of hip joint dislocations. Two patients (5%) underwent subsequent revision hip arthroplasty within the first 12 months of initial revision. Femoral stem subsidence at 1 year averaged 5.9 mm. All fractures showed radiological evidence of union. The Oxford hip score was fair, averaging 31/48 by 1 year post-op, and then plateaued at 32.8/48 at 2 years post-op. Conclusion. 5 year follow-up of this novel operative technique in revision arthroplasty of Vancouver B periprosthetic hip fractures has confirmed the benefits, with no cases of hip dislocation, along with overall satisfactory patient clinical outcomes

This study aimed to compare the early clinical results and stem subsidence between three consecutive series of revision hip replacement cases with femoral impaction bone grafting to evaluate the effects of developments in technique. In the original series 1 (n=23), bone graft was irradiated at 25kG. I n series 2 (n=12) non-irradiated double washed graft and long stems were used as required. In series 3 (n=21) modular tamps were used. Sensitive radiographic analysis techniques, EBRA and RSA, were used to measure stem subsidence. Major stem re-revision was required in five hips in series one, one hip in series two and no hips in series three. Two periprosthetic fractures occurred in series one. There was a statistically significant reduction in stem subsidence at the cement-bone interface at 12 months between series one and series two and three (p<0.05). In series three there was negligible stem subsidence at the cement-bone interface. Technique developments in femoral impaction grafting, including the use of modular tamps designed to simply the procedure, yields excellent early clinical and radiographic results. Using RSA, we have shown that the fixation of the stems in bone is comparable to that achieved in primary hip replacement

Introduction. To report the short to medium term results of acetabular reconstruction using reinforcement/reconstruction ring, morcellised femoral head allograft and cemented metal on metal cup. Methods. Single centre retrospective study of 6 consecutive patients who underwent acetabular reconstruction for revision hip surgery. The acetabulum was reconstructed using morcellised femoral head allograft and reinforcement or reconstruction ring fixed with screws. The Birmingham cup – designed for cementless fixation, was cemented into the ring in all cases. The uncemented Echelon stem with metal on metal modular head was used for reconstructing the femur. Data from our previous in-vitro study had shown good pull out strength of a cemented Birmingham cup. Results. There were 2 men and 4 women with a mean age of 75 years(57-83). Revision was performed for aseptic loosening in 2, septic loosening in 2 and peri-prosthetic fracture with loosening in 2 patients. All patients were reviewed clinically and radiographically at a mean of 36 months follow-up(range 24 - 42 months). Revision was not necessary in any patient for failure of acetabular or femoral fixation. However, 1 patient had revision to a proximal femoral replacement and constrained cup for recurrent infection and osteomyelitis at 24 months. This patient was excluded from the final analysis. The mean Harris hip score at last follow up was 79(range 70-89). Radiographic analysis revealed good graft incorporation and no signs of loosening or cup/ring migration. No dislocations or metal ion problems were recorded in this series. Conclusions. To the best our knowledge, this is the first series using cemented metal on metal cups within a reinforcement/reconstruction ring for revision hip arthroplasty. Excellent cemented fixation of the cup, manufactured for cementless fixation, was obtained at surgery with no evidence of loosening, and no dislocations at minimum 24 months follow up

Purpose. In revision hip surgery, Type IIIB femurs have presented the greatest historical challenge to achieving stable fixation and osseous integration. This study evaluated the intermediate term outcome of a modular, tapered, distal fixation revision femoral component used in a consecutive revision hip series with special attention to its performance in the defective Type IIIB femur. Methods. Between February 2002 and January 2005, 51 consecutive revision hip arthroplasties were performed using modular, tapered, distal fixation femoral components. The femoral defects at the time of revision surgery were classified using a system previously described by Paprosky. The most recent radiographs were reviewed and clinic notes examined to assess femoral component stability. Results. At a minimum of 4.2 years and a mean of 5.8 years follow-up, 2 patients were lost to follow-up. Revision cases classified by the Paprosky femoral defect classification system included 14 Type IIIB hips (28%). All hips reviewed (100%) had radiographic evidence of bony ingrowth. No stem migrated more than 2mm. There were no failures at the modular junction and no component disassociation.??Conclusion: A modular, tapered distal fixation femoral component had a 100% survival rate at mean 5.8 year follow-up after revision surgery. All femoral components showed successful osseous-integration. The ability with modularity to independently place the diaphyseal segment of a femoral component in the best remaining femoral host bone may have provided the greatest opportunity for osseous-integration. In this consecutive revision hip series there was no instance of modular junction fracture or component related failure in cases with minimal or no proximal bone support

