Femoral fixation in the face of considerable bone loss: cylindrical and extensively coated femoral components.

One option for dealing with considerable femoral bone deficiency at revision surgery is the use of extensively porous coated cobalt-chrome cylindrical stems. This technique has been shown to be a reliable, technically straightforward method that can be applied to all but the most severe femoral structural defects. Very high rates of osseointegration and durability of fixation are obtained when simple principles are followed. The key to success is obtaining initial endosteal diaphyseal fixation over 5 cm-7 cm. To achieve this, adequate exposure and accurate bone preparation are essential. The limitations of this technique relate directly to the severity of bone loss, which can be easily predicted on plain preoperative radiographs. For Paprosky 3B and 4 defects, other options such as allograft prosthetic composites, impaction grafting, or alternate modes of distal fixation should be considered.