Total Hip Arthroplasty in Proximal Femoral Deformities and Retained Hardware

Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with retained hardware. Conditions can produce femoral deformities including fracture, previous surgery, developmental dysplasia, growth and metabolic diseases. Treatment must be individualized to address the level of the deformity, the type of deformity, and bone quality. Radiological evaluation addressing the full extent of the proximal femoral deformity is discussed. The proposed classification system uses the anatomic location of the deformity with sub classification into the geometry of the deformity whether torsional, angular, and translational in nature or from disproportion in size of the femoral anatomy. Treatment strategies are tailored according to the deformity or hardware retained in the proximal femur. The clinical success of the primary THA after proximal femoral procedures is negatively affected.