A Combined Use of Custom-Made Partial Pelvic Replacement and Proximal Femur Megaprosthesis in the Treatment of Severe Bone Loss after Multiple Total Hip Arthroplasty Revisions

Abstract

Hip arthroplasty failures (either septic or aseptic) often require multiple revisions, thus leading to severe bone defects. The most common reconstruction methods do not allow the management of severe defects. For this reason, in recent years, techniques borrowed from surgical oncology have been applied in the field of revision surgery to deal with both acetabular and femoral bone losses. In this article, two cases of severe bone deficiency following multiple hip arthroplasty revisions that were treated with a custom-made hip prosthesis combined with a proximal femur megaprosthesis are presented. Both implants were silver coated. A review of the literature was conducted to analyze similar cases treated with either a custom-made prosthesis or a proximal femur megaprosthesis. At the 2-year follow-up, all prostheses were in site without clinical or radiographic signs of implant loosening. No postoperative complications occurred. At the last follow-up, both patients resumed their daily life activities with an MSTS score of 23 and 21, respectively. The combined approach of a proximal femur megaprosthesis with a custom-made partial pelvic replacement is a solution that allows severe bone deficiency cases to be tackled with good functional results. Additionally, silver coating may help prevent recurrence of infection.