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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 1,
11-15.
doi: 10.1302/0301-620X.90B1.19494 Copyright © 2008 by British Editorial Society of Bone and Joint Surgery Use of an internal proximal femoral replacement with distal fixation in revision arthroplasty of the hipP. K. Jaiswal, MRCS, Specialist Registrar1; J. Jagiello, MRCS, Specialist Registrar1; L. A. David, FRCS(Tr & Orth), Specialist Registrar1; G. Blunn, PhD, Professor of Biomedical Engineering1; R. W. J. Carrington, FRCS(Tr & Orth), Consultant Orthopaedic Surgeon1; J. A. Skinner, FRCS(Tr & Orth), Consultant Orthopaedic Surgeon1; S. R. Cannon, FRCS, Consultant Orthopaedic Surgeon1; and T. W. R. Briggs, FRCS, Consultant Orthopaedic Surgeon11 Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK. Correspondence should be sent to Mr P. K. Jaiswal at 36 Rothsay Street, London SE1 4UE, UK; e-mail: pkjaiswal05{at}googlemail.com
We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with failed total hip replacement and severe proximal femoral bone loss by revision using a distal fix/proximal wrap prosthesis. The mean follow-up was for 55.3 months (25 to 126). The mean number of previous operations was 2.2 (1 to 4). The mean Oxford hip score decreased from 46.2 (38 to 60) to 28.5 (17 to 42) (paired t-test, p < 0.001) and the mean Harris Hip score increased from 30.4 (3 to 57.7) to 71.7 (44 to 99.7) (paired t-test, p < 0.001). There were two dislocations, and in three patients we failed to eradicate previous infection. None required revision of the femoral stem. This technique allows instant distal fixation while promoting biological integration and restoration of bone stock. In the short term, the functional outcome is encouraging and the complication rates acceptable in this difficult group of patients.
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