Abstract
Revision of the total hip femoral component in the presence of significant bone loss requires a variety of implants as well as fixation devices and bone substitute materials.
Rule 1: Fix the implant into the best remaining bone.
A variety of stem shapes and sizes are needed to fill the bone cylinder. Stem modularity is helpful to fashion a good fit, but every taper junction is a liability as a potential source of metal debris and a weak spot in the stem. Rather, fully porous-coated titanium femoral components with a tapered stem design are safe, convenient, and reasonably inexpensive.
Rule 2: Reconstruct the bone to accept a rigidly fixed intramedullary stem.
Cables, strut allograft, plates, and screws are needed to support the remaining bone.
Rule 3: Manage the bone so that it is still viable after the implant is inserted.
As much intraosseous and extraosseous blood supply as possible should be maintained, so broaching rather than extensive reaming is the best choice for maintaining bone viability.
Rarely more exotic procedures such as reduction osteotomy must be done to achieve rigid fixation of implants.
