Authors: David A Ibrahim Navin D Fernando
Publish Date: 2016/08/02
Volume: 475, Issue: 3, Pages: 917-921
Abstract
Projections suggest that the incidence of revision THA performed in the United States will nearly double by 2030 resulting in as many as 96700 such procedures per year 2 18 Various indications for hip revision exist including aseptic loosening periprosthetic joint infection fracture recurrent instability and more recently adverse local tissue reactions resulting from metal corrosion Regardless of the cause of the revision achieving rigid femoral fixation between the implant and the host bone at the time of revision is essential The extent of femoral bone loss may represent a substantial impediment to achieving this goal and as such having a thoughtful approach to evaluating bone loss is very importantThe Paprosky classification of femoral bone loss including Type I I Type II II Type IIIA IIIA Type IIIB IIIB and Type IV IV femoral deficiency is shown Published with the permission of Wolters Kluwer from Della Valle CJ Paprosky WG Classification and an algorithmic approach to the reconstruction of femoral deficiency in revision total hip arthroplasty J Bone Joint Surg Am 2003851–6Revision THA commonly results in some degree of bone loss at the time of implant removal The most widely accepted standard for femoral revision involves the use of an uncemented femoral component relying on osteointegration to provide definitive biologic fixation 1 17 22 25 37 To achieve biologic fixation a high degree of mechanical stability obtained at the time of femoral reconstruction typically is necessary Mechanical stability of an uncemented implant is largely dependent on the quality of the residual femoral bone Many different cementless femoral implants achieve this goal using different approaches typically accomplished through a combination of implant geometry and surface finishA classification system that defines femoral insufficiency based on the location of the bone loss and the likelihood of achieving mechanical and biologic fixation may allow surgeons to plan preoperatively for the type of femoral implant necessary to achieve a durable reconstruction and this is among the goals of the Paprosky classification Other purposes of this classification like so many others include communication among physicians categorization of procedures for comparative research and anticipation of prognosis
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