THR Revision - Femoral Bone Loss

Clinical Scenario

A 65-year-old female with type 2 diabetes and obesity presents with increasing right hip pain 5 years after cemented THR. She has start-up pain and thigh pain. X-rays show a loose femoral stem with significant metaphyseal bone loss. ESR and CRP are normal.

Questions & Model Answers

How would you classify the femoral bone loss?

What reconstruction options would you consider?

During stem removal, you fracture the femur at the isthmus. How do you manage this?

How do you exclude infection before revision hip arthroplasty?

When and how would you perform an extended trochanteric osteotomy?

What are the expected outcomes and complications of revision hip arthroplasty for aseptic loosening?

Exam Tips

Opening Statement: This patient has a failed cemented THR with femoral bone loss. After excluding infection with normal inflammatory markers and aspiration, I would plan revision with a reconstruction strategy based on Paprosky classification.

Common Pitfalls:

Always exclude infection before revision
Preoperative templating but prepare for intraoperative surprises
Intraoperative fracture must be managed definitively