Revision Total Hip Arthroplasty Using a Tibial Cone and Impaction Grafting for Severe Femoral Bone Loss

Abstract

Case: An 84-year-old woman presented 6 years after revision total hip arthroplasty (rTHA) with worsening hip pain and a Paprosky classification IIIB femoral defect. rTHA was performed using a proximal femur replacement. Given her osteoporosis and poor bone stock, a tibial cone and impaction grafting (IG) were used for megaprosthesis fixation. At the 33-month follow-up, the patient was pain-free and radiographs demonstrated a well-fixed implant. Conclusion: In the setting of massive defects of poor-quality bone, novel use of a tibial cone and IG can be implemented to achieve implant fixation and maximize patient outcomes.