Management of Significant Femoral Bone Loss with Use of Modular Stems

Significant femoral bone loss can be encountered in the multiply revised patient. Deficient proximal bone requires either a bulk allograft or a femoral component that allows stable distal fixation. Extensively coated stems have shown excellent results for many revisions but have shown higher rates of failure among patients with femoral remodeling in retroversion, an enlarged endosteal diameter, or an ectatic canal. A modular tapered stem is an alternative in this subset of patients. A modular tapered implant provides axial and rotational stability through the use of distal splines while the proximal body segments can allow independent adjustment of leg length, offset, and anteversion. We previously reported the 1- to 4-year (average 2 years) results of modular tapered femoral prosthesis in cementless femoral revisions. In the previous study there were 16 patients all with Type IIIB or IV Paprosky femurs. This is a follow-up of that article reporting on 24 patients, all with Type IIIB or IV Paprosky femurs with a follow-up of 2 to 5 years (average 3 years). We revised one component for subsidence, one component was revised for fracture at the modular junction, and one component was revised for sepsis.