Proximal femoral fixation: When bone stock allows

Revision of the failed femoral component of a total hip arthroplasty can be challenging. Multiple reconstructive options are available, and thus meticulous preoperative planning is required. The Paprosky Femoral Classification is useful as it helps the surgeon determine bone stock, and which type of femoral reconstruction is most appropriate. Diaphyseal-engaging stems bypass the often-compromised proximal femur and have a high rate of both initial success and long-term durability. These stems do, however, have some downside including risk of cortical perforation and expense. Thus, there can be advantages to a stem that gains primary fixation in the metaphysis including lower cost, ease of insertion/extraction, and preservation of bone stock if future revisions are required. Cases appropriate for a proximal load-bearing revision stem are Paprosky type 1 or 2 femurs.