Introduction. Modern processing techniques in bone banking are thought to decrease the presence of allogenic material in bone. This project was performed to observe any changes in peripheral blood lymphocyte subsets in response to allografted bone used in revision hip replacement. Methods. 87 patients were entered into this prospective study and grouped according to whether impaction allograft was used or not. Samples were collected pre-operatively and at set time intervals up to one year post-operatively. Using flow cytometry, analysis of venous blood allowed counts of the following cells: Helper T-lymphocytes, cytotoxic T-lymphocytes, memory T-lymphocytes, naïve T-lymphocytes, Natural Killer cells and B-lymphocytes. Results. All patients had a successful outcome at one year. 50 patients with radiologically defined host-graft union were compared with 37 patients who did not receive an allograft. Pre-operatively, a significant difference (p=0.03) was found between the groups of patients with respect to Natural Killer cells but other subsets showed no significant difference. Post-operatively, the significant difference between Natural Killer cells resolved. T-helper lymphocytes, cytotoxic lymphocytes, memory T-lymphocytes and naïve T-lymphocytes in both groups showed decreases in values immediately post-surgery, recovering to normal values within 6 weeks post-surgery. The allograft group showed significant increases from baseline in cytotoxic T-lymphocytes at 6 months (p<0.01) and memory T-lymphocytes one year post-operatively (p=0.04). B-lymphocyte numbers did not alter significantly from baseline. Discussion. Cytotoxic T-lymphocytes recognise HLA-class I molecules which are present on all nucleated cells and have been implicated in having a role in osteoclast regulation. Memory T-lymphocytes are produced after a naïve T-lymphocyte is exposed to an antigen. The observed increases of these subsets were not observed in the non-grafting group suggesting the allografted bone had elicited an immunological response. At 12 months all grafts appeared radiologically stable and the immunological response may have been beneficial to the outcome

Introduction. Impaction bone grafting for reconstitution of acetabular bone stock in revision hip surgery has been used for nearly 30 years. We report results in a group of patients upon whom data has been collected prospectively with a minimum ten year follow-up. Material and Methods. Acetabular impaction grafting was performed in 305 hips in 293 patients revised for aseptic loosening between 1995 and 2001. In this series 33% of cases required stainless steel meshes to reconstruct medial wall or rim defects prior to graft impaction. These meshes were the the only implants used for this purpose in this series. All Paprosky grades of defect were included. Clinical and radiographic outcomes were collected in surviving patients at a minimum of 10 years following the index operation; mean follow-up was 12.4 years (SD 1.5; range 10.0–16.0). Results. Kaplan-Meier survivorship with revision for aseptic loosening as the endpoint was 86% (95% CI 81.1 to 90.9%). Clinical scores for pain relief and function remained satisfactory (mean OHS 33.3, Harris hip score for pain 36.7, Harris hip score for function 27.3). Of the 125 hips still available with at least 10 years of radiographic follow-up, 97 appeared stable and 28 were judged to be radiologically loose; however, there was no significant difference in the pain and function scores between the two groups. The overall complication rate was 11.5%, including 1% peri-operative death, 3.3% dislocation and 0.3% deep infection. Discussion. This is the largest series of medium- to long-term results of acetabular impaction bone grafting with a cemented cup for revision hip arthroplasty reported to date. The technique is particularly successful when used for Paprosky grade 1 and 2 deficiencies; grade 3 deficiencies may be better managed with a different method for reconstructing larger defects e.g. trabecular metal augments. Conclusion. This series shows good long-term results for impaction bone grafting of acetabular deficiencies in revision hip surgery, with survivorship of 86% for aseptic loosening at 13.5 years and satisfactory clinical outcomes

Introduction. Osteolysis causing proximal femoral deficiency is a major problem in revision hip arthroplasty. Various methods including impaction bone grafting and bone allografts have been used to address this issue. We have analysed bone reformation using extended trochanteric osteotomy and distally fixed proximal hydroxyapatite-coated modular revision hip system (Stryker Restoration System) in 100 consecutive revisions by a single surgeon. Method. Consecutive patients undergoing revision of femoral stem using posterior approach, extended trochanteric osteotomy and modular hip revision system were included in the study. Exclusion criteria were infection and loss of follow up. Paprosky grading system was used to assess bone loss. Standardized pre-op radiographs and follow-up radiographs at 6 weeks, 6 months and yearly post surgery were used for analysis. Minimum follow-up of 18 months (1.5–3.5 years). Bone reformation is quantified as definite reformation, some evidence of reformation and no bone reformation. Extended trochanteric osteotomy union rates and subsidence rates were also observed. Result. Average age of patients was 71 years with 54% females and 46% males. The majority of femurs had significant bone loss (Paprosky type III 84%, Type II 16%). Bone reformation was evident in all patients and early bone reformation was observed in most patients in this study. The extended trochanteric osteotomy union rate was 100%. Subsidence was observed in 6 patients out of which 4 were non progressive (3patients 5–10mm and 1patient less than 5mm) and 2 were progressive and significant (more than 10 mm) with 1 patient requiring re-revision. Discussion. All patients in the study demonstrated reconstitution of the proximal femoral deficiency. Stability of the reconstruction, and viability of the osteotomy flap are key for a successful outcome. We believe this technique is reliable, reproducible and good option for the treatment of proximal femoral deficiency in revision total hip surgery. Await long term outcome

Failure of the femoral component after a primary or revision THA is commonly associated with some degree of femoral bone loss. Depending on the quantity and quality of the remaining host bone, femoral stem revision can be challenging.

Twenty patients with severe proximal femoral bone loss due to prosthetic loosening were treated by Wagner cementless self-locking revision stems with a mean follow up of 24 months (range 18–36 months). The indication of revision surgery was aseptic loosening in 16 patients and septic loosening in 4 cases.

At the end of the follow up the mean Harris hip score increased from 35 to 86 points. Definite radiographic evidence of bone regeneration in the bony defects was achieved within 3 months in all patients.

Implantation of a Wagner cementless selflocking revision stem provided satisfactory results. The Wagner SL Revision prosthesis, firmly and rotationally stable fixed in the medullary cavity of the healthy bone distal from the original prosthetic bed, with its conical longitudinal ribs and cementless anchorage, bridges the defective prosthetic bed and hereby leads to a condition of relative mechanical stability. With time, there is active ossification in the old prosthetic bed, replacing lost bone.