(vi) Endoprosthetic replacement of the proximal femur

Poor bone quality is a risk factor for failure in revision hip arthroplasty. Severe bone loss situations (Paprosky IV) require unique and innovative solutions, building on the experience in oncology where proximal femoral replacement and endoprosthetic reconstruction is a common procedure. Large amounts of bone loss from a variety of aetiologies can be reliably dealt intraoperatively, with on-table modularity in the implant range, extending to total femoral reconstruction. Techniques of exposure and reconstruction, though initially daunting, are in reality straightforward and are described. Previous concerns about high rates of complications such as instability at the hip joint have been significantly reduced by the use of careful soft tissue closure, large head (>36 mm), bipolar and dual mobility articulations